Ọgwụ Aterocardium: ntuziaka maka ojiji

Aterocardium dị n'ụdị mbadamba ihe mkpuchi-fim: okirikiri, biconvex, pink (paịlị 10 ọ bụla na ọnya, na ngwugwu kaadi nke 1 ma ọ bụ 4 blisters).

Ngwakọta 1 mbadamba:

ihe na-arụ ọrụ: clopidogrel (n'ụdị clorosidogrel hydrosulfate) - 75 mg,
ihe inyeaka: magnesium stearate, povidone, lactose monohydrate, stgelatinized starch, polyethylene glycol 6000, microcrystalline cellulose,
Uwe mkpuchi: Opadry II Pink (hypromellose, triacetin, titanium dioxide, lactose monohydrate, polyethylene glycol, indigo carmine aluminom varnish, Charlot na-acha uhie uhie aluminom).

Ihe ngosi maka ojiji

Ejiri Aterocardium gbochie ngosipụta nke atherothrombosis n'ụdị ndị ọrịa okenye:

ndị ọrịa metụrụ n'ọbara ischemic (ọgwụgwọ na-ebido ụbọchị asaa mgbe ọ gbasịrị ọnya, mana ọ rughị ọnwa 6 mgbe ihe a mechara),
ndị ọrịa nwere ọrịa myocardial infarction (ọgwụgwọ na-amalite ụbọchị ole na ole mgbe nkụchi obi gasịrị, mana ọ gbaghị ụbọchị iri atọ na ise ka ihe a mechara).
ndị ọrịa nwere ọrịa ọnya akwara (akwara atherothrombosis na akwara nke akwara nke ala).
ndị ọrịa nwere nnukwu myocardial infarction na ọkwa ST na-ebuli elu n'otu oge na ASA (acetylsalicylic acid) (n'ime ndị ọrịa na-anata ọgwụgwọ ọgwụ ọkọlọtọ na ndị egosipụtara maka ọgwụgwọ thrombolytic),
ndị ọrịa nwere nnukwu ọrịa obi na-arịa ọrịa na-enweghị ụbụrụ nke ST elu (myocardial infarction na-enweghị ebili mmiri Q ma ọ bụ angina na-akwụghị ụgwọ) n'otu oge na acetylsalicylic acid.

Ihe ngbanwe

nnukwu ikeji imeju
ọbara ọbara intracranial, ọnya afọ na ọnọdụ ndị ọzọ nwere nnukwu ọbara ọgbụgba,
ụkọ lactase, ịkpa ókè galactose, ọrịa glucose-galactose ọrịa,
ụmụaka na ndị na-eto eto nọ n’agbata afọ 18,
tụụrụ ime
inye ara
ịmụba uche mmadụ na clopidogrel ma ọ bụ ihe ọ bụla nke inye ọgwụ ahụ aka.

A na-eji mkpachapụ anya (Aterocardium ejiri nlezianya mee ihe):

agafeghị oke na ọrịa ịba ọcha n'anya.
gbasara akwara
hemorrhagic diathesis (akụkọ ihe mere eme),
Mgbapụta ahụ, mmerụ ahụ na ọnọdụ ndị ọzọ metụtara ọrịa nke ịba ụba ọbara ọgbụgba,
ojiji a na-ejikọ ya na heparin, ASA, ọgwụ mgbochi mkpali na-abụghị steroidal na inhibitors glycoprotein IIb / IIIa.

Usoro onunu ogwu na nhazi

Ana aralụ mbadamba Aterocardium, n'agbanyeghị nri nri.

Usoro akwadoro maka ndị okenye, gụnyere ndị ọrịa agadi, bụ mbadamba 1 otu ugboro n'ụbọchị.

Na nnukwu akụrụngwa na-arịa ọrịa na-enweghị ọkwa ST, a na-amalite ọgwụgwọ site na iji mkpokọta 300 mg otu ugboro, wee gaa n’ihu na-agbaso (75 mg) otu ugboro kwa ụbọchị yana mgbakwunye na acetylsalicylic acid na ọgwụ kwa ụbọchị nke 75-325 mg. Iwere ọgwụ acetylsalicylic acid dị elu na-eme ka ọbara ọgbụgba dịkwuo ike, ya mere, a naghị atụ aro ka ị were ihe karịrị 100 mg nke ASA kwa ụbọchị.

E guzobeghị ezigbo oge ọ dị n'ọgwụgwọ, mana nsonaazụ nke ọmụmụ egosila na Aterocardium kwesịrị iwere ọnwa 12. Achọpụtara mmetụta kachasị na ọgwụgwọ mgbe ọnwa atọ gachara ọgwụ.

Na nnukwu myocardial infarction na ST nke mgbago elu, ọgwụgwọ na-amalite site na otu ibu (300 mg) yana Acetylsalicylic acid, yana ma ọ bụ na-enweghị ọgwụ thrombolytic. A kwaghị ndị ọrịa gafere afọ 75 iji nweta ọgwụ a ga na-ebu ya. Ntinye ASA na ebido dịka o kwere mee, ọ dịkarịa ala izu anọ.

