Clopidogrel teva

Ndị na-ahụ maka ọgwụ

Ndị ọrụ Antithrombotic. Ndị ọrụ Antiplatelet. Koodu ATX B01A C04.

Mgbochi nke atherothrombosis na ndị okenye

• n'ime ndị ọrịa nwere ọrịa myocardial infarction (mmalite ọgwụgwọ bụ ụbọchị ole na ole, mana ọ dịghịkarịa ala karịa ụbọchị 35 mgbe mmalite ahụ), ọrịa ọnya afọ (mmalite ọgwụgwọ bụ 7 ụbọchị, mana ọ karịghị ọnwa 6 mgbe mmalite) ma ọ bụ ndị na-achọpụta ọrịa ahụ. nsogbu akwara (nsogbu akwara na atherothrombosis nke arịa nke ala ala),
• n'ime ndị ọrịa nwere nnukwu ọnyá ọnya (ACS):
• ya na ọrịa akwara na-arịa ọrịa na-enweghị ụma akụkụ ST na-akwụghị ọtọ (ma ọ bụ angyossial infarction na-enweghị nkwaghari Q), gụnyere ndị ọrịa nwere nkụda mmụọ n'oge angioplasty cocut, na njikọ acetylsalicylic acid (ASA)
• ya na nnukwu myocardial infarction na ihe ST na-eme ka ọ dị elu, yana acetylsalicylic acid (na ndị ọrịa na-anata ọgwụ ọkọlọtọ na ndị egosipụtara ọgwụgwọ thrombolytic).

Mgbochi nke atherothrombotic na ihe omume thromboembolic na atrial fibrillation:

• clopidogrel na ASA ka egosiputara n’ebe ndị okenye nọ n ’ọrịa ọgbụgba akwara, bụ ndị nwere ọnwere ihe ọghọm maka ihe omume vaskụla, nke enwere ọgwụ mgbochi na vitamin K antagonists (AVK) na ndị nwere obere ọbara ọgbụgba, maka mgbochi nke atherothrombotic na thromboembolic ihe tinyere ọnya afọ.

Usoro onunu ogwu na nhazi

Ndị okenye, gụnyere ndị ọrịa agadi. Clopidogrel ka etinyere 75 mg 1 oge kwa ụbọchị, n'agbanyeghị nri nri.

Ọgwụ Clopidogrel na ndị ọrịa nwere ACS na-enweghị ngalaba akụkụ ebuli (ejighị ọgwụ angina pectoris ma ọ bụ infịction myocardial na-enweghị ebugharị QG na ECG) na-amalite site na otu iko 300 mg, wee gaa n’ihu na 75 mg otu ugboro kwa ụbọchị (ya na acetylsalicylic acid (ASA) na dose 75 325 mg / ụbọchị). Ebe ọ bụ na ị ofụ ọgwụ ASA dị elu na-eme ka ọbara ọgbụgba dịkwuo elu, a na-atụ aro ka ọ ghara ịfefe ọgwụ acetylsalicylic acid nke 100 mg. E guzobebeghị ezigbo ọgwụgwọ ọ bụla. A kọrọ uru nke iji ọgwụ ahụ ruo ọnwa iri na abụọ, na-ahụkarị nsonaazụ ka ọnwa 3 gachara.

Ọrịa ya na nnukwu myocardial infarction na nnukwu ngalaba ST Enyere clopidogrel ka ọ bụrụ 75 mg otu ugboro n’ụbọchị, na-ebido n’otu nbudata nke 300 mg na ASA, yana ma ọ bụ n’enweghị ọgwụ ọgwụ thrombolytic. Ọgwụgwọ ndị ọrịa gbagoro afọ 75 na-amalite na-enweghị nnukwu clopidogrel. Ekwesịrị ịmalite ọgwụgwọ njikọta ozugbo enwere ike mgbe mmalite nke mgbaàmà na ọ kwesịrị ịga n'ihu ma ọ dịkarịa ala izu anọ. Abụọ uru nke ijikọtara clopidogrel na ASA maka ihe karịrị izu anọ na ọrịa a amụbeghị.

Maka ndị ọrịa nwere ọnya firamillation, a na-eji clopidogrel mee ihe n'otu ọgwụ nke 75 mg. Na clopidogrel, a ga-amalite iji ASA ma ga n'ihu (na usoro nke 75-100 mg kwa ụbọchị).

Ọ bụrụ na ị na-efu otu ọgwụ:

• ma ọ bụrụ na ihe na-erughị 12:00 agafeela kemgbe oge ọ dị mkpa ị toụ ọgwụ ọzọ, onye ọrịa ahụ kwesịrị ị doseụ ọgwụ ahụ echefuru ozugbo, a ga-ewerekwa ọgwụ na-esote n’oge ọ na-eme,
• ma ọ bụrụ na ihe karịrị elekere 12:00 agafeela, onye ọrịa ahụ kwesịrị ị theụ ọgwụ ọzọ na-esote n’oge ọ na-emebu mana ọ bụghị okpukpu abụọ nke okpukpu ahụ iji kwụọ ụgwọ maka ihe efu.

Odida ntaramahụhụ . Ahụmahụ ọgwụgwọ nke iji ọgwụ ahụ eme ihe na ndị ọrịa nwere ọdịda ezughị oke nwere oke.

Imeju imeju . Ahụmahụ ọgwụgwọ nke iji ọgwụ ahụ eme ihe na ndị ọrịa nwere ọrịa imeju na-agafeghị oke na ohere nke hemorrhagic diathesis nwere oke.

Mmeghachi omume ọjọọ

A kọrọ na ọbara ọgbụgba bụ ihe na-esokarị mmejọ ma na-abụkarị ọnwa mbụ nke ọgwụgwọ.

A na-ekesa mmeghachi omume na-adịghị mma n'etiti akụkụ ahụ, ugboro ole omume ha ka akọwara dịka ndị a: oge ​​(site ³ 1/100 ruo ≤ 1/10), ugboro ugboro (site na ³ 1/1000 ruo /1 1/100), adịkarịghị (site na ³ 1/10 000 ruo ≤ 1/1000), dịkarịrị ala (ọkwa Idenye aha

Mpempe usoro onunu ogwu

Mbadamba ihe mkpuchi nke 75 mg

Otu mbadamba ihe

ihe na-arụ ọrụ: clopidogrel hydrosulfate 97.857 mg,

dakọtara na clopidogrel 75,00 mg

ndị na-ahụ maka ya: lactose monohydrate (200 mesh), microcrystalline cellulose (Avicel PH 101), cellulose hydroxypropyl (Klucel LF), celclose microcrystalline (Avicel PH 112), crospovidone (Collidon CL), mmanu mmanu mmanu hydrogenated I (Sterotex-s) sulfur lauryl

ihe mejupụtara shei: lactose monohydrate, hypromellose 15 cP, titanium dioxide (E171), polyethylene glycol 4000, iron oxide red (E172), iron oxide yellow (E172), indigotine (E 132, indigo carmine aluminom varnish FD&C blue No. 2)

Edebere mbadamba nkume ndị ahụ site n ’odo na-acha odo odo ruo na pink, nke na-acha uhie uhie, akara“ 93 ”n’akụkụ ya na“ 7314 ”n’akụkụ nke ọzọ.

Ngwongwo ogwu

Mgbe nchịkwa ọnụ gasịrị, a na-amata clopidogrel ngwa ngwa site na eriri afọ. Nkezi ọkwa plasma dị elu nke clopidogrel na-agbanweghi agbanwe (ihe dị ka 2.2-2.5 ng / ml mgbe otu ọgwụ nke 75 mg) ruru minit iri anọ na ise mgbe ị takingụ ọgwụ ahụ. Mwepu nke ewepụtara site na mkpochapụ akwara nke clopidogrel metabolites dịkarịa ala 50%.

Clopidogrel na isi ya (adịghị arụ ọrụ) na-ekesa metabolite n'ime ọbara na-eme ka njikọ dị na protein Plasma mmadụ (98% na 94%, otu isi). Ejikọtaghi ihe otutu n’oghere ihe.

Clopidogrel na-arịa metabolism kpụ ọkụ n'ọnụ na imeju. Clopidogrel bụ metabolized na ụzọ abụọ: otu bụ esterases na-eduga ma na-eduga na hydrolysis site na ịmalite ihe na-adịghị ike nke carbonxylic acid (85% nke metabolites dị n'ọbara), nke ọzọ na-agbagha site na cytochrom P450 dị iche iche. 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. Metabolzọ metabolic a na-agbagha site na CYP3A4, CYP2C19, CYP1A2 na CYP2B6. A na - agbanye metabolite na - arụ ọrụ nke ukwuu na - ejikọ ngwa ngwa na n'ụzọ na - ezighi ezi na ndị na - anabata platelet, si otú a na - egbochi nchịkọta platelet.

Cmax nke metabolite na-arụ ọrụ na-abawanye ugboro abụọ, ma mgbe ọ gbasasịrị otu nkeji nke clopidogrel 300 mg, yana mgbe ọ na-agbaso ọgwụ nke 75 mg maka ụbọchị 4. A na-achọpụta Cmax ihe dịka nkeji 30-60 mgbe nchịkwa gachara.

Mgbe ị gachara Clopidogrel, ihe dị ka 50% dị na mmamịrị ahụ yana ihe dị ka 46% na ọrịa n'ime awa 120 mgbe nchịkwa gasịrị. Mgbe otu ọgwụ ji ọgwụ mee ihe ruru 75 mg, iwepu ọkara ndụ nke clopidogrel bụ ihe dịka awa 6. Ndụ ọkara nke isi (adịghị arụ ọrụ) metabolite na-ekesa n’ime ọbara bụ elekere asatọ gachara otu nlekọta ma ọ bụ ugboro ugboro.

CYP2C19 sonyere na nguzobe nke metabolite na-arụ ọrụ na metabolite dị n'etiti, 2-oxo-clopidogrel. Mmetụta ọgwụ na antiplatelet nke metabolite na-arụ ọrụ nke clopidogrel dịgasị iche dabere na CYP2C19 genotype.

CYP2C19 * 1 allele kwekọrọ na metabolism zuru oke arụ ọrụ, ebe CYP2C19 * 2 na CYP2C19 * 3 alleles abụghị arụ ọrụ. Ihe ekwenti okwu CYP2C19 * 2 na CYP2C19 * 3 maka otutu ihe ekwenti nile nwere olu di ala na Europe (85%) na Asia (99%) metabolizers ewela. Allezọ ndị ọzọ ejikọtara na metabolism na-anọghị ma ọ bụ na-ebelata na-adịkarị obere ma gụnyere CYP2C19 * 4, * 5, * 6, * 7 na * 8. Mgbasawanye nke CYP2C19 bụ ihe kwesịrị ịdị, na-ebute metabolism na-adịchaghị ala ma na -adị nwayọ nke CYP2C19, dabere na agbụrụ / agbụrụ. Enwere obere data ederede maka ndị Eshia, nke na-anaghị ekwe ka anyị nyochaa mmetụta nke CYP2C19 genotyping na nsonaazụ nke ihe omume.

Onye ọrịa nwere ọnọdụ metadolizer ngwa ngwa ga-enwe ụzọ abụọ nwere ọrụ furu efu, dị ka akọwara n’elu. Ogologo genotype nke ngwa ngwa CYP2C19 metabolizer bụ ihe dịka 2% maka ndị Europe, 4% nke agbụrụ Africa na 14% nke ndị China. Enwere ule iji chọpụta CYP2C19 genotype onye ọrịa.