Nsonaazụ

sistem nri: otutu oge - nsogbu dyspeptik, ure nke afọ, ọbara ọgbụgba, afọ ọsịsa, ugboro ugboro - ọgbụgbọ, ọgbụgbọ, gastritis, ọnya afọ, ọnya afọ, afọ ntachi, adịkarịghị - ọbara ọgbụgba, ọrịa na - adịkarịghị - stomatitis, colitis (n'ime gụnyere lymphocytic ma ọ bụ ọnya afọ), pancreatitis, retroperitoneal na eriri afọ na-ebute nsị,
sisitemu ịba ọcha n'anya: ọ na - adịkarịghị - ịba ọcha n'anya, oke imeju na-akpata, arụ ọrụ na-arịa imeju.
Ọkpụkpụ akwara obi: ọtụtụ mgbe - hematoma, ọ na-adịkarịkarị - vasculitis, ọbara ọgbụgba dị ukwuu, hypotension ọbara, ọbara ọgbụgba site na ọnya arụ ọrụ,
sistem hematopoietic: ugboro ugboro - leukopenia, thrombocytopenia, eosinophilia, adịkarịghị - neutropenia (gụnyere siri ike), ọ dịkarịghị - anaemia, agranulocytosis, granulocytopenia, thrombotic thrombocytopenic purpura, pancytopenia, thrombocytopenia siri ike,
usoro iku ume: ọtụtụ mgbe - imi imi, ọ na - adịkarịkarị - bronchospasm, ọbara ọgbụgbọ, ọbara na-adọ ara, pneumonitis,
sistemụ akwara: etiti oge - ọgbụgba, paresthesia, ọbara ọgbụgba (mgbe ụfọdụ na-egbu egbu), isi ọwụwa, ọ dịkarịsịrị ụtọ - ntagasị, ihe ijuanya, ọgba aghara,
akwara anụ ahụ: ugboro ugboro - ngụgụ, njikọta ma ọ bụ ọbara ọgbụgba, obere - ọgbụgba n'ihi ọrịa nke ntị na nnụnụ.
sistem mọzụlụ: dịkarịsịrị ike - ogbu na nkwonkwo, myalgia, hemarthrosis, ogbu na nkwonkwo,
sistemụ urinary: ugboro ugboro - hematuria, ọ dịkarịsịrị ike - mmụba na plainma creatinine, glomerulonephritis,
anụ ahụ na ọnya anụ ahụ: mgbe mgbe - ọbara ọgbụgba subcutaneous, ugboro ugboro - itching, ihe ngbu, purpura, very slight - urticaria, lichen planus, erythematous fash, eczema, der bulitis, angioedema,
mmeghachi omume nfụkasị ahụ: ọ dịkarịghị - mmeghachi omume anaphylactic, ọrịa ọbara,
ndị na - egosi ụlọ nyocha: ugboro ugboro - ịgbatị oge ọbara ọgbụgba,
ndị ọzọ: ọ na - adịkarịghị - ahụ ọkụ.

Ntụziaka pụrụ iche

Ọ bụrụ na enyo enyo na ọbara ọgbụgba, ule kwesịrị ekwesị na / ma ọ bụ nyocha ọbara zuru oke kwesịrị ịme ngwa ngwa.

Ekwesịrị ịkagbu Aterocardium ụbọchị 7 tupu usoro ịwa ahụ a tụrụ aro, ebe ọgwụ a na-abawanye oge ọbara ọgbụgba.

E kwesiri ịdọ ndị ọrịa aka na ntị na oge ọgwụgwọ clopidogrel, ọbara ọgbụgba nwere ike ịdị ogologo ma kwụsịchaa. Ọnọdụ ọbara ọgbụgba ọ bụla ma ọ bụ ebe ikpere ọbara kwesịrị ịgwa dọkịta gị.

Aterocardium anaghị emetụta ma ọ bụ nwee obere mmetụta na ọsọ nke mmeghachi omume psychomotor na ike itinye uche. Ọ bụrụ na akpịrị na-amalite mgbe ị na-a theụ ọgwụ ahụ, ị kwesịrị ịhapụ ịnya ụgbọ ala na ihe omume ndị ọzọ nwere ike ịdị ize ndụ.

Omume ọgwụ

Njikọ Platelet na-egbochi ndị ọzọ na-heparin. Ngwongwo ogwu. Clopidogrel na - egbochi mgbochi nke adenosine diphosphate (ADP) na onye na - anabata ya na platelet na - esote na - arụ ọrụ nke GPIIb / IIIa nke na - esochi mmetụta ADP ma, yabụ, na - egbochi ịgbakọ nchịkọta platelet. Clopidogrel na - egbochikwa nchịkọta platelet nke ndị ọzọ na - eme ka ọ ghara ịdị mma site na igbochi mmụba nke ọrụ platelet site na ADP wepụtara ma na-agbanwezi ndị na - anabata ADP platelet. Platelet ndị nwere mmekọrịta chiri anya na-agbanwe ruo mgbe ngwụcha nke ndụ ha. A na-eweghachi ọrụ nkịtị na platelet na ọnụego kwekọrọ na ọnụego ọhụrụ platelet.
Site na ụbọchị mbụ iji mee ihe kwa ụbọchị nke 75 mg nke ọgwụ ahụ, a na-achọpụta mbelata dị ukwuu na nchịkọta ADP na-akpata. Ihe omume a na-agbawanye ike ma na-akwụkwa ike n’agbata ụbọchị asaa na asaa. Mgbe kwụsiri ike, ogo nke mgbochi nke nchịkọta n’okpuru mmetụta nke usoro kwa ụbọchị nke 75 mg bụ site na 40% ruo 60%. Ọgbakọ Platelet na oge ọgbụgba ga-alaghachi na ntọala dị ka ụbọchị ise mgbe ịkwụsị ọrụ ọgwụgwọ.
Mgbe ọ nwesịrị nchịkwa ọnụ na 75 mg, ọ na-abanye ngwa ngwa site na mgbaze. Nkezi ọnụọgụ plasma kachasị elu nke clopidogrel na-agbanweghi agbanwe (ihe dị ka 2.2-2.5 ng / ml mgbe otu ọgwụ were 75 mg) mejupụtara ihe dịka nkeji iri anọ na ise mgbe ịghasịrị. Anakpo Absorption bụ opekata mpe 50%, dị ka egosipụtara site na mpụta nke metabolites clopidogrel na mmamịrị. Clopidogrel na metabolite nke na - ekesa ọbara n'ime vitro na - ejikọkwa na protein nke plasma mmadụ (98% na 94%, otu isi). Njikọ a na-emejupụta n'ụzọ dị iche iche n'ọtụtụ nyocha.
Na vitro na vivo enwere abuo
Clopidogrel bụ ndọtị nke ụzọ ndị dị mkpa nke metabolism ya: otu gafere na ntinye esterases ma na-eduga hydrolysis site na ịmalite nke arụ ọrụ carbonxylic acid (nke kpatara pasent 85 nke metabolites na-agagharị na plasma), na enzymes nke cytochrome P450 na-etinye aka na nke ọzọ. Nke mbu, clopidogrel aburula ihe ndi ozo nke 2-oxo-clopidogrel. N'ihi usoro metabolic ọzọ nke 2-oxo-clopidogrel, a na-emepụta usoro thiol, metabolite na-arụ ọrụ. Na vitro, ụzọ metabolic a na-agbagha site na enzymes CYP3A4, CYP2C19, CYP1A2, CYP2B6. Ihe na-arụ ọrụ metabolite nke clopidogrel, nke dịpụrụ adịpụ na vitro, ngwa ngwa na n'ụzọ na-enweghị agakọ na-ejikọ ndị na-anabata platelet, na-egbochi nchịkọta platelet.
120 awa mgbe ịbubata ya, ihe dị ka 50% nke ọgwụ a takenụbara dị na mmamịrị yana 46% na feces. Mgbe nchịkwa ọnụ nke otu ọgwụ, ọkara ndụ nke clopidogrel bụ ihe dị ka awa 6. Ọkara ndụ nke isi (adịghị arụ ọrụ) metabolite na-ekesa n’ime ọbara bụ elekere asatọ ka nchịkwa ọgwụ na otu ugboro.
Ọtụtụ enzyme CYP450 polymorphic na-eme ka clopidogrel ghọọ metabolite na-arụ ọrụ, na-eme ka ọ rụọ ọrụ. CYP2C19 na-etinye aka na nguzobe nke metabolite na-arụsi ọrụ ike na metabolite nke 2-oxo-clopidogrel. Aclọ ọgwụ ọgwụ nke metabolite na-arụsi ọrụ ike na ihe mgbochi antiplatelet, dabere na nchịkọta nke nchịkọta platelet, dịgasị iche na CYP2C19 genotype. CYP2C19 * 1 allele kwekọrọ na metabolism zuru oke na-arụ ọrụ, ebe CYP2C19 * 2 na CYP2C19 * 3 alleles kwekọrọ na metabolism ike gwụrụ. Ndi oke a nile di maka 85% nke ihe nile gha eme ka ihe ghara iru ala na ndi 99% n’As. Allezọ ndị ọzọ metụtara metabolism na-esighi ike gụnyere CYP2C19 * 4, * 5, * 6, * 7 na * 8, mana ha dị obere karịa na onu ogugu.

Usoro onunu ogwu na nhazi

Ndị okenye na ndị ọrịa agadi. N'ime, mbadamba 1 (75 mg) otu ugboro n'ụbọchị, n'agbanyeghị nri oriri.

N'ime ndị ọrịa nwere nnukwu ọrịa coronary syndrome (ACS) na-enweghị nrịba nke ST (nkwalite angina ma ọ bụ myocardial infarction na-enweghị ebili mmiri QG na ECG), a na-amalite usoro ọgwụgwọ Aterocardium na otu iko 300 mg, wee gaa n’ihu na 75 mg otu ugboro kwa ụbọchị na mgbakwunye na acetylsalicylic acid ( ASA) na onwonye nke 75-325 mg kwa ubochi. 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. Nsonaazụ nke ọmụmụ a na-atụ aro iji ọgwụ ahụ ruo ọnwa iri na abụọ, na-ahụkarị nsonaazụ ka ọnwa 3 gasịrị ọgwụgwọ.

Maka ndị ọrịa nwere nnukwu myocardial infarction na ST ngalaba nke ịdị elu, a na-enye clopidogrel 75 mg otu ugboro kwa ụbọchị, na-amalite site na otu iko 300 mg na njikọ ya na ASA, yana ma ọ bụ na-enweghị ọgwụ thrombotic. 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. Abughi uru nke ijikota clopidogrel na ASA ihe kariri izu anọ agughi akwukwo na oria a.

Pharmacogenetics. N'ime ndị nwere metabolism adịghị ike nke CYP2C19, achọpụtara mmeghachi omume na ọgwụgwọ clopidogrel. Ntinyela usoro onunu ogwu kacha mma n’etiti ndi mmadu n’enweghi ike idi ndu ha.

Odida ntaramahụhụ. Ahụmahụ nke iji ọgwụ ahụ eme ihe na ndị ọrịa nwere ọdịda akụrụngwa nwere oke. Ekwesịrị iji ọgwụ mee ihe na nlezianya (lee mpaghara "Akụkụ ojiji").

Imeju imeju. Ahụmahụ nke iji ọgwụ ahụ eme ihe na ndị ọrịa nwere ọrịa imeju na ohere nke hemorrhagic diathesis nwere oke. Ekwesịrị iji ọgwụ mee ihe na nlezianya (lee mpaghara "Akụkụ ojiji").