Enweghị nnukwu ọdịiche dị na mkpughe na metabolite na-arụ ọrụ na ngbanye mgbako nke platelet agakọ (PAT) n'etiti ultrafast, ngwa ngwa na ọkara metabolizer. Na metabolizer ngwa ngwa, ikpughe metabolite na-arụ ọrụ na-agbadata site na 63-71% ma e jiri ya tụnyere ngwa ngwa metabolizer. Mgbe etinyere usoro 300 mg / 75 mg regimen, a na-ahụ mbelata ihe nzaghachi antiplatelet na metabolizer dị ala, na nkezi PAT (5 μM ADP) ịbụ 24% (awa 24) na 37% (ụbọchị 5) ma e jiri ya tụnyere 39% PAT (awa 24) ) na 58% (ụbọchị 5) nke metabolizer ngwa ngwa na 37% (awa 24) na 60% (ụbọchị 5) nke metabolizer na-ajụ. Mgbe metabolizer dị nwayọ nọ na 600 mg / 150 mg regimen, ikpughe metabolite nọ n'ọrụ ka ukwuu na usoro 300 mg / 75 mg. Na mgbakwunye, PAT bụ 32% (awa 24) na 61% (ụbọchị 5), nke bụ karịa nke ngwa ngwa metabolizer bụ nke dị na 300 mg / 75 mg regimen, mana nke yiri ndị ọzọ nke CYP2C19 metabolizer dị na 300 mg / 75 regimen mg E guzobeghị usoro kwesiri ekwesi maka ndị ọrịa a.

A na - eji mbelata nke metabolite na - arụ ọrụ belata 28% na metabolizer na - agbago site na 72% na metabolizer nwayọ, ebe mkpokọta nchịkọta platelet (5 μM ADP) belata na ọdịiche na PAT nke 5.9% na 21.4%, n'otu n'otu, mgbe e jiri ya tụnyere ngwa ngwa. metabolizer.

A maghị ọgwụ ọgwụ nke metabolite nke clopidogrel n'ime ndị a (ya na ọrụ imeju na akụrụ na-arụ ọrụ) amabeghị ndị mmadụ pụrụ iche.

Renrụ ọrụ na-arụ ọrụ na ụlọ

Mgbe usoro ogwu clogidogrel ugboro ugboro na 75 mg kwa ụbọchị na ndị ọrịa nwere ọrịa akụrụ siri ike (njikwa creatinine site na 5 ruo 15 ml / min), mwepu nke nchịkọta platelet kpatara ADP (adenosine diphosphate) adịghị ike (25%) karịa na isiokwu siri ike, agbanyeghị, ịgbatị oge ọbara ọgbụgba yiri oge ọbara ọgbụgba n’arụ ahụike ndị natara 75 mg nke clopidogrel kwa ụbọchị. Na mgbakwunye, enwere nnabata ọgwụgwọ dị mma maka ndị ọrịa niile.

Ọrụ imeju na-arụ ọrụ

Mgbe usoro ogwu clogidogrel ugboro ugboro na 75 mg kwa ụbọchị maka ụbọchị 10 n'ime ndị ọrịa nwere nnukwu ọrụ imeju, mmachi nke nchịkọta platelet nke ADP kpatara yiri na nke ahụ. Ọ dịkwa ogologo oge nke ọbara ọgbụgba na otu abụọ anaghị agbanwe agbanwe.

Clopidogrel bụ ihe dị mkpa maka ihe nọ n'ọrụ, otu n'ime ihe metabolites nke bụ ihe na - egbochi mkpokọta platelet.Enzymes CYP2C19 bụ Clopidogrel bụ metabolized, na-ebute nzụlite metabolite na-arụ ọrụ nke na-egbochi nchịkọta platelet. Onye na-arụ ọrụ clopidogrel metabolite ahọrọ na-egbochi ikechikọta adenosine diphosphate (ADP) na PletY PletY platelet ya na ntinye nke GPIIb / IIIa glycoprotein na-esote n'ihi ADP, si otú a na-egbochi nchịkọta platelet. N'ihi mgbanwe nke ejikọtara ọnụ, platelet ndị emetụtara emetụtala ndụ ha niile (ihe dịka ụbọchị 7-10), a na-eweghachi ọrụ nkịtị nke platelet na ọnụego kwekọrọ na usoro platelet. Nchịkọta nke platelet kpatara site na ndị agonist na-abụghị ADP na-egbochi mmechi nke ndọtị platelet site na ikpughe ADP wepụtara.

Ebe ọ bụ na etolite metabolite na-arụ ọrụ site na iji enyoymes CYP450, ụfọdụ n'ime ha bụ polymorphic ma ọ bụ ọgwụ ọgwụ ndị ọzọ na-ebelata, ọ bụghị ndị ọrịa niile nwere ikike zuru ezu.

Nri ugboro ugboro nke 75 mg kwa ụbọchị site na ụbọchị mbụ na-eduga na nnukwu mgbochi nke nchịkọta platelet nke ADP kpatara. Mmetụta inhibitory na-abawanye n'ụzọ na-aga n'ihu ma rute n'ọnọdụ ịha nhata n'ime ụbọchị 3-7. Na ọkwa ha, a na-ahụ ọkwa mgbochi ihe dị ka 75 mg kwa ụbọchị ma na-esite na 40% ruo 60%. Njikọ Platelet na oge ọbara ọgbụgba na-alaghachi n'ike mbụ ya, ọ na-abụkarị ụbọchị ise ka agachara ọgwụgwọ.

Mgbochi nke ihe atherothrombotic:

- n'ime ndị ọrịa nwere myocardial infarction (site ọtụtụ ụbọchị ruo

Usoro onunu ogwu na nhazi

Edere Clopidogrel-Teva n'ọnụ ọnụ agbanyeghị iri nri.

Maka ndị okenye na ndị ọrịa agadi, a na-enye clopidogrel-Teva na otu ọgwụ nke 75 mg.

Na nnukwu akụrụngwa na-arịa ọrịa na-enweghị ịwelite akụkụ ST (enweghi ike angina ma ọ bụ infịction myocardial na-enweghị ebili mmiri Q), a na-enye ọgwụ ahụ otu ntụtụ nke 300 mg. Ọgwụ mmezi bụ 75 mg kwa ụbọchị (yana yana acetylsalicylic acid na kilogram 75-325 mg / ụbọchị) maka ọnwa iri na abụọ. A na-ahụkarị ọgwụ ọgwụgwọ kachasị mgbe ọnwa atọ gachara. A naghị atụ aro ka ọ gafee ọgwụ acetylsalicylic acid karịrị 100 mg, n'ihi oke ọbara ọgbụgba.

Na nnukwu myocardial infarction na mmụba na mpaghara nke ST, a na-enye ọgwụ ahụ na ọgwụ nke 75 mg kwa ụbọchị (yana mgbakwunye na acetylsalicylic acid) na-amalite site na otu ibu nke 300 mg, yana ma ọ bụ na-enweghị ọgwụ thrombolytic. N'ime ndị ọrịa gafere afọ iri asaa na ise, a na-eme ọgwụgwọ Clopidogrel-Teva na-ejighị otu mmachi ịkwụ ụgwọ. Ekwesịrị ịmalite ọgwụgwọ njikọta ozugbo enwere ike mgbe mmalite nke mgbaàmà ma gaa n'ihu opekata mpe izu anọ.

N'iburu firamillation atrial, a na-enye ọgwụ ahụ ka ọ bụrụ otu ọgwụ nke 75 mg, yana Acetylsalicylic acid 75-100 mg kwa ụbọchị.

Ọ bụrụ n ’ịwụsị ị takingụ ọgwụ na-erughị awa iri na abụọ site n’usoro oge niile, onye ọrịa ahụ kwesịrị ị doseụ ya otu ọgwụ ahụ, wee were ọzọ were ya n’oge a kara aka. Ọ bụrụ na ihe karịrị awa iri na abụọ agafeela, onye ọrịa ahụ kwesịrị ị takeụ otu ọgwụ n’oge ọ kara aka, ekwesịghị ị notụ okpukpu abụọ.

Renrụ ọrụ na-arụ ọrụ na ụlọ

Ahụmahụ ọgwụgwọ Clopidogrel n'ebe ndị ọrịa nwere ọrụ ezumike ọrụ dị ụkọ. Ya mere, n'ihe banyere ndị ọrịa dị otú ahụ, a ga-eji ọgwụ kpachara anya.

Ọrụ imeju na-arụ ọrụ

Ahụmahụ na iji ọgwụ ọjọọ eme ihe na ndị ọrịa nwere ọrụ imeju na-arụ ọrụ nke oke aka, ọ na-adịkarị mfe ịba ọcha n'anya. N'akụkụ a, na onu ogugu a, ekwesiri iji ogwu mee ihe nlezianya.

Nsonaazụ

Ọbara ọgbụgba bụ mmeghachi omume kachasị njọ edekọtara na ule nyocha na oge ịre ahịa, ebe edere ya na ọnwa mbụ nke ọgwụgwọ.

Mmeghachi omume na-emebi emebi achọpụtala na nnwale ụlọ ọgwụ ma ọ bụ nke a kọrọ na mkpesa mberede.

Ihe ngbanwe

- Hypersensitivity na ihe na-arụ ọrụ ma ọ bụ ihe ndị dị na ọgwụ ahụ

- nnukwu nsogbu nke imeju

- nnukwu ọbara ọgbụgba (ọnya afọ, ọbara ọbara intracranial)

-eme ka galactose ghara inwe nsogbu, Lapp lactase erughi nri ma obu glucose-galactose malabsorption

- ime na lactation

- ụmụaka na-erubeghị afọ 18

Mkparịta ụka ọgwụ ọjọọ

Ọgwụ anaticoagulants nke na-egbu egbu: iji ọgwụ mkparịta ụka clopidogrel na-agwọ ọrịa anticoagulants anaghị atụ aro ya, ebe ọ bụ na ngwakọta a nwere ike ime ka ọbara ọgbụgba dịkwuo elu. N'agbanyeghị eziokwu ahụ bụ na ị 75ụ 75 mg nke clopidogrel kwa ụbọchị adịghị agbanwe ọgwụ pharmokokinetics nke S-warfarin ma ọ bụ nke International normalized ratio (INR) na ndị ọrịa na-ewere warfarin ruo ogologo oge, otu oge iji clopidogrel na warfarin na-abawanye n'ihe ize ndụ ọbara ọgbụgba n'ihi nsonaazụ ya abụọ na hemostasis. ọgwụ.

Glycoprotein IIb / IIIa inhibitors: ekwesịrị iji clopidogrel jiri nlezianya mee ihe na ndị ọrịa na-anabatakarị IIb / IIIa glycoprotein inhibitors.

Acetylsalicylic acid (ASA): ASA anaghị agbanwe mgbochi egbochi nke mkpokọta platelet na ADP butere, mana clopidogrel na-eme ka mmetụta nke ASA pụta na nchịkọta platelet mebiri. Agbanyeghị, otu oge nlekọta nke ASA na 500 mg ugboro abụọ kwa ụbọchị anaghị eme ka mmụba dị ukwuu na oge ọgbụgba n'ihi clopidogrel. N'agbata clopidogrel na acetylsalicylic acid, enwere ike ịmekọrịta ọgwụ ọgwụ, nke na-eduga n'ịba ụba nke ọbara ọgbụgba. Yabụ, iji otu ọgwụ ndị a n’otu oge kwesịrị iji nlezianya rụọ ọrụ. Ka osi di, Clopidogrel na ASA ka edeputara onu rue ihe otu afo.

Heparin: clopidogrel achọghị mgbanwe maka ntụtụ heparin ma ọ bụ na ọ dịghị emetụta mmetụta heparin na coagulation ọbara. N'otu oge a, iji heparin eme ihe adịghị emetụta ihe mgbochi nke nchịkọta platelet nke Clopidogrel kpatara. N'agbata clopidogrel na heparin, enwere ike ịmekọrịta ọgwụ ọgwụ, nke na-eduga n'ịba ụba ọbara ọgbụgba. Yabụ, iji otu ọgwụ ndị a n’otu oge kwesịrị iji nlezianya rụọ ọrụ.