Ihe na-egosi na usoro onunu ogwu:

Mgbochi nke mgbaàmà nke atherothrombotic na ndị okenye:

Na ndị ọrịa na-arịa nnukwu ọrịa obi

Ndị nwere ọrịa myocardial infarction (ọ dị mkpa ịmalite ọgwụgwọ mgbe ụbọchị ole na ole gasịrị, mana ọ bụghị ihe karịrị ụbọchị 35 site na mmalite nke nkụchi obi), ọnya afọ ischemic (ọ dị mkpa ịmalite ọgwụgwọ mgbe ụbọchị asaa gasịrị, mana ọ bụghị ihe karịrị ọnwa 6 mgbe ọnya ahụ gasịrị), ma ọ bụ ndị ọrịa nwere ọrịa nke akwara ozi (atherosclerosis nke arịa nke ala ala na mmebi nke akwara).

N'ime ndị ọrịa na-enweghị ihe mgbago nke ST na ECG (myocardial infarction na-enweghị ebili Q ma ọ bụ angina na-akwụghị ụgwọ), gụnyere ndị nwere stent arụnyere n'oge angioplasty coronary percutaneous, jikọtara ya na acetylsalicylic acid

N'ime ndị ọrịa nwere nnukwu myocardial infarction, mgbe ngalaba nke ST bilitere na njikọta acetylsalicylic acid (n'ime ndị ọrịa na-anata ọgwụgwọ ọgwụ ọkọlọtọ na ndị chọrọ ọgwụgwọ thrombolytic)

Ndi okenye na ndi oria ndi agadi kwesiri iri 1 mbadamba (75 mg) site na onu otu ubochi, n’agbanyeghi nri iri.

Maka ndị ọrịa nwere nnukwu ọrịa obi na-arịa ọrịa na-enweghị ụma akụkụ ST (myocardial infarction na-enweghị ebili mmiri Q ma ọ bụ angina na-akwụghị ụgwọ), a na-atụ aro ibu 300 mg na mmalite ọgwụgwọ.

Mgbe ahụ, a na-enye mbadamba mbadamba ụrọ (75 mg) otu ugboro kwa ụbọchị, yana ọgwụ acetylsalicylic acid na usoro nke 75-325 mg / ụbọchị.

E guzobeghị ezigbo oge usoro ọgwụgwọ.

Dabere na nsonaazụ nke ọmụmụ, edepụtara mmetụta kachasị mgbe ọnwa atọ gasịrị site na mmalite nke ọgwụgwọ, uru dị na iji ọgwụ ahụ bụ ọnwa iri na abụọ.

N'ime ndị ọrịa nwere nnukwu myocardial infarction, nke edere ihe ndekọ ST nke agbago elu na ECG, a na-enye ọgwụ ahụ na usoro ọgwụ nke 75 mg otu ugboro n'ụbọchị.

Ọ dị mkpa ịmalite iji Aterocardium na-eburu 300 mg na ngwakọta acetylsalicylic acid.

Ekwesịrị ịgwọ ndị ọrịa gafere afọ iri asaa na anọ n'enweghị ntụtụ. Ekwesịrị ịmalite njikọta nke Aterocardium na acetylsalicylic acid ozugbo mmalite nke mgbaàmà ma gaa n'ihu ruo izu anọ. Egoputaghi uru ndi mmadu n’ita ogologo oge.

N'ime ndị ọrịa nwere metabolism nwayọ nwayọ nke CYP 2C19, a na-edekọ azịza maka ọgwụgwọ Aterocardium.

E guzobebeghị ezigbo usoro usoro ọgwụgwọ maka ndị ọrịa dị otú a.

Ahụmịhe nke Aterocardium na ndị ọrịa nwere ọdịda akụrụngwa nwere oke. Dọrọ ọgwụ a maka ndị dị otu a.

Ọzọkwa, jiri nlezianya debe Aterocardium ka ndị ọrịa nwere ọrịa imeju na ndị nọ n'ihe ize ndụ nke ibute ọrịa hemorrhagic diathesis.

Mmetụta ọghọm:

Site na usoro hematopoietic: leukopenia, thrombocytopenia, eosinophilia, neutropenia (gụnyere nke siri ike), thrombotic thrombocytopenic purpura, pancytopenia, anaemia (gụnyere ọrịa), thrombocytopenia siri ike, granulocytopenia, agranulocycytosis.

Site na usoro obi: hematomas, ọbara ọgbụgba, ọbara mgbagha, vasculitis, ọbara ọgbụgba site na ọnya postoperative.

Site na usoro nri: afọ ọsịsa, dyspepsia, mgbu nke afọ, ọbara ọgbụgba, afọ ntachi, ọgbụgbọ, ọnya afọ, vomiting, gastritis, flatulence. Ọrịa na - adịkarị obere nwere ike ịbụ colitis (gụnyere lymphocytic ma ọ bụ ọnya afọ), pancreatitis, stomatitis, eriri afọ na retroperitoneal na-enwe nsonaazụ na-egbu egbu.

Site na imeju: ịba ọcha n'anya, ọrịa imeju na-akpata oke, nyocha imeju na-arụ ọrụ.

Site n'akụkụ nke usoro ụjọ ahụ: paresthesia, dizziness, isi ọwụwa, ọbara ọgbụgba intracranial (mgbe ụfọdụ na-ejedebe na ọnwụ), hallucinations, aghara aghara, ọgba aghara.

Site na akwara anụ ahụ: azụ, azụ, ọbara ọgbụgba, ọgbụgbọ metụtara ọgbụgba na ntị ma ọ bụ labyrinth.

Site na anụ ahụ na ọnya subcutaneous: ọbara ọgbụgba subcutaneous, itching, purpura, friji akpụkpọ, erythematous friza, angioedema, bullous dermatitis (Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis), lichen planus, eczema, urticaria.

Site na sistem iku ume: imi imi, ọbara na-efe efe (ọnya afọ, ọbara ọgbụgba), ọnya nje na -akpọ, bronchospasm.

Site na usoro akwara: ogbu na nkwonkwo, hemarthrosis, myalgia, ogbu na nkwonkwo.

Site na usoro urinary: hematuria, ubara ọkwa nke creatinine n'ime ọbara, glomerulonephritis.

Hypersensitivity mmeghachi omume: mmeghachi omume anaphylactic, ọrịa ọbara.

Mgbanwe na plọg Laboratory: mbelata nke platelet na ọkwa neutrophil, mmụba na oge ọbara ọgbụgba.

Mmetụta ndị ọzọ: ahụ ọkụ, ọbara ọgbụgba na ntụtụ ebe.

Mmekọrịta na ọgwụ ndị ọzọ na mmanya:

Ndị na-egbochi protein IIb / IIIa. Ekwesịrị inye ọgwụ a ka ọ jiri nlezianya nye ndị ọrịa nọ n'ihe ize ndụ ọbara ọgbụgba n'ihi ịwa ahụ, trauma ma ọ bụ ọnọdụ ndị ọzọ nke chọrọ ojiji nke protein IIb / IIIa inhibitors.

Jụọ. ASA anaghị emetụta mmetụta inhibitory nke clopidogrel na nchịkọta ADP na-eweta, mana clopidogrel na-eme ka mmetụta nke ASA pụta na nchịkọta platelet n'okpuru ọrụ collagen.

Nhazi oge nke 500 mg nke ASA ugboro abụọ n'ụbọchị maka otu ụbọchị edugaghị nnukwu mgbanwe n'oge ọgbụgba. Oge Aterocardium na ASA n’otu oge chọrọ ịkpachara anya, ebe enwere ọghọm ọbara ọgbụgba.

Anticoagulants nke ọgwụ. N'ihi nnukwu nsogbu ọbara ọgbụgba na-adịghị mma, anaghị akwadoro iji ọgwụ anticoagulants na ọgwụ nje na atherocardia.

Heparin. Mmụta emere gosiri na ojiji nke clopidogrel anaghị emetụta nsonaazụ nke heparin ma ọ chọghị nhazi nke ikpeazụ. Mbanye nke heparin emetụtaghị mmetụta nke clopidogrel. Mana n'ihi oke ịba ụba ọbara ọgbụgba, a naghị atụ aro maka otu oge iji ọgwụ ndị a.

Ndị ọrụ Thrombolytic. A mụrụ nchekwa nchekwa nke Aterocardium, fibrin-akọwapụtara nke ọma ma ọ bụ fibrin akọwapụtara na-arịa ọrịa thrombolytic na heparin na ndị ọrịa nwere nnukwu myocardial infarction. Ohere nke ịmalite ọbara ọgbụgba bụ otu esi ejikọta ndị na-ejikọ thrombolytic na heparin na ASA.

Ndị NSAID. Ojiji nke Aterocardium na naproxen na-enwewanye ohere nke ọbara ọgbụgba dị ukwuu. Enweghị data na mmekọrịta nke clopidogrel na ọgwụ mgbochi ọgwụ mgbochi mkpali na-abụghị ọgwụ steroid.

Njikọ ya na ọgwụ ndị ọzọ. Ebe ọ bụ na etolite metabolite nke clopidogrel bụ nke a na-eme n'okpuru CYP 2C19, ojiji nke ọgwụ na-ebelata ọrụ nke enzyme a na-eduga n'ịbelata mkpokọta nke metabolite na-arụ ọrụ na, yabụ, na-ebelata mmetụta nke Aterocardium. Ya mere, ọ dị mkpa iji zere nchịkwa oge nke Aterocardium na ọgwụ na-emetụta ọrụ CYP 2C19. Ọgwụ ndị dị ka: esomeprazole, omeprazole, fluoxetine, fluvoxamine, moclobemide, voriconazole, ticlopidine, fluconazole, ciprofloxacin, carbamazepine, cimetidine, chloramphenicol na oxcarbazepine.

Ndị na-egbochi proton mgbapụta.

E gosiputara na ogo mgbochi nke CYP 2C19 enzyme n’okpuru oru nke ogwu n’aka otu proton pump inhibitors abụghị otu. Data dị adị na-egosi ohere nke mmekọrịta n'etiti Aterocardium na ọgwụ ọ bụla na ndị otu a. Enweghị ihe akaebe doro anya na ọgwụ ndị ọzọ na-ebelata mmepụta hydrochloric acid (antacids, H2 blockers) na-emetụta mmetụta antiplatelet nke Aterocardium.

Thejikọtara ọnụ nke Aterocardium na atenolol na nifedipine emeghị ka ịdị irè nke ọgwụ ndị a kwụsị. Na mgbakwunye, akụrụngwa ọgwụ nke clopidogrel agbanweghị mgbe a na-eji cimetidine, digoxin, theophylline, estrogen, na phenobarbital.

Ihe antacids anaghị emetụta oriri nke clopidogrel.

Mmụta emere gosiri na ihe ndị a na-emepụta carbonyl nke clopidogrel nwere ike igbochi ọrụ cytochrome P450 2C9. Ikekwe, nke a nwere ike ibute mmụba nke plasma nke NSAIDs, tolbutamide na phenytoin, metabolism nke na-eme n'okpuru mmetụta nke cytochrome P450 2C9. Mana nsonaazụ nyocha gosiri na tolbutamide na phenytoin nwere ike were atherocard were ya.

Onweghi mmekorita di omimi nke a choputara n'etiti Aterocardium na beta-adrenergic blockers, diuretics, mgbochi ndi a na-a cala ahu ndi mmadu, ihe mgbochi, antidiabetic, antiepileptik, antiepileptik, anti-cholesterol-wedering treatment, and hormone cure therapy III antagonists.