Ndị ọrụ Thrombolytic: a tụlere nchekwa nke njikọta nke clopidogrel na fibrin-akọwapụtara nke ọma na ndị na - abụghị fibrin akọwapụtara na ndị ọrịa nwere nnukwu myocardial infarction. Ugboro ọbara ọgbụgba dị egwu na-adị ka nke a hụrụ site n'iji ndị nnọchianya thrombolytic na heparin na ASA.

Ọgwụ antisteroidal anti-inflammatory ọgwụ (NSAIDs): ijikọtara ọnụ nke clopidogrel na naproxen na-eme ka ọbara ghara ịdị ụkọ site na eriri afọ. Agbanyeghị, n'ihi enweghị nnyocha ụlọ ọgwụ zuru ezu banyere mmekọrịta ya na ndị NSAID ndị ọzọ, ugbu a amabeghị ma mmụba nke ọbara ọgbụgba bụ akparamagwa nke NSAID niile. Ya mere, ime NSAIDs n'otu oge (gụnyere ndị na-egbochi COX-2) na clopidogrel chọrọ ịkpachara anya.

Usoro ọgwụgwọ ọzọ: ebe ọ bụ na clopidogrel bụ metabolized na metabolite ya na-arụ ọrụ nke na-eji CYP2C19, a na-atụ anya na iji ọgwụ ọjọọ eme ihe na-egbochi ọrụ enzyme a ga-eduga na mbelata ọgwụ ndị na-arụ ọrụ nke clopidogrel. Ihe omuma a putara nke nmekorita a apughi ihe doro anya.Dịka mkpachapụ anya, ịhapụ ịardedụ ọgwụ n'otu oge na-egbochi CYP2C19.

Ọgwụ ndị na-egbochi CYP2C19 gụnyere omeprazole na esomeprazole, fluvoxamine, fluoxetine, moclobemide, voriconazole, fluconazole, ticlopidine, ciprofloxacin, cimetidine, carbamazepine, oxcarbazepine na chloramphenicol.

Ndị na-egbochi Protin Pump (PPI):

Omeprazole na dose 80 mg otu ugboro n'ụbọchị, ewere ya n'otu oge na clopidogrel, ma ọ bụ na oge awa 12 n'etiti usoro ọgwụ abụọ, na -ebelata ikpughe metabolite nọ n'ọrụ site na 45% (ị na-eburu ya) na 40% (dose mmezi). Mbelata sitere na 39% (nkeji na-akwụ ụgwọ) yana 21% (usoro mmezi) nwere njikọta na mbelata nke nchịkọta platelet. Esomeprazole, nke ejiri clopidogrel mee ya, a na-atụkwa anya ka ọ belata mkpughe nke metabolite nọ n'ọrụ. Dịka ihe eji akpachapụ anya, ekwesighi iji omeprazole ma ọ bụ esomeprazole n'otu oge na clopidogrel.

A na-ahụbelata mbelata nke metabolite n'ihe gbasara pantoprazole na lansoprazole.

A na - ebelata plasma nke metabolites na - arụ ọrụ site na 20% (ị na - ebuputa ya) na 14% (dose mmezi) n'oge ọgwụgwọ na pantoprazole na dose 80 mg otu ugboro n'ụbọchị. Nke a na-esote mbelata nke mgbako nke platelet site na 15% na 11% n'otu n'otu. Nke a pụtara na enwere ike iji pantopidozole mee ihe.

Enweghị ihe akaebe na ọgwụ acid ndị ọzọ na-ebelata ọgwụ ọjọọ, dịka H2 receptor blockers (ewezuga cimetidine, nke bụ CYP2C19 inhibitor) ma ọ bụ ọgwụ antacids, na-egbochi ọrụ Clopidogrel antiplatelet.

Ọgwụ ndị ọzọ:

Enweghị mmekọrịta dị n'ụlọ ọgwụ dị mkpa dị na ụlọ ọgwụ achọpụtara mgbe ị na-ewere clopidogrel na atenolol ma ọ bụ nifedipine ma ọ bụ jiri ihe ndị a. Ojiji nke phenobarbital ma ọ bụ estrogen emetụtaghị ọgwụ ọrụ nke clopidogrel.

A na-agbanwe ọgwụ ọgwụ nke digoxin na theophylline site na iji clopidogrel.

Antacids anaghị agbanwe ogo nnabata nke clopidogrel.

Phenytoin na tolbutamide, nke metabolized na-eji CYP2C9, nwere ike iji clopidogrel mee ihe n'enweghị nsogbu.

Emebeghi omumu banyere nmekorita nke clopidogrel na ogwu ndi ozo nke enyere ndi oria atherothrombosis (na mgbakwunye ogwu ndia ekwuputara). Agbanyeghị, maka ndị ọrịa na-ekere òkè na ọnwụnwa nke ọrịa clopidogrel bụ ndị were, yana clopidogrel, ọgwụ dịgasị iche iche, enweghị mmekọrịta mmekọrịta dị egwu na-adakarị na ụlọ ọgwụ. Ọgwụ ndị a gụnyere diuretics, beta-blockers, angiotensin-na-agbanwe enzyme inhibitors (ACE inhibitors), ndị na-akpọ calcium, cholesterol na-ebelata ọgwụ ọjọọ, vasodilators, ọgwụ antidiabetic (gụnyere insulin), ọgwụ antiepileptik, na ndị na-egbochi GPII. Ndị na - anabata IIIa.

Ntụziaka pụrụ iche

Ọbara ọgbụgba na ọbara ọgbụgba

N'ihi ọghọm ọbara ọgbụgba na mmeghachi omume na-adịghị mma n'oge ọgwụgwọ, ọ bụrụ na mgbaàmà ụlọ ọgwụ na-egosi ọbara ọgbụgba, a ga-eme nnwale ọbara n'ozuzu ya na / ma ọ bụ ule ndị ọzọ kwesịrị ekwesị ozugbo. Dịka ndị ọzọ na-ahụ maka ọgwụ mgbochi, ekwesịrị iji clopidogrel jiri nlezianya mee ihe maka ndị ọrịa nwere ike ịnọ n'ihe ize ndụ nke ọbara ọgbụgba na-emetụta trauma, ịwa ahụ ma ọ bụ ọnọdụ ndị ọzọ, yana ndị ọrịa agwọ ọrịa ASA, heparin, IIb glycoprotein inhibitors. / IIIa ma ọ bụ ọgwụ mgbochi na - abụghị ọgwụ steroidal (NSAIDs), gụnyere ndị na - egbochi COX-2. Ekwesịrị iji nlezianya nyochaa ndị ọrịa maka ihe ịrịba ama ọ bụla nke ọbara ọgbụgba, gụnyere ọbara mgbaka, karịsịa izu mbụ nke ọgwụgwọ na / ma ọ bụ usoro obi ma ọ bụ ịwa ahụ.Ekwesighi iji Clopidogrel na anticoagulants na-eme ọnụ n'otu oge, ebe nke a nwere ike ịbawanye ọbara ọgbụgba.

Ọ bụrụ na onye ọrịa ahụ ga - anata ịwa ahụ ịwa ahụ, yana mmetụta antiplatelet nwa oge na - achọghị, a ga-akwụsị clopidogrel ụbọchị asaa tupu ịwa ahụ. Tupu usoro ịwa ahụ ọ bụla na ị andụ ọgwụ ọ bụla, ndị ọrịa kwesịrị ịdọ ndị na-agwọ ọrịa na ndị dọkịta ezé aka na ntị na ha na-ewere clopidogrel.

Clopidogrel na-agbatị oge ọbara ọgbụgba ma ekwesịrị iji nlezianya mee ya na ndị ọrịa nwere mgbanwe mgbanwe ọrịa metụtara ọbara ọgbụgba (karịsịa eriri afọ na akwara).

Ekwesịrị ịgwa ndị ọrịa na mgbe ị na-ewere Clopidogrel-Teva (naanị ma ọ bụ yana njikọta na ASA), ọ nwere ike ogologo oge iji kwụsị ọbara ọgbụgba ahụ, na ha kwesịrị ịgwa dọkịta ha ma ọ bụrụ na ha na-agba ọbara ọ bụla na-atụghị anya (site na ọnọdụ ma ọ bụ ogologo oge). .

Thrombotic Thrombocytopenic Purpura (TTP)

O siri ike, a kọọrọ banyere ọgwụ thrombotic thrombocytopenic purpura (TTP) mgbe ojiji ọgwụ ọgwụ Clopidogrel-Teva, na mgbe ụfọdụ mgbe obere mkpughe gasịrị. Ihe e ji mara ya bụ thrombocytopenia na microemiopathic hemolytic anaemia, yana mgbanwe mgbanwe akwara, ọnya akwara, ma ọ bụ ahụ ọkụ. TTP bu ndu nke choro igba oso n’agha, tinyere plasmapheresis.

A kọrọ na ịnwe clopidogrel na-eduga na mmepe nke enweta hemophilia enwetara. Enwere ike ịtụle ohere inwetara hemophilia site na mmụba dịpụrụ adịpụ na oge akụkụ mkpụrụ akụkụ (APTT), na-enwe ọbara ọgbụgba. Ọgwụ ndị ọrịa nwere nkwenye siri ike nke haemophilia enwetara na nyochaa ọnọdụ ha kwesịrị ka ndị ọkachamara mezie ya, a ga-akwụsịkwa Clopidogrel.

Ọkpụkpụ azụ mgbu na-adịbeghị anya

N'ihi ụkọ data, a gaghị atụ aro ọgwụ ahụ na 7 ụbọchị mbụ mgbe ọrịa ọgbụgbọ na-akpata nnukwu ọnya.

Cytochrome P450 2C19 (CYP2C19)

Pharmacogenetics: N'ime ndị ọrịa na-eji ngwa ngwa CYP2C19 metabolizer, clopidogrel na-emepụta metabolites na-adịghị arụ ọrụ na usoro onyonyo a tụrụ aro, yana ọ nwere mmetụta dị ala na platelet. Enwere ule iji chọpụta CYP2C19 genotype na ndị ọrịa.

Ebe ọ bụ na nguzobe nke metabolites clopidogrel metabolites na-apụta, na akụkụ, yana ntinye nke CYP2C19, a na-atụ anya na iji ọgwụ ndị na-egbochi ihe enzyme a ga-eduga na mbelata nke mkpokọta nke metabolites ndị dị otú ahụ. Ekpebibeghị ịdị mkpa ọgwụgwọ nke mmekọrịta a. Dịka ihe eji akpachapụ anya, a naghị akwado iji ọgwụ mgbochi CYP2C19 dị ike ma ọ bụ nke na-agbanwe agbanwe n'otu oge ọgwụ a.

Ọrụ nrụgide

Ebe ọ bụ na akọọrọ mmegharị mmeghachi omume na-eduga mmeghachi omume nfụkasị n'etiti thienopyridines, ekwesịrị ịchọpụta ma onye ọrịa ahụ nwere akụkọ banyere hypersensitivity na thienopyridines ndị ọzọ, dị ka ticlopidine na prasugrel. N'ime ndị ọrịa nwere akụkọ banyere hypersensitivity na talatin ndị ọzọ, a ga-enyocha nlezianya anya n'oge ọgwụgwọ maka ihe ịrịba ama nke hypersensitivity na clopidogrel.

Renrụ ọrụ na-arụ ọrụ na ụlọ

Ahụmahụ ọgwụgwọ Clopidogrel n'ebe ndị ọrịa nwere ọrụ ezumike ọrụ dị ụkọ. Ya mere, n'ihe banyere ndị ọrịa dị otú ahụ, a ga-eji ọgwụ kpachara anya.