Ngwakọta na akụrụngwa:

Otu mbadamba 1 nwere:

Clopidogrel 75 mg

Ngwa inye aka: microcrystalline cellulose, magnesium stearate, lactose monohydrate, stgelatinized sitter, polyethylene glycol 6000, povidone K 25, iron oxide (E 172)

Ngwakọta dị mkpa - clopidogrel - họrọ nke na - egbochi mmachi nke ADP n’ebe ndị na - anabata ya nọ na - emegharị ihe ndagwurugwu ya na arụmọrụ GPIIb / IIIa na - esote ADP, na - ebute mgbochi nke nchịkọta platelet.

Ihe mgbochi nke platelet agwakọtara site na ndị ọzọ agonist na-emekwa site na igbochi mmụba nke ọrụ platelet site na ADP wepụtara ma na-agbanwe agbanwe ndị na-anabata platelet ADP.

Platelet na mmekọrịta ya na Clopidogrel na-agbanwe mgbanwe ruo mgbe ngwụsị nke ndụ ha.

Ọrụ Platelet na-alaghachi na nkịtị mgbe oge achọrọ maka mmeghari eke nke mkpụrụ ndụ ọbara ndị a.

Site na ụbọchị mbụ iji mee ihe ugboro ugboro nke 75 mg nke ọgwụ ahụ, e dekọtara ọnụ ọgụgụ dị ukwuu nke nchịkọta ADP na-akpata platelet.

A na-eme ka mmetụta a kawanye mma, na-akwụsie ike n'etiti etiti ụbọchị atọ na ụbọchị asaa nke ọgwụgwọ.

Nkezi ogo nke inhibition aggregation n'okpuru ọrụ nke onunu ogwu nke 75 mg na steeti kwụsiri ike bụ 40-60%.

Ogologo oge ọbara ọgbụgba na ọnụego nchịkọta platelet na-alaghachi na ntọala na nkezi ụbọchị ise ka emechara ọgwụgwọ.

Mgbe nchịkwa ọnụ nke ọgwụ ahụ na usoro nke 75 mg, mmụba ngwa ngwa na ngụkọ ahụ na-apụta. Ogologo ọkwa plasma kachasị elu nke clopidogrel na-agbanweghi agbanwe (na ego nke 2.2-2.5 / ml mgbe otu mkpụrụ ọgwụ 75 mg nke ọgwụ ahụ) ruru nkeji iri anọ na ise mgbe ị nwesịrị Aterocardium.

Mwepu nke clopidogrel na mmamịrị na-egosi na nnabata nke ihe na-arụ ọrụ dịkarịa ala 50%.

Na nyocha nke vitro, clopidogrel na metabolites ya na-adịghị arụ ọrụ na plasma ọbara na-ejikọghachikarị protein, njikọ a na-ejigide saturation ya n'ọtụtụ nchịkọta.

A na-eme metabolism nke eke clopidogrel n'ime imeju. Na vivo na vitro enwere uzo abuo nke metabolism.

Nke izizi ya na ntinye esterases, na-eduga na hydrolysis site na ịmalite nguzobere acid acid dị nso (ihe a mejupụtara 85% nke metabolites niile dị n'ọbara).

A na-arụ ụzọ metabolic nke abụọ site na ntinye nke sistemụ enzyme cytochrome P450.

Nke mbu, a na –eme ihe n'etiti 2-oxo-clopidogrel mebere agbari site na clopidogrel, nke mechara bụrụ metabolite na-arụ ọrụ (usoro sitere na thiol). Metabolite nọ n'ọrụ dịpụrụ adịpụ na vitro ngwa ngwa na n'ụzọ na -agbanwe onwe ya na ngwa nnabata platelet, na-akpaghasị nchịkọta platelet.

Ihe dị ka 50% nke nchịkwa a na-apụ apụ na mmamịrị yana ihe dịka 46% na ọrịa feces mgbe elekere 120 gachara. Ọkara ọkara nke otu ọgwụ bụ 6 awa.

Ọkara ndụ nke metabolite na-adịghị arụ ọrụ bụ awa 8 (ma mgbe ha na-a singleụ otu ọgwụ ma na mgbe nchịkwa gachara).

Mbadamba ụrọ mkpuchi 75 mg Nke 10, 40.

Mgbe ọ dị ihe kariri 25 ogo Celsius na nkwakọ ngwaahịa mbụ.

Ngwongwo ogwu

Clopidogrel na - egbochi mgbochi nke adenosine diphosphate (ADP) n'ebe onye na - anabata ihe dị na platelet na - esote ịgbalite GPIIb / IIIa site na ADP ma si otú a gbochie nchịkọta nke platelet. Clopidogrel na-ewepụkwa nchịkọta platelet nke ndị ọzọ na - atụgharị maka ndị ọzọ site na igbochi mmụba nke ọrụ platelet site na ADP wepụtara ma na-agbanwezi ndị na - anabata ADP platelet. Platelet ndị nwere mmekọrịta chiri anya na-agbanwe ruo mgbe ngwụcha nke ndụ ha. A na-eweghachi ọrụ nkịtị na platelet na ọnụego kwekọrọ na ọnụego mmelite platelet.

Site na ụbọchị izizi nke usoro ọgwụ ugboro ugboro ugboro nke 75 mg, mbelata dị ukwuu na nchịkọta ADP webatara platelet na-apụta. Ihe omume a na-agbawanye ike ma na-akwụkwa ike n’agbata ụbọchị asaa na asaa. Mgbe kwụsiri ike, ogo nke mgbochi nke nchịkọta n’okpuru mmetụta nke usoro kwa ụbọchị nke 75 mg bụ site na 40% ruo 60%. Njikọ Platelet na oge ọgbụgba na-alaghachi na ntọala n'ụzọ dịkarịa ụbọchị ụbọchị ise kwụsịrị ọgwụgwọ.

Mgbe ọ nwesịrị nchịkwa ọnụ na 75 mg, ọ na-abanye ngwa ngwa site na mgbaze.

Oke pesma kachasị nke clopidogrel na-agbanweghi agbanwe (ihe dị ka 2.2-2.5 ng / ml mgbe otu ọgwụ were 75 mg) mezuru ihe dịka nkeji iri anọ na ise mgbe etinyere ya. Anakpo Absorption bụ opekata mpe 50%, dị ka egosipụtara site na mpụta nke metabolites clopidogrel na mmamịrị. Clopidogrel na metabolite nke na - ekesa ọbara n'ime vitro na - ejikọkwa na protein nke plasma mmadụ (98% na 94%, otu isi).

Njikọ a na-anọgide na-abụ ihe na-adịgide adịgide n'ọtụtụ nchịkọta.

Clopidogrel na-agbakọ n'ọbara nke ukwuu. Na vitro na vivo, ụzọ abụọ dị mkpa nke metabolism ya: otu na-esite na ntinye esterases ma na-eduga hydrolysis site na ịmalite nke na-adịghị arụ ọrụ nke carbonxylic acid (nke kpatara pasent 85 nke metabolites na-ekesa na plasma ọbara), na enzymes nke cytochrome P450 sistemụ na-etinye aka na nke ọzọ .

Nke mbu, clopidogrel aburula ihe ndi ozo nke 2-oxo-clopidogrel. N'ihi usoro metabolic ọzọ nke 2-oxo-clopidogrel, a na-emepụta usoro thiol, metabolite na-arụ ọrụ. Na vitro, ụzọ metabolic a na - emegharị ya na enzymes CYP3A4, CYP2C19, CYP1A2, na CYP2B6. Ihe na-arụ ọrụ metabolite nke clopidogrel, nke dịpụrụ adịpụ na vitro, ngwa ngwa na n'ụzọ na-enweghị agakọ na-ejikọ ndị na-anabata platelet, si otú a na-egbochi nchịkọta platelet.

Oge awa 120 agachara mmerụ ahụ, ihe dị ka 50% nke ọgwụ a na-apụ apụ na mmamịrị yana 46% na feces. Mgbe nchịkwa ọnụ nke otu ọgwụ, ọkara ndụ nke clopidogrel bụ ihe dịka 6:00. Ọkara ndụ nke isi (adịghị arụ ọrụ) metabolite na-ekesa n’ime ọbara bụ elekere asatọ nke asatọ ka ọgwụ a gbasiri ike.

Pharmacogenetics. Ọtụtụ enzyme CYP450 polymorphic na-eme ka clopidogrel ghọọ metabolite na-arụ ọrụ, na-eme ka ọ rụọ ọrụ. CYP2C19 na-etinye aka na nguzobe nke metabolite na-arụsi ọrụ ike na metabolite nke 2-oxo-clopidogrel. Aclọ ọgwụ ọgwụ nke metabolite na-arụsi ọrụ ike na ihe mgbochi antiplatelet, dabere na nchịkọta nke nchịkọta platelet, dịgasị iche na CYP2C19 genotype. CYP2C19 * 1 allele kwekọrọ na metabolism zuru oke na-arụ ọrụ, ebe CYP2C19 * 2 na CYP2C19 * 3 alleles kwekọrọ na metabolism ike gwụrụ. Allles ndị a bụ maka 85% nke alleles, belata ọrụ dị ọcha na 99% na ndị Asians. Allezọ ndị ọzọ metụtara metabolism na-esighi ike gụnyere CYP2C19 * 4, * 5, * 6, * 7 na * 8, mana ha dị obere karịa na onu ogugu.

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 na-arịa nnukwu ọrịa obi:

̶ nwere nnukwu ọrịa obi na-arịa ọrịa na-enweghị ụma akụkụ ST (angnstial unalction ma ọ bụ myocardial infarction na-enweghị ebili mmiri Q), gụnyere ndị ọrịa nwere etinyere stent n'oge ọrịa angioplasty na-emebi emebi, yana Acetylsalicylic acid (ASA)

̶ nwere nnukwu myocardial infarction yana mmụba nke mpaghara ST yana ngwakọta acetylsalicylic acid (na ndị ọrịa na-anata ọgwụ ọkọlọtọ na ndị gosipụtara ọgwụgwọ thrombolytic).

Mgbochi nke atherothrombotic na thromboembolic ihe na atrial fibrillation. E gosipụtara Clopidogrel yana ASA na ndị okenye nwere ọrịa ọnya ọgbụgba, nke nwere opekata mpe otu ihe ga-eme maka ihe omume vaskụla, ebe enwere ọgwụ mgbochi na vitamin K antagonists (AVK) na ndị nwere obere ọbara ọgbụgba, maka mgbochi nke atherothrombotic na thromboembolic ihe tinyere ọnya afọ. Hụkwa akụkụ "Njirimara ọgwụ".

Mkparịta ụka ọgwụ ọjọọ

Agaghị akwadoro ikpokọta usoro ọgwụgwọ Aterocardium na ọgwụ anticoagulants n'ihi na egwu nke mmụba nke ike ọbara ọgbụgba.

Nmekorita nke ekwuputara na oge nke clopidogrel ya na ihe ogwu ndi ozo.