Ọrụ imeju na-arụ ọrụ

Ahụmahụ na iji ọgwụ ọjọọ eme ihe na ndị ọrịa nwere ọrụ imeju na-arụ ọrụ nke oke aka, ọ na-adịkarị mfe ịba ọcha n'anya. N'akụkụ a, na onu ogugu a, ekwesiri iji ogwu mee ihe nlezianya.

Ime na lactation

N'ihi enweghi data nyocha banyere nsogbu nke clopidogrel n'oge afọ ime, ọ bụ ihe amamihe dị na ya ka ị ghara iji clopidogrel n'oge ime dị ka akpachara anya.

Ọmụmụ preclinical egosighi mmetụta ọjọọ ọ bụla na ọgwụ ọjọọ na-enwe n'afọ ime, ombrayonia / nwa ebu n'afọ, na ịmụ nwa ma ọ bụ mmepe ahụ.

Amabeghị ma clopidogrel na-abanye na mmiri ara ara mmadụ. Ọmụmụ preclinical egosila na clopidogrel na-abanye n’ime mmiri ara. Dika ihe eji akpachapụ anya, ekwesịghị inye ụmụaka ara ara n'oge a na-agwọ ọrịa Clopidogrel-Teva.

Ọmụmụ preclinical egosighi na clopidogrel na-emetụta ọmụmụ.

Akụkụ nke nsonaazụ ọgwụ ahụ nwere ike ịnya ụgbọ ma ọ bụ usoro nwere ike ibute

N'ihi ihe oge nke ọgbụgbọ ma ọ bụ mmetụta ndị ọ na-adịghị ahụkebe, a ga-eji ọgwụ ahụ kpachara anya mgbe ị na-anya ụgbọ ala.

NKWUKWU PHARMACOLOGIC

ọgwụ ọgwụ. Clopidogrel na-ahọrọ nke ọma igbochi nnabata nke ADP na ndị na-anabata platelet na ịgbalite nke glycoprotein (GP) IIb / IIIa ma si otú a na-egbochi nchịkọta platelet. Clopidogrel na - egbochikwa nchịkọta platelet site na ihe ndị ọzọ. Ọgwụ a anaghị emetụta ọrụ PDE.

Clopidogrel na-agbanwe agbanwe na-anabata platelet ADP ndị na - anabata ya, yabụ na platelet na - anọgide na - arụ ọrụ oge ndụ niile, a na - eweghachi ọrụ nkịtị mgbe emechara platelet (ihe dị ka ụbọchị 7 ka e mesịrị). Site na onu ogugu enwere ugbua na onodu ogwu ghari nke platelet agutara, elebara ya anya rue mgbe elekere abụọ gasiri oji nke clopidogrel. Nchịkwa ugboro ugboro nke dose nke 75 mg na-eduga na nnukwu mgbochi nke nchịkọta platelet. Nsonaazụ ahụ na-aga n’ihu n’ihu, a na-enwekwa ọnọdụ kwụsiri ike mgbe ụbọchị 3-7 gachara. Ọzọkwa, nkezi ogo inhibition nke nchịkọta n'etiti mmetụta nke 75 mg bụ 40-60%. Ọgbakọ Platelet na oge ọgbụgba na-alaghachi na ntọala na nkezi ụbọchị 7 ka ịkwụsịtụ clopidogrel.

Mlọ ọgwụ Mgbe ị takingụsịrị ọgwụ ọgwụ dị 75m, a na-etinye clopidogrel ngwa ngwa na ngọngọ nri. Agbanyeghị, itinye uche ya na plasma ọbara bụ ihe a na-eleghara anya ma mgbe awa 2 gasịchara nchịkwa eruteghị nha ahụ (0.025 μg / l).

Clopidogrel na-agbakọ ngwa ngwa n'imeju. Ihe bụ isi metabolite ya bụ mmanụ sitere na carbonxylic acid ma were ihe dịka 85% nke ihe mejupụtara na plasma ọbara. C_max nke metabolites a na plasma ọbara mgbe usoro nke clopidogrel ugboro ugboro na dose nke 75 mg bụ ihe dịka 3 mg / l ma na-enweta ya 1 awa mgbe nchịkwa.

Ndị na-ahụ maka ọgwụ metabolites bụ isi metabolite gosipụtara mmekọrịta dị larịị n'etiti dose of clopidogrel 50-150 mg. Clopidogrel na metabolite ya na - agbanwe agbanwe na - egbochi ọgwụ protein site na vitro (98 na 94%, n'otu n'otu). A na - eme ka njikọ nke a ghara ịdị na-enwetụbeghị ụdị ya.

Mgbe ị takingacachara, ihe dị ka 50% nke ọgwụ a isụbara dị na mmamịrị yana ihe dịka 46% na ọnya n'ime awa 120 mgbe nchịkwa gasịrị. Ndi_½ isi metabolite bụ 8 awa

Ọdịdị nke metabolite bụ isi na plasma ọbara dị elu karị n'ọrịa ndị agadi (karịa afọ 75) ma e jiri ya na ndị ọrụ afọ ofufo na-eto eto nwere ahụ ike. Agbanyeghị, nnukwu plasma adịghị mgbakwunye na mgbanwe dị na nchịkọta platelet na oge ọgbụgba. Theta oke metabolite na plasma ọbara mgbe ewere 75 mg / ụbọchị dịkarịsịrị ala na ndị ọrịa nwere ọrịa akụrụ siri ike (nwebisi creatinine (CC) 5-15 ml / min) ma e jiri ya tụnyere ndị ọrịa nwere akụrụ na-adịghị ala ala (CC 30-60 ml / min ) na ndị ọrụ afọ ofufo nwere ahụ ike.Ọ bụ ezie na a na-ebelata ihe mgbochi na nchịkọta ADP na-akpata platelet (25%) ma e jiri ya tụnyere ndị ọrụ afọ ofufo nwere ahụ ike, oge ọbara na-agbatịkwu ruo otu oge ahụ dịka ndị ọrụ afọ ofufo siri ike natara clopidogrel na dose 75 mg / ụbọchị.

mgbochi nke atherothrombosis na ndị okenye:

• n'ime ndị ọrịa mgbe ọria infịction myocardial (mmalite ọgwụgwọ - ụbọchị ole na ole ka e mesịrị, mana ọ dịghị oge karịa ụbọchị 35 mgbe mmalite ahụ), ọnya afọ ischemic (mmalite nke ọgwụgwọ - ụbọchị 7, mana ọ rughị ọnwa 6 mgbe mmalite) ma ọ bụ ọrịa nwere nsogbu nchọpụta. akwara (emebi akwara na atherothrombosis nke arịa nke ala ala).
• n'ime ndị ọrịa nwere nnukwu ọnyá ọnya (ACS):
• ya na ACS na-ebuliteghị akụkụ S - T (angina pectoris na-ejighị n'aka ma ọ bụ infịction myocardial na-enweghị ebili mmiri Q), gụnyere ndị ọrịa bụ ndị na-agbachi ihu n'oge angioplasty coronary percutaneous, yana njikọ acetylsalicylic acid,
• yana nnukwu myocardial infarction yana ihe dị elu nke S - T, yana Acetylsalicylic acid (na ndị ọrịa na-anata ọgwụ ọkọlọtọ na ndị egosipụtara ọgwụgwọ thrombolytic).

Egosiputa atherothrombotic na ihe omume thromboembolic na akwara fibrillation: clopidogrel na acetylsalicylic acid ka egosipụtara maka ndị ọrịa okenye nwere ọnya fibrillation, ndị nwere opekata mpe otu ihe ọghọm maka ihe omume nke vaskụl, contraindications maka ọgwụgwọ na ọbara K antagonists, na obere ihe ize ndụ nke prophylaxis na ọnya ọbara na ọbara mgbaze na mgbochi ọbara na ihe omume thromboembolic, tinyere ọrịa strok.

AKPỌ

ndị okenye, gụnyere ndị ọrịa agadi. Clopidogrel ka etinyere 75 mg 1 oge kwa ụbọchị, n'agbanyeghị nri nri.

Ọgwụ Clopidogrel nke ndị ọrịa nwere ACS na-ebulite S S T (enweghị angina pectoris ma ọ bụ myocardial infarction na-enweghị ebugharị QG na ECG) na-amalite na otu iko 300 mg, wee na-aga n’ihu na 75 mg otu ugboro kwa ụbọchị (ya na acetylsalicylic acid na dose 75-7 325 mg / ụbọchị). Ebe ọ bụ na iji ọgwụ elu nke acetylsalicylic acid na-abawanye ohere nke ọbara ọgbụgba, a na-atụ aro ka ọ ghara ịfefe 100 mg. E guzobebeghị ezigbo ọgwụgwọ ọ bụla. A kọrọ uru nke iji ọgwụ ahụ ruo ọnwa iri na abụọ, ma rụpụtara nsonaazụ kachasị mgbe ọnwa 3 nke ọgwụgwọ gasịrị.

Maka ndị ọrịa nwere nnukwu myocardial infarction na mbuli elu nke S - T, a na-enye clopidogrel 75 mg otu ugboro kwa ụbọchị, na-amalite site na otu iko 300 mg na ngwakọta acetylsalicylic acid, yana ma ọ bụ na-enweghị ọgwụ thrombolytic. Ọgwụgwọ ndị ọrịa karịrị afọ iri asaa na ise bidoro n’ebughi oke clopidogrel. Ekwesịrị ịmalite ọgwụgwọ njikọta ozugbo enwere ike mgbe mmalite nke mgbaàmà ma gaa n'ihu opekata mpe izu anọ. Abamuru nke iji ngwakọta nke clopidogrel na acetylsalicylic acid ruo ihe karịrị izu anọ amụtabeghị na ọrịa a.

N'ime ndị ọrịa nwere ọnya firamillation, a na-eji clopidogrel mee ihe n'otu ọgwụ nke 75 mg. Na clopidogrel, a ga-amalite iji acetylsalicylic acid wee gaa n'ihu (na usoro nke 75-100 mg / ụbọchị).

Ọ bụrụ na ị na-efu otu ọgwụ:

• ọ bụrụ na erughi awa iri na abụọ agafeela n’oge ọ dị mkpa ị doseụ ọgwụ ọzọ, onye ọrịa ahụ kwesịrị ị doseụ ọgwụ ahụ echefuru ozugbo, a ga-ewerekwa mmiri ọgwụ na-esote n’oge ọ na-eme,
• ọ bụrụ na ihe karịrị elekere iri na abụọ agafeela, onye ọrịa ahụ kwesịrị ị doseụ mmiri ọzọ na-esote oge ọ na-emebu, mana etinyekwala ya okpukpu abụọ iji kwụọ ụgwọ nke agbaghara.

Odida ntaramahụhụ. Ahụmahụ a na-enweta na ọgwụ nwere ndị ọrịa nwere ezughị oke gbasara ezumike pere mpe.

Imeju imeju. Ahụmahụ ọgwụgwọ nke iji ọgwụ ahụ eme ihe na ndị ọrịa nwere ọrịa imeju na-adịghị ala ala na ihe ize ndụ nke hemorrhagic diathesis nwere oke.

EGO NA-EGO

A kọrọ na ọbara ọgbụgba bụ ihe na-akpata mmeghachi ahụ ma na-emekarị ọnwa mbụ nke ọgwụgwọ.

A na-ekesa mmeghachi omume na-adịghị mma n'etiti akụkụ ahụ, ugboro ole nke ihe ha mere na-akọwapụta dịka ndị a: oge ​​(site na ≥1 / 100 ruo ≤1 / 10), ugboro ugboro (site na ≥1 / 1000 ruo ≤1 / 100), adịkarịghị (site na ≥1 / 10,000 ruo ≤ 1/1000), dịkarịsịrị ala (sitere na sistemụ ọbara na akwara lymphatic: ọ na - adịkarịghị - thrombocytopenia, leukopenia, eosinophilia, neutropenia, gụnyere neutropenia, adịkarịghị - thrombotic thrombocytopenic purpura, aplastic anaemia, pancytopenia, agranulocytotopen, thrombocytotopenia, thrombocytotopeniaia .

N'akụkụ nke sistem ahụ ji alụso ọrịa ọgụ: ọ dịkarịghị - ọrịa serum, mmeghachi omume anaphylactoid, nke a na-amaghị - cross-hypersensitivity laarin thienopyridines (dị ka ticlopidine, prasugrel) (lee Akwụkwọ NKWUKWU EGO).

Site na psyche: ọ na - adịkarịkarị - ịkọ echiche, ọgba aghara.

Site na usoro ụjọ ahụ: ọ na - adịkarịghị - ọbara ọgbụgba intracranial (n'ọnọdụ ụfọdụ, egbu egbu), isi ọwụwa, paresthesia, dizziness, na-adịkarị obere - mgbanwe na uto.

Site n'akụkụ akụkụ ahụ nke ọhụụ: ugboro ugboro - ọbara ọgbụgba na mpaghara anya (njikọta, akwara, azụ).

N’akụkụ akụkụ anụ ahụ na-anụ ihe: ọ na - adịkarịghị obere - umengwụ.

Site na arịa: ọtụtụ mgbe - hematoma, ọ na-adịkarịke - nnukwu ọbara ọgbụgba, na-agba ọbara site na ọnya ọnya, vasculitis, hypotension arterial.

Site na sistem iku ume: ọtụtụ mgbe - imi imi, dịkarịsịrị obere - na-agba ọbara na akụkụ okuku ume (hemoptysis, ọbara ọgbụgba), bronchospasm, ọrịa obi na-efe efe, nkụ na-efe efe nke eosinophilic.

Site na usoro digestive: oge ​​- ọbara ọgbụgba, afọ ọsịsa, ọnya afọ, dyspepsia, infrequently - gastric and duodenal ọnya, gastritis, vomiting, ọgbụgbọ, afọ ntachi, flatulence, adịkarịghị - mbufụt ọgbụgba, adịkarịghị - eriri afọ na ọbara ọgbụgba na-egbu egbu, pancreatitis, colitis (karịsịa ọnya ma ọ bụ lymphocytic), stomatitis.

Site na sistemu ịba ọcha n'anya: ọ dịkarịsịrị ike - nnukwu ọrịa imeju, ọrịa ịba ọcha n'anya, nsonaazụ na - adịghị mma nke ndị na - egosipụta ọrụ imeju.

N’akụkụ anụ ahụ na ọnya subcutaneous: mgbe mgbe - ọbara ọgbụgba nke subcutaneous, adịkarịghị - ihe ọkụ, itching, intradermal hemorrhage (purpura), adịkarịghị - bulmat dermatitis (epicmality necrolysis, Stevens-Johnson syndrome, erythema multiforme), angioedema, cutaneous or exfoliative. , urticaria, ọrịa hypersensitivity syndrome, ọrịa ụkwara ume ọkụ na eosinophilia na ngosipụta sistemu (ọrịa syndrome), eczema, lichen planus.

Site na usoro mọzụlụ: dịkarịsịrị ike - ọbara ọgbụgba akwara (hemarthrosis), ogbu na nkwonkwo, ogbu na nkwonkwo, myalgia.

Site na akụrụ na usoro urinary: ugboro ugboro - hematuria, adịkarịghị - glomerulonephritis, ụba creatinine na ọbara.

Ọnọdụ izugbe na mmeghachi omume na saịtị ịgba ahụ: mgbe - ọbara ọgbụgba na ntụtụ ahụ, ọ na - adịkarị ọkụ - ahụ ọkụ.

Ọmụmụ ụlọ nyocha: na - adịkarịghị - oge ọbara ọgbụgba dị ogologo, mbelata ọnụ ọgụgụ nke neutrophils na platelet.

AKWSTRUCTIONKWỌ NDEC NA-EGO

ọnọdụ ọbara ọgbụgba na ọnụọgụ ọrịa metụtara ọrịa hematological. Ọ bụrụ n’ịchọpụta mgbaama ọbara na-agba n’oge iji ọgwụ ahụ, nnwale ọbara zuru oke na / ma ọ bụ ule ndị ọzọ dabara adaba kwesịrị ozugbo. Dị ka ndị ọzọ antiplatelet, ekwesịrị iji clopidogrel jiri nlezianya mee ihe na ndị ọrịa nwere nnukwu ọbara ọgbụgba n'ihi trauma, ịwa ahụ ma ọ bụ ọnọdụ ndị ọzọ, yana n'ihe banyere ndị ọrịa na-eji acetylsalicylic acid, heparin, IIb / IIIa glycoprotein inhibitors ma ọ bụ NSAIDs, akpan akpan COX-inhibitors. 2 ma ọ bụ nhọrọ serotonin reuptake inhibitors (SSRIs). Ọ dị mkpa iji nlezianya nyochaa ngosipụta nke mgbaàmà ọbara ọgbụgba n'ime ndị ọrịa, gụnyere ọbara ọgbụgba zoro ezo, ọkachasị n'izu ndị mbụ nke ọgwụgwọ na / ma ọ bụ usoro mmerụ ahụ na obi na ịwa ahụ.Ekwesighi iji Clopidogrel na anticoagulants na-eme ihe n'otu oge, ebe nke a nwere ike ime ka ọbara ọgbụgba dịkwuo ike.

N'ihe banyere usoro ịwa ahụ nke ezubere, nke na-anaghị achọ ojiji nke ndị na-egbochi antiplatelet, a ga-akwụsị ịgwọ clopidogrel ụbọchị 7 tupu ịwa ahụ. Ndị ọrịa kwesịrị ịgwa ndị dọkịta, gụnyere ndị dọkịta ezé, na ha na-a cloụ ọgwụ clopidogrel, tupu ha edee usoro ịwa ahụ ọ bụla, ma ọ bụ tupu iji ọgwụ ọhụrụ. Clopidogrel na-eme ka oge ọbara ọgbụgba dị ogologo, n'ihi ya, ekwesịrị iji ya mee nke ọma na ndị ọrịa nwere nnukwu ọbara ọgbụgba (ọkachasị eriri afọ na intraocular).

E kwesiri ịdọ ndị ọrịa ọdụ na oge ọgwụgwọ na clopidogrel (naanị ya ma ọ bụ na jikọtara ya na acetylsalicylic acid), ọbara ọgbụgba nwere ike kwụsịchaa karịa ka ọ dị na mbụ, nakwa na ha kwesịrị ịgwa dọkịta banyere okwu ọ bụla nke ọbara ọbara na-adịghị ahụkebe (ebe ma ọ bụ ogologo oge).

Thrombotic thrombocytopenic purpura. Achọpụtakarị ikpe nke thrombotic thrombocytopenic purpura (TTP) mgbe ejiri Clopidogrel, mgbe ụfọdụ ọbụlagodi mgbe o were obere oge. E gosipụtara TTP site na thrombocytopenia na microangiopathic hemolytic anaemia na ngosipụta akwara ozi, dalfunction akụrụ, ma ọ bụ ahụ ọkụ. TTP nwere ike ịbụ ọnọdụ nwere ike igbu mmadụ, yabụ chọrọ ọgwụgwọ ozugbo, gụnyere plasmapheresis.

Inweta haemophilia. Mmepe nke enwetara hemophilia mgbe ejiri Clopidogrel mee ihe. Mgbe ekwenyela ogologo oge elekere akụkụ ọkara elekere (APTT) na ọbara ọgbụgba ma ọ bụ na-enweghị ọbara ọbara, ekwesịrị itule mmepe nke hemophilia enwetara. Ndị ọrịa dị otú a kwesịrị ịkwụsị iji clopidogrel ma gakwuru ọkachamara iji nweta ọgwụgwọ kwesịrị ekwesị.

Ọrịa mgbu afọ mgbu na-adịbeghị anya. N'ihi data ezughi ezu, a naghị atụ aro ya ka ọ kọwapụta clopidogrel na ụbọchị 7 mbụ mgbe ọrịa ọgbụgba na-akpata isi.

Cytochrome P450 2C19 (CYP 2C19). Pharmacogenetics. N'ime ndị ọrịa nwere ọrụ mkpụrụ ndụ ihe nketa nke CYP 2C19, a na-ahụkarị mbelata nke metabolite na-arụsi ọrụ ike nke clopidogrel na plasma ọbara na mmetụta antiplatelet na-ebelata. Enwere ule nke nwere ike ịchọpụta CYP 2C19 genotype na onye ọrịa.

Ebe ọ bụ na agbanwere clopidogrel ka ọ bụrụ metabolite na-arụ ọrụ ya na akụkụ nke CYP 2C19, ị theụ ọgwụ ọjọọ ndị na-ebelata ọrụ nke enzyme a nwere ike iduga mbelata mkpokọta metabolite na-arụ ọrụ nke clopidogrel na plasma ọbara. Kaosinadị, abatabeghị ịdị mkpa nke mmekọrịta a. Ya mere, dịka ihe mgbochi, ekwesiri iji mgbochi ndị CYP 2C19 siri ike ma na-agagharị agagharị (lee INTERACTIONS).

Mkparịta ụka Allergic. Ekwesịrị inyocha ndị ọrịa maka akụkọ banyere ịgwọ ọrịa mmadụ na ọrịa ndị ọzọ (dị ka ticlopidine, prasugrel), ebe enwere akụkọ banyere nfụkasị ọgbụgba n'etiti thienopyridines (lee ADIFESIKE ỌR)).

Thienopyridines nwere ike ibute mmeghachi omume nfụkasị na-adịghị ala ala, dịka angioedema, ihe ọkụ ọkụ, mmeghachi omume hematological (thrombocytopenia, neutropenia).

Ndị ọrịa nwere nfụkasị na / ma ọ bụ mmeghachi omume hematologic mgbe ị na-a usingụ ọgwụ site na otu sitenopyridine nwere ike ịnwe ohere dị elu nke otu mmeghachi omume mgbe ị na-eji temapyridine ndị ọzọ. Ya mere, a ga-enyocha ndị ọrịa dị otú a.

Ndị otu ọrịa pụrụ iche. Ahụmahụ ọgwụgwọ na clopidogrel na ndị ọrịa nwere akụrụ gbasara akwara nwere oke, yabụ, ekwesịrị ịkọwa ndị ọrịa dị otú ahụ na nlezianya (leeAKPO APUTA).

Ahụmahụ nke iji ọgwụ ahụ eme ihe na ndị ọrịa nwere ọrịa imeju na-agafeghị oke na enwere ike ịnwe ọbara ọgbụgba nwere oke. Yabụ, ekwesịrị inye ndị ọrịa dị etu a nkọ nkọ (lee APPLICATION).

Ndị pụrụ iche. Clopidogrel-Teva nwere lactose. Ndị ọrịa nwere ọrịa a ketara eketa dịka galactose ekweghị, ụkọ lappase ma ọ bụ ọrịa glucose-galactose malabsorption ekwesịghị ị medicationụ ọgwụ a.

Prekpachara anya maka mkpofu ahihia. A ga-ekpofu akwụkwọ ndobe ọgwụ ndị ọzọ na-ejibeghi ma ọ bụ ekpofu dị ka iwu obodo si dị.

Jiri n'oge ime na lactation. N'ihi ụkọ data ụlọ ọgwụ, ojiji nke clopidogrel n'oge afọ ime bụ ihe a na-achọghị maka ụmụ nwanyị dị ime (ịkpachara anya).

Ọmụmụ anụmanụ anaghị ekpughe mmetụta ọjọọ na -adaghị enwe na ịtụrụ ime, etuto n'afọ / nwa ebu n’afọ, na ịmụ nwa na ịmụ nwa.

Amaghi ma ekpudoputara Clopidogrel na mmiri ara ara. Nnyocha ụmụ anụmanụ egosiwo na clopidogrel na-abanye na mmiri ara ara, yabụ, a ga-akwụsị inye inye ụmụaka ara n'oge a na-agwọ clopidogrel.

Ọmụmụ. Nnwale ndị dị na anụmanụ ụlọ nyocha anaghị ekpughe mmetụta ọjọọ nke clopidogrel na ọmụmụ.

Childrenmụaka. Edere Clopidogrel-Teva maka ụmụaka.

Ikike iji metụta ọnụego mmeghachi omume mgbe ị na-anya ụgbọala ma ọ bụ usoro ndị ọzọ. Clopidogrel anaghị emetụta ma ọ bụ nwee obere mmetụta na ịkwọ ụgbọala ma ọ bụ usoro ndị ọzọ.

NWA EGO

ogwu anticoagulants. Ekwesighi iji Clopidogrel na anticoagulants na-eme ihe n'otu oge, ebe ngwakọta dị otú ahụ nwere ike ime ka ọbara ọgbụgba dịkwuo ike. Ọ bụ ezie na iji clopidogrel na ọgwụ nke 75 mg / ụbọchị adịghị agbanwe agbanwe na profaịlụ pharmacokinetic nke S-warfarin ma ọ bụ ọkwa mba ụwa (INR) na ndị ọrịa a gwakọtara ya na warfarin ogologo oge, otu oge iji clopidogrel na warfarin na-abawanye ohere nke ọbara ọgbụgba n'ihi nnwere onwe utịp ke hemostasis.

Ndị na-egbochi Glycoprotein IIb / IIIa. Ekwesịrị iji Clopidogrel jiri nlezianya mee ihe na ndị ọrịa nwere nnukwu ọbara ọgbụgba n'ihi trauma, ịwa ahụ ma ọ bụ ọnọdụ ndị ọzọ eji eji IIb / IIIa glycoprotein receptor inhibitors n'otu oge.

Acetylsalicylic acid. Acetylsalicylic acid anaghị agbanwe mmetụta inhibitory nke clopidogrel na nchịkọta platelet ADP, mana clopidogrel na-eme ka mmetụta nke acetylsalicylic acid dị na nchịkọta platelet mejupụtara na nchịkọta. Agbanyeghị, ojiji nke 500 mg nke acetylsalicylic acid ugboro abụọ kwa ụbọchị maka ụbọchị 1 emeghị ka mmụba dị ukwuu na oge ọgbụgba, agbatịwo n'ihi Clopidogrel. Ebe ọ bụ na mmekọrịta nke ọgwụ na ọgwụ n'etiti clopidogrel na acetylsalicylic acid ga-ekwe omume iji ohere dịwanye elu nke ọbara ọgbụgba, otu oge ị ofụ ọgwụ ndị a chọrọ ịkpachara anya. N'agbanyeghị nke a, enwere ahụmịhe na-ewere clopidogrel na acetylsalicylic acid ọnụ ruo otu afọ.

Heparin. A kọrọ na clopidogrel achọghị ndozi nke heparin ma ọ dịghị emetụta mmetụta nke heparin na coagulation. Ojiji nke heparin emegharịghị ịgbanwe ihe mgbochi na clopidogrel na nchịkọta platelet. Ebe ọ bụ na mmekọrịta nke ọgwụ na ọgwụ na-eme n'etiti clopidogrel na heparin ga-ekwe omume iji ohere dịwanye elu nke ọbara ọgbụgba, otu oge ị ofụ ọgwụ ndị a chọrọ ịkpachara anya.

Ndị ọrụ Thrombolytic.A mụwo nchekwa nke ojiji nke clopidogrel, fibrin akọwapụtara nke ọma ma ọ bụ ndị nwere fibrin akọwapụtara na ndị ọrịa nwere nnukwu myocardial infarction. Ugboro ọbara ọgbụgba dị egwu dịka nke achọpụtara site n'otu oge nke ọgwụ thrombolytic na heparin na acetylsalicylic acid.

Ndị NSAID. A na-akọ na ojiji ihe nkpokọta na clopidogrel na naproxen ka ọ na -eme ka ọnụego ọbara ọgbụgba na-ekweghị akwụsị akwụsị. Agbanyeghị, n'ihi enweghị ọmụmụ banyere mmekọrịta nke ọgwụ na NSAIDs ndị ọzọ, ekwetabeghị ma ihe ize ndụ nke ọbara ọgbụgba na-abawanye mgbe ejiri ya na NSAID niile. Ya mere, ịkpachara anya dị mkpa mgbe ị na-eji NSAIDs, akpan akpan COX-2 inhibitors, na clopidogrel.

Nhọrọ Serotonin Reuptake Inhibitors (SSRIs). Nyere eziokwu ahụ bụ na SSRI na-emetụta ọrụ platelet na-abawanye ohere nke ọbara ọgbụgba, n'otu oge, iji SSRIs na clopidogrel na-achọ ịkpachara anya.

Njikọ ya na ọgwụ ndị ọzọ. Ebe ọ bụ na agbanwere clopidogrel ka ọ bụrụ metabolite na-arụ ọrụ ya na akụkụ nke CYP 2C19, ojiji nke ọgwụ na-ebelata ọrụ nke enzyme a nwere ike iduga na mbelata nke mkpokọta metabolite na-arụ ọrụ nke clopidogrel na plasma ọbara. Emebeghị ka amata ihe gbasara ogwu gharii. Ya mere, dịka ihe mgbochi, ekwesịrị ịhapụ imeji ihe CYP 2C19 inhibitors siri ike na ngbanwe.

Ọgwụ na-egbochi ọrụ nke CYP 2C19 gụnyere omeprazole, esomeprazole, fluvoxamine, fluoxetine, moclobemide, voriconazole, fluconazole, ticlopidine, ciprofloxacin, cimetidine, carbamazepine, oxacarbazepine na chlora.

Ndị na-egbochi proton mgbapụta. Ntinye nke metabolite nọ n'ọrụ n'ime ọbara belatara site na iji otu oge ma ọ bụ obere elekere nke awa 12 n'agbata usoro nke clopidogrel na omeprazole na dose 80 mg. Mbelata a jikọtara ọnụ na mbelata nke nchịkọta platelet. Esomeprazole na-atụ anya ịbanye na mmekọrita yiri nke ahụ na clopidogrel.

Ejiri pantoprazole ma ọ bụ lansoprazole mara ọkwa mbelata ọbara metabolism.

Amatabeghị mmekọrịta dị n'etiti ọgwụ ọgwụ na ojiji nke clopidogrel n'otu oge na atenolol, nifedipine, ma ọ bụ na ọgwụ abụọ ahụ akọwapụtaghị ya. Na mgbakwunye, ọrụ ọgwụ nke clopidogrel nọgidere bụrụ ihe na-agbanweghị agbanwe mgbe ị na-eji phenobarbital na estrogen.

Nsonaazụ nke digoxin ma ọ bụ theophylline agbanweghị mgbe eji clopidogrel.

Ihe anakpo Antacids emetụtaghi ọkwa nnabata nke clopidogrel.

Enwere ike belata ịdị irè nke ọgwụ antithrombotic nke clopidogrel site na ọkara mgbe ejiri ya na ndị na-egbochi proton pump. N'okwu a, ọdịiche dị na nchịkwa n'oge oge anaghị emetụta mbelata arụmọrụ nke clopidogrel. Agaghị atụkọta ngwakọta nke clopidogrel na proton pump inhibitors.

Metabolites Carboxylic clopidogrel nwere ike igbochi ọrụ nke cytochrome P450 2C9. Nke a nwere ike ịbawanye ọkwa plasma nke ọgwụ ọjọọ dịka phenytoin na tolbutamide, yana ndị ọzọ metabolized site na iji cytochrome P450 2C9. N'agbanyeghị nke a, nsonaazụ nke nyocha ụlọ ọgwụ na-egosi na enwere ike iji phenytoin na tolbutamide mee ihe n'otu oge na clopidogrel.

Ewezuga ozi gbasara mmekorita ya na ọgwụ ụfọdụ akọwapụtara n'elu, ọmụmụ banyere mmekọrịta nke clopidogrel yana ọgwụ ndị a na-enyekarị ndị ọrịa nwere atherothrombosis.Agbanyeghị, ndị ọrịa sonyere na nyocha nke ụlọ ọgwụ nke clopidogrel jiri ọgwụ ndị ọzọ n'otu oge, gụnyere diuretics, β-adrenoreceptor blockers, ACE inhibitors, calcium antagonists, cholesterol belata ndị na-akpata, coronary vasodilators, ọgwụ antidiabetic (gụnyere insulin), ọgwụ antiepileptik, homonụ. ogwu na GPIIb / IIIa antagonists, n’enweghi ihe ngosi nke ihe ojoo di egwu.

OGBONA

site na ịdoụbiga mmiri ókè N'ihe banyere ọbara ọgbụgba, a na-atụ aro ọgwụgwọ Symptomatic.

Amaghị ọgwụ mgbochi Clopidogrel. Ọ bụrụ na ọ dị mkpa imezi oge ogologo oge ọgbụgba dị ogologo, enwere ike ịkwụsị nsonaazụ clopidogrel site na mmịnye ọbara na platelet.

Ntuziaka maka iji clopidogrel-teva

Mbadamba ụrọ - 1 mbadamba:

Ihe ndị na-arụ ọrụ: clopidogrel - 75 mg,

7 ma ọ bụ 10 PC. - blisters (2, 4, 8, 9, 12) - ngwugwu nke kaadiboodu.

Mgbe nchịkwa ọnụ gachara ntụtụ nke 75 mg, clopidogrel na-abanye ngwa ngwa site na ngari nri. Agbanyeghị, itinye uche na plasma ọbara na-abawanye ntakịrị ma mgbe awa 2 gasịchara nchịkwa erughi ọkwa nke enwere ike ikpebi (0.025 μg / L).

Ngwa ngwa metabolized na imeju. Ihe bụ isi metabolite bụ ọgwụ sitere na carbonxylic acid ma were ihe dịka 85% nke ihe bidoro na-ekesa na plasma. Cmax nke metabolite dị na plasma ọbara mgbe usoro nke Clopidogrel ugboro ugboro bụ ihe dịka 3 mg / l ma a na-ahụ ihe dị ka elekere 1 mgbe nchịkwa.

Ejiri ọgwụ pharmacokinetics nke metabolite bụ mmekọrịta dị larịị na ụdị nke clopidogrel 50-150 mg.

Clopidogrel na metabolite na - agbanwe agbanwe na - enweghị mgbochi na plasma protein na vitro (98% na 94%, n'otu aka ahụ). Mmekọrịta a anaghị enwe afọ ojuju n'ọtụtụ nchịkọta.

Mgbe ịbubigidegrel pụtara akara 14C, ihe dị ka 50% nke ọgwụ a isụbara dị na mmamịrị ma ihe dịka 46% nwere ọnya maka elekere 120. T1 / 2 nke metabolite bụ isi bụ awa 8.

E jiri ya tụnyere ndị ọrụ afọ ofufo na-eto eto nwere ahụ ike, ịka plasma nke metabolite dị elu dị elu karịa na ndị ọrịa agadi (afọ 75 na karịa), na-enweghị mgbanwe na nchịkọta platelet na oge ọbara ọgbụgba.

N'ime ọrịa akụrụ siri ike (CC 5-15 ml / min), ịta ihe bụ isi metabolite na plasma ọbara dị ala karịa ọrịa akụrụ na-adịghị ala ala (CC 30-60 ml / min) na ndị ọrụ afọ ofufo nwere ahụ ike. Ọ bụ ezie na e belatara ihe mgbochi na nchịkọta ADP na-eweta nchịkọta platelet ma e jiri ya tụnyere nke ndị ọrụ afọ ofufo siri ike, oge ọbara ọgbụgba mụbara ruo na nke ndị ọrụ afọ ofufo ahụ siri ike.

Inhibitor Platelet nchịkọta. N'ịhọrọ nke ọma na-egbochi ịchikọta adenosine diphosphate (ADP) na ndị na-anabata platelet na ịgbalite nke GPIIb / IIIa, si otú a na-egbochi nchịkọta platelet. Ọ na - egbochi nchịkọta platelet nke ndị agonist ndị ọzọ kpatara site na igbochi ụba ọrụ platelet site na ADP wepụtara. Achọghị ọrụ PDE.

Clopidogrel na-agbanwe agbanwe ndị ADP na-anabata ya na platelet, ya mere platelet na-anọgide na-arụ ọrụ na “ndụ” ha, a na-eweghachi ọrụ nkịtị ka a na-eweghachi ha (mgbe ihe dị ka ụbọchị asaa).

Ihe na-egosi maka iji clopidogrel-teva

Mgbochi nke nsogbu thrombotic n'ahụ ndị ọrịa nwere infarction myocardial infarction, ọrịa strok ischemic, ma ọ bụ mpaghara akwara. Na acetylsalicylic acid maka igbochi nsogbu nke thrombotic na nnukwu ọrịa coronary: ya na ngalaba ST na - ebuli ya na ohere nke thrombolytic therapy, na - enweghị nkwalite ST akụkụ (angina pectoris na - ejighi ike, myocardial infarction na - enweghị nsogbu ebili mmiri Q), gụnyerena ndị ọrịa na-enwe stent.

Mgbochi nke nsogbu nke thrombotic na thromboembolic, gụnyere ọrịa ọnya, na ọnya fibrillation atrial fibrillation (ọnya fibrillation) na ọnụnọ nke ihe dịkarịa ala n'ihe banyere mmepe nke nsogbu vaskụla, enweghi ike ịnara anticoagulants na-adịghị ala ala na ọbara ọgbụgba (yana yana acetylsalicylic acid).

Clopidogrel-teva Jiri ime na ụmụaka

Emebeghị nnyocha omumu zuru oke ma gbasie ike banyere nchekwa nke clopidogrel n'oge afọ ime. Enwere ike itinye ngwa naanị n'ọnọdụ mberede.

Amabeghị ma clopidogrel na mmiri ara ara na-apụ apụ n’ahụ mmadụ. Ọ bụrụ na ọ dị mkpa, iji n'oge a na-enye nwa kwesịrị ikpebi ịkwụsị ọrụ ara.

Na omumu nyocha umu anumanu jiri Clopidogrel na onunu 300-500 mg / kg / ubochi, enweghi ihe omuma teratogenic na ihe ojoo na omumu na ito imu nwa. E guzobere na clopidogrel na metabolites ya na-apụ apụ na mmiri ara.

Clopidogrel Teva Dosage

Were ọnụ 1 oge / ụbọchị.

Usoro mbido na mmezi bụ 75 mg / ụbọchị. Ighapu ego bu 300 mg / ubochi.

Usoro ntinye akwụkwọ ahụ na-adabere n'ihe ngosipụta na ọnọdụ ụlọ ọgwụ.

A na-eji Clopidogrel jiri nlezianya na -echekarị ọbara ọgbụgba n'ihi trauma, ihe ịwa ahụ, na nsogbu usoro. Site na usoro ịwa ahụ na-eme atụmatụ (ma ọ bụrụ na achọghị ka ọ bụrụ nke na-adịghị mma), a ga-akwụsị clopidogrel ụbọchị asaa tupu ịwa ahụ.

Ejiri Clopidogrel jiri nlezianya mee ihe na ndị ọrịa nwere nnukwu nsogbu ịba ọcha n'anya, n'ime nke diathesis hemorrhagic nwere ike ime.

Mgbe ihe mgbaàmà nke ọbara ọgbụgba dị ukwuu (goms ọbara ọgbụgba, menorrhagia, hematuria) gosipụtara, ọmụmụ banyere usoro hemostasis (oge ọbara ọgbụgba, ọnụ ọgụgụ platelet, nnwale ọrụ ọrụ). A na-atụ aro ka ileba anya mgbe niile nke ndị na-egosi ihe imeju nke imeju arụ ọrụ.

Jiri mkpachapụ anya n'otu oge na warfarin, heparin, NSAIDs, ogologo oge - yana acetylsalicylic acid, n'ihi ugbu a, nchekwa nke ngwa dị otú ahụ esighi ike.

N'ime ihe omumu nyocha, achoputaghi uto ma obu ihe ojoo.

Mmetụta ikike ịkwọ ụgbọ ala na usoro nchịkwa

Edebeghị nsonaazụ clopidogrel n'ikike ịnya ụgbọ ala na usoro nchịkwa.

Dodoụbiga ya ókè

Site na oke nhicha nke clopidogrel, mmụba n'oge oge ọbara ọgbụgba na nsogbu ndị sochirinụ nwere ike ịhụ. N'ihe banyere ọbara ọgbụgba, a na-atụ aro ọgwụgwọ Symptomatic.

A maghị ihe ngwọta nke omume clopidogrel amaghi. Ọ bụrụ na ịchọrọ idozi oge ọbara agbatịpụrụ agbatị, enwere ike ịkwụsị nsonaazụ clopidogrel site na mmịnye ọbara platelet.

Jiri n’oge ime ma ọ bụ n’ịra

N'ihi enweghi data nyocha banyere iji clopidogrel n'oge afọ ime, ọ bụ ihe na-adịghị mma ịdere ụmụ nwanyị dị ime (ịkpachara anya).

Ọmụmụ anụmanụ anaghị ekpughe mmetụta ọjọọ na -adaghị enwe na ịtụrụ ime, etuto n'afọ / nwa ebu n’afọ, na ịmụ nwa na ịmụ nwa.

Amaghi ma ekpughere clopidogrel na mmiri ara ara. Nnyocha ụmụ anụmanụ egosiwo na mmiri ara ehi na-apụ apụ, yabụ, a ga-akwụsị inye ya ara mgbe a na-agwọ clopidogrel.

Nnwale ndị dị na anụmanụ ụlọ nyocha anaghị ekpughe mmetụta ọjọọ nke clopidogrel na ọmụmụ.

Edere Clopidogrel-Teva maka ụmụaka.

Njirimara ngwa

Ọbara ọgbụgba na ọnụọgụ ọrịa metụtara ọrịa hematological.

Ọ bụrụ na n’oge ị thereụ ọgwụ ahụ enwere mgbaama na-egosi na ọ ga-ekwe omume ọbara ọgbụgba, a ga-eme nnwale ọbara dị ukwuu na / ma ọ bụ ule ndị ọzọ kwesịrị ekwesị ozugbo. Dịka ndị ọzọ antiplatelet, ekwesịrị iji clopidogrel jiri nlezianya mee ihe na ndị ọrịa nwere nnukwu ọbara ọgbụgba n'ihi trauma, ịwa ahụ ma ọ bụ ọnọdụ ndị ọzọ, yana ndị ọrịa na-eji ASA, heparin, IIb / IIa glycoprotein inhibitors ma ọ bụ ọgwụ mgbochi na-abụghị steroidal, akpan akpan COX-inhibitors. 2 ma ọ bụ ọgwụ serotonin reuptake inhibitors (SSRIs) ma ọ bụ ọgwụ ndị ọzọ nwere ike ịbawanye ohere nke ọbara ọgbụgba (dịka ọmụmaatụ, pentox ifillin). Ọ dị mkpa iji nlezianya nyochaa ngosipụta nke mgbaàmà ọbara ọgbụgba n'ime ndị ọrịa, gụnyere ọbara ọgbụgba zoro ezo, ọkachasị n'izu ndị mbụ nke ọgwụgwọ na / ma ọ bụ usoro mmerụ ahụ na obi na ịwa ahụ. Ekwesighi iji Clopidogrel na anticoagulants na-eme ihe n'otu oge, ebe ọ nwere ike ime ka ọbara ọgbụgba dịkwuo ike.

N'ihe banyere usoro ịwa ahụ na-eme atụmatụ, oge ụfọdụ chọrọ ojiji nke ndị na-ahụ maka antiplatelet, a ga-akwụsị ọgwụgwọ na clopidogrel ụbọchị 7 tupu ịwa ahụ. Ndị ọrịa kwesịrị ịkọrọ ndị dọkịta, gụnyere ndị dọkịta ezé na ha na-ewere clopidogrel, tupu ịkọwa ha ụdị ịwa ahụ ọ bụla ma ọ bụ tupu ịmalite ọgwụ ọhụrụ. Clopidogrel na-agbatịkwu oge ọbara ọgbụgba, yabụ, ejiri ya kpachara anya na ndị ọrịa nwere nnukwu ọbara ọgbụgba (ọkachasị eriri afọ na akwara).

E kwesiri ịdọ ndị ọrịa ọdụ na oge ọgwụgwọ na clopidogrel (naanị ya ma ọ bụ na njikọta na ASA), ọbara ọgbụgba nwere ike ịkwụsị ka oge na-aga, nakwa na ha kwesịrị ịgwa dọkịta banyere ọnọdụ ọ bụla na-enweghị atụ (ebe ma ọ bụ oge) ọbara ọgbụgba.

Thrombotic thrombocytopenic purpura (TTP).

Achọpụtakarị ikpe nke thrombotic thrombocytopenic purpura (TTP) mgbe nchịkwa clopidogrel, mgbe ụfọdụ ọbụna mgbe ọ jiri obere oge. E gosipụtara TTP site na thrombocytopenia na microangiopathic hemolytic anaemia na ngosipụta akwara ozi, dalfunction akụrụ, ma ọ bụ ahụ ọkụ. TTP nwere ike ịbụ ọnọdụ nke nwere ike igbu mmadụ, yabụ chọrọ ọgwụgwọ ozugbo, gụnyere plasmapheresis.

Mmepe nke enwetara hemophilia mgbe ejiri Clopidogrel mee ihe. Mgbe ekwenyela ogologo oge elekere akụkụ ọkara elekere (APTT) na ọbara ọgbụgba ma ọ bụ na-enweghị ọbara ọbara, ekwesịrị itule mmepe nke hemophilia enwetara. Ndị ọrịa dị otú a kwesịrị ịkwụsị iji clopidogrel ma gakwuru ọkachamara iji nweta ọgwụgwọ kwesịrị ekwesị.

Ọrịa mgbu afọ mgbu na-adịbeghị anya.

N'ihi data ezughi ezu, a naghị atụ aro ya ka ọ kọwapụta clopidogrel na ụbọchị 7 mbụ mgbe ọrịa ọgbụgba na-akpata isi.

Cytochrome P450 2C19 (CYP2C19).

Pharmacogenetics. N'ime ndị ọrịa nwere ọrụ mkpụrụ ndụ ihe nketa nke CYP2C19, a na-ahụta mbelata nke metabolite na-arụsi ọrụ ike na plasma na mmetụta antiplatelet dị obere. Enwere ule iji mata CYP2C19 genotype na onye ọrịa.

Ebe ọ bụ na agbanwere clopidogrel ka ọ bụrụ metabolite na-arụ ọrụ ya na akụkụ nke ihe CYP2C19, ị ofụ ọgwụ na-ebelata ọrụ nke enzyme a nwere ike iduga na mbelata nke mkpokọta metabolite na-arụ ọrụ nke clopidogrel na plasma. Kaosinadị, abatabeghị ịdị mkpa nke mmekọrịta a. Yabụ, dị ka ihe mgbochi, aga-ezere ojiji ndị Inhibitors CYP2C19 siri ike ma na-agagharị agagharị (lee.Nkebi “Nmekorita ya na umu ogwu ogwu na ndi ozo na nmekorita”.

Ekwesịrị iji Clopidogrel jiri nlezianya mee ihe na ndị ọrịa n'otu oge na-ewere ngwaahịa ndị mejupụtara cytochrome CYP2C8.

Mkparịta ụka Allergic.

Ekwesịrị inyocha ndị ọrịa maka akụkọ banyere ịgwọ ọrịa mmadụ na ọrịa ndị ọzọ (dị ka ticlopidine, prasugrel), ebe enwere akụkọ banyere nfụkasị nkwonkwo n'etiti thienopyridines (lee akụkụ “Mmeghachi Mgbagha”).

Thienopyridines nwere ike ibute mmeghachi omume nfụkasị na-adịghị ala ala, dịka angioedema, ihe ọkụ ọkụ, mmeghachi omume hematological (thrombocytopenia, neutropenia).

Ndị ọrịa nwere akụkọ mmeghachi omume nfụkasị na / ma ọ bụ mmeghachi omume hematological mgbe ị na-a aụ ọgwụ site na otu thienopyridine nwere ike inwe oke ihe ize ndụ nke otu mmeghachi omume ahụ mgbe ị na-eji thienopyridines ndị ọzọ. Ya mere, maka ndị ọrịa dị otú a ga-akpachara anya.

Ndị otu ọrịa pụrụ iche.

Ahụmahụ ọgwụgwọ na clopidogrel na ndị ọrịa nwere gbasara akwara n’obere, ya mere, ndi ọrịa dị etu a kwesiri iji nlezianya depụta ọgwụ ahụ (lee Nkebi “Usoro Ọgwụ na Nchịkwa”).

Ahụmahụ nke iji ọgwụ ahụ eme ihe na ndị ọrịa nwere ọrịa imeju agafeghị oke na enwere ike ịmịchara mmadụ n'ọgụ. Yabụ, ekwesịrị inye ndị ọrịa dị etu a clopidogrel (lee mpaghara “Usoro Ọgwụ na Nchịkwa”).

Clopidogrel-Teva nwere lactose. Ndị ọrịa nwere ọrịa ọrịa akụrụngwa dịka ụyọkọ galactose, ụkọ Lappase ma ọ bụ ndị nwere nsogbu glucose-galactose malabsorption ekwesịghị ị thisụ ọgwụ a.

Prekpachapụ anya n'ihe gbasara mkpofu ahihia

A ga-ekpofu ahịhịa ndị a na-ejighị ọgwụ ọ bụla ma ọ bụ ekpofu dị ka iwu si dị.

Mmekọrịta na ọgwụ ndị ọzọ na ụdị mmekọrịta ndị ọzọ

Ọgwụ ndị nwere ike ime ka ọbara ọgbụgba dịkwuo elu

Enwere ohere dị ukwuu nke ọbara ọgbụgba n'ihi ikike nke ọgwụ. Jiri mkpachapụ anya jiri ọgwụ ndị ọzọ nwere ike ịbawanye ohere nke obara.

Anticoagulants nke ọgwụ. Ekwesighi iji Clopidogrel na anticoagulants na-eme ihe n'otu oge, ebe ngwakọta dị otú ahụ nwere ike ime ka ọbara ọgbụgba dịkwuo ike. Na agbanyeghi na iji clopidogrel na dose nke 75 mg kwa ụbọchị agbanweghị profaịlụ pharmacokinetic nke S-warfarin ma ọ bụ ọkwa mba ụwa (INR) na ndị ọrịa a gwakọtara ya na warfarin ruo ogologo oge, otu oge iji clopidogrel na warfarin na-amụba ohere nke ọbara ọgbụgba n'ihi ya. nnwere onwe mmetụta na hemostasis.

Ndị na - egbochi Glycoprotein IIb, / IIIA . Ekwesịrị iji Clopidogrel jiri nlezianya mee ihe na ndị ọrịa nwere nnukwu ọbara ọgbụgba n'ihi trauma, ịwa ahụ ma ọ bụ ọnọdụ ndị ọzọ nke glycoprotein IIb, / IIIA inhibitors na-eme n'otu oge.

Acetylsalicylic acid (ASA). Acetylsalicylic acid anaghị agbanwe mmetụta inhibitory nke clopidogrel na nchịkọta platelet ADP, mana clopidogrel na-eme ka mmetụta nke ASA pụta na nchịkọta platelet na-eweta. Agbanyeghị, ojiji nke 500 mg nke ASA ugboro abụọ n'ụbọchị otu ụbọchị anaghị akpata mmụba dị ukwuu n'oge ọbara ọgbụgba, agbatịwo n'ihi Clopidogrel. Ebe ọ bụ na mmekọrịta nke ọgwụ na ọgwụ n'etiti clopidogrel na acetylsalicylic acid ga-ekwe omume iji ohere dịwanye elu nke ọbara ọgbụgba, otu oge ị ofụ ọgwụ ndị a chọrọ ịkpachara anya.N'agbanyeghị nke a, enwere ahụmịhe iwere clopidogrel na ASA ọnụ ruo otu afọ.

Heparin. A kọrọ na clopidogrel achọghị ndozi nke heparin ma ọ dịghị emetụta mmetụta nke heparin na coagulation. Ojiji nke heparin emegharịghị ịgbanwe ihe mgbochi na clopidogrel na nchịkọta platelet. Ebe ọ bụ na mmekọrịta nke ọgwụ na ọgwụ na-eme n'etiti clopidogrel na heparin ga-ekwe omume iji ohere dịwanye elu nke ọbara ọgbụgba, otu oge ị ofụ ọgwụ ndị a chọrọ ịkpachara anya.

Ndị ọrụ Thrombolytic. A nyochaala nchekwa nke clopidogrel, fibrin akọwapụtara nke ọma ma ọ bụ ndị nwere fibrin akọwapụtara na ndị ọrịa nwere nnukwu myocardial infarction. Ugboro ọbara ọgbụgba dị egwu dịka nke a hụrụ na oge nke ọgwụ thrombolytic na heparin na ASA.

Ọgwụ antisteroidal anti-inflammatory ọgwụ (NSAIDs). A na-akọ na ojiji ihe nkpokọta na clopidogrel na naproxen ka ọ na -eme ka ọnụego ọbara ọgbụgba na-ekweghị akwụsị akwụsị. Agbanyeghị, n'ihi enweghị ọmụmụ banyere mmekọrịta nke ọgwụ na NSAIDs ndị ọzọ, o dochaghị anya, ohere nke ọbara ọgbụgba na-abawanye mgbe ejiri ya na NSAID niile. Ya mere, ịkpachara anya dị mkpa mgbe ị na-eji NSAIDs, akpan akpan COX-2 inhibitors, na clopidogrel.

Nhọrọ Serotonin Reuptake Inhibitors (SSRIs). Nyere na SSRIs na-emetụta njirimara platelet ma bulie ohere nke ọbara ọgbụgba, n'otu oge iji SSRIs na clopidogrel chọrọ ịkpachara anya.

Ndị na - egbochi Proton Pump Inhibitors (PPIs).

Ntinye nke metabolite nọ n'ọrụ n'ime ọbara belatara site na iji otu oge ma ọ bụ obere elekere nke awa 12 n'agbata usoro nke clopidogrel na omeprazole na dose 80 mg. Mbelata a jikọtara ọnụ na mbelata nke nchịkọta platelet. Esomeprazole na-atụ anya ịbanye na mmekọrita yiri nke ahụ na clopidogrel.

A kọwo data dị egwu banyere mmekọrịta mmekọrịta ọgwụ / ọgwụ pharmacokinetic yana ihe egwu dị na obi. N'akụkụ a, ekwesịrị iji nlezianya kụọ clopidogrel na omeprazole ma ọ bụ esomeprazole.

Ejiri pantoprazole ma ọ bụ lansoprazole hụrụ mbelata metabolites n'ime ọbara. Enwere ike iji Clopidogrel jiri pantoprazole.

Enweghị ihe akaebe na ọgwụ ndị ọzọ na-ebelata acid, dị ka ndị na-egbochi proton ma ọ bụ ọgwụ antacids, na-emetụta ọrụ mgbochi nke clopidogrel.

Ihe antacids anaghị emetụta ogo nnabata nke clopidogrel.

Njikọ ya na ọgwụ ndị ọzọ. Ebe ọ bụ na clopidogrel na-agbanwe na metabolite ya na-arụ ọrụ na akụkụ nke CYP2C19, ojiji nke ọgwụ na-ebelata ọrụ nke enzyme a nwere ike iduga na mbelata nke mkpokọta metabolite na-arụ ọrụ nke clopidogrel na plasma. Emebeghị ka amata ihe gbasara ogwu gharii. Ya mere, dị ka ihe mgbochi, ekwesịrị iji gbochie inhibitors CYP2C19 siri ike ma na-agagharị agagharị.

Nkwadebe nke nwere ike ma ọ bụ na-egbochi obere ọrụ nke CYP2C19 gụnyere omeprazole, esomeprazole, fluvoxamine, fluoxetine, moclobemide, voriconazole, fluconazole, ticlopidine, carbamazepine na efavirenz.

Mkparịta ụka ọgwụ na ahụike dị mkpa site na iji clopidogrel n'otu oge atenolol, nifedipine ma ọ bụ na ọgwụ abụọ ahụ achọpụtaghị. Na mgbakwunye, ọrụ ọgwụ nke clopidogrel nọgidere bụrụ ihe na-agbanweghị agbanwe mgbe ị na-eji phenobarbital na estrogen .

Ngwongwo Pharmacokinetic digoxin ma ọ bụ theophylline agbanweghị site na iji ya n'otu oge iji clopidogrel.

Metabolites Carboxylic clopidogrel nwere ike igbochi ọrụ nke cytochrome P450 2C9.Nke a nwere ike ịbawanye ọkwa plasma nke ọgwụ ọgwụ dịka phenytoin na tolbutamide, na ndị ọzọ metabolized site na iji cytochrome P450 2C9. N'agbanyeghị nke a, nsonaazụ nke nyocha ụlọ ọgwụ na-egosi nke ahụ phenytoin na tolbutamide enwere ike iji ya na clopidogrel.

Ọgwụ ndị na-anọchi ọgwụ cytochrome CYP2C8

A kọwo na Clopidogrel mụbara mkpughe n’ebe ndị ọrụ afọ ofufo dị mma nọ. Ekwesịrị iji usoro Clopidogrel na ọgwụ ndị CYP2C8 cytochrome mepụtara (dịka ọmụmaatụ, paclitaxel) na-akpachapụ anya, nyere ohere ịba ụba itinye uche ha na plasma ọbara.

Ewezuga ozi gbasara mmekorita ya na ọgwụ ụfọdụ akọwapụtara n'elu, ọmụmụ banyere mmekọrịta nke clopidogrel yana ọgwụ ndị a na-enyekarị ndị ọrịa nwere atherothrombosis. Agbanyeghị, ndị ọrịa sonyere n'ọmụmụ ihe gbasara clopidogrel jiri ọgwụ ndị ọzọ n'otu oge ahụ, gụnyere diuretics, beta-blockers, ACE inhibitors, calcium antagonists, cholesterol belata ọgwụ, coronary vasodilators, ọgwụ antidiabetic (gụnyere insulin), ọgwụ antiepileptik, ọgwụ nnọchi ọgwụ. na ndị na - ebuso GPIIb / IIIa ọgụ, na - enweghị ihe ngosi nke mmetụta ọjọọ dị njọ na-adakarị.