ọgwụ mgbochi na - abụghị steroidal anti-inflammatory (gụnyere COX-2 inhibitors), ASA, protein IIb / IIIa inhibitors, ọgwụ thrombolytic, heparin: enwere ike ọbara ọgbụgba (jiri clopidogrel jiri nlezianya na njikọ a),
fluconazole, fluoxetine, omeprazole, moclobemide, esomeprazole, voriconazole, carbamazepine, ticlopidine, chloramphenicol, ciprofloxacin, fluvoxamine, oxcarbazepine, cimetidine (ọgwụ na-egbochi ihe omume nwoke na-eme ka ọ kwụsịlata ọrụ ya), ọ na-eme ka arụ ọrụ ya belata, ọ na-ebelata ihe omimi ya, mbelata nguzobe ya
proton pump inhibitors: mmeghachi omume mmeghachi omume ga-ekwe omume, yabụ, akwadoghị ịgwakọta ndị a, belụsọ mgbe ọ dị mkpa,
ọgwụ a gwakọtara site na iji cytochrome P450 2C9: enwere ike ịbawanye ọkwa nke ọgwụ ndị a na plasma (ma e wezụga tolbutamide na phenytoin, nke nwere nchebe na Aterocardium),
atenolol, nifedipine, estrogen, cimetidine, phenobarbital, theophylline, antacids, digoxin, diuretics, ndị na - egbochi ACE (enzyme angiotensin), ndị na - egbochi beta, ndị na - egbochi calcium, antiepileptik, hypocholesterolemic na ọgwụ ndị ọzọ. ịgbasa arịa ọbara ọgbụgba, GPIIb / IIIa antagonists, ọgwụ nnọchi ọgwụ ọgwụ: ọ nweghị mmekọrịta dị oke mkpa ụlọ ọgwụ amapụtara.

Analogues nke Aterocardium bụ: Clopidogrel, Plavix, Cardinal Aspirin, Dipyridamole.

Mmetụta akụkụ

hematoma, odi obere

ọbara ọgbụgba, ọbara ọgbụgba site n'ọwa arụ, vasculitis, hypotension arterial,

site na usoro nri: nkịtị - afọ mgbu, afọ ọsịsa, dyspepsia, eriri afọ, eriri afọ, ọgbụgbọ, afọ na ọnya afọ, gastritis, vomiting, flatulence, adịkarịghị nkịtị - retroperitoneal ọbara ọgbụgba, adịkarịghị nkịtị - pancreatitis, ọnya afọ (gụnyere ọnya afọ ma ọ bụ lymhocytic), ọrịa afọ na-egbu egbu na ọbara ọgbụgba azụ, stomatitis,

site na sistemụ ịba ọcha n'anya: ọ dịkarịsịrị ike - nnukwu ọrịa imeju, ọrịa ịba ọcha n'anya, ulere ọrụ imeju na-arịa ya,

site na sistemụ akwara na-esite: isi ọwụwa - isi ọwụwa, paresthesia, dizzness, ọbara ọgbụgba intracranial (n'ọnọdụ ụfọdụ, egbu egbu), ọ na - adịkarịkarị - ọgba aghara, hallucinations, ọgba aghara,

sitere na akwara anụ ahụ: abụghị nke a na-ahụkarị - anya ọbara

(njikọta, akwara, azụ), adịkarịghị - ọgbụgbọ (ọrịa nke ntị na labyrinth),

n'akụkụ anụ ahụ na ọnya subcutaneous: anụ ahụ - ọbara ọgbụgba subcutaneous, na - abụghị ihe nkịtị - ọnya ọnya, itching, purpura, adịkarịghị nkịtị - angioedema, erythematous fash, bulmat dermatitis (toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, kraemia), lichen planus

site na sistem iku ume: ihe na-ahụkarị - imi imi, nke na - anaghị ahụkarị ya - ọbara ọgbụgba (iku ume, ọbara ọgbụgba), bronchospasm, ọrịa obi na-efe efe,

site na musculoskeletal system: dịkarịsịrị adịkarị - hemarthrosis, ogbu na nkwonkwo, ogbu na nkwonkwo, myalgia,

site na sistemụ urinary: ihe na - abụghị - hematuria, nke a na - ahụkarị - glomerulonephritis, creatinine na - abawanye n'ọbara,

A na-ahụta mmeghachi omume hypersensitivity, a na-ahụkarịkarị - ọrịa ọbara, mmeghachi omume anaphylactic,

Ihe ngosi nke ulo-akwukwo: adighi adi - ịgbatị oge nke obara, gbadata n'ogo nke neutrophils na platelet,

ndị ọzọ: nkịtị - ọbara ọgbụgba na ntụtụ ahụ, ahụkarị ụkwara - ọkụ.

Mmekọrịta na ọgwụ ndị ọzọ na ụdị mmekọrịta ndị ọzọ

Anticoagulants nke ọgwụ. A naghị atụ aro iji ihe mkpuchi emechi na clopidogrel, ebe ọ bụ na enwere ohere nke ịba ụba ọbara ọgbụgba.

Ndị na-egbochi glycoprotein IIb, / IIIA. Ekwesịrị iji Aterocardium kpachara anya na ndị ọrịa nwere nnukwu ọbara ọgbụgba n'ihi trauma, ịwa ahụ ma ọ bụ ọnọdụ ndị ọzọ nke eji glycoprotein IIb, IIAa inhibitors na-eji n'otu oge.

Acetylsalicylic acid (ASA). ASA anaghị agbanwe mmetụta inhibitory nke clopidogrel na nchịkọta ADP na-eweta, mana clopidogrel na-eme ka mmetụta nke ASA pụta na nchịkọta platelet na-eweta. Agbanyeghị, ojiji nke 500 mg nke ASA ugboro abụọ kwa ụbọchị maka ụbọchị 1 emeghị ka mmụba dị ukwuu na oge ọbara ọgbụgba, agbatịkwuru n'ihi ojiji nke clopidogrel. Ebe ọ bụ na mmekọrịta dị 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, ejiri clopidogrel na ASA jikọtara ọnụ ruo otu afọ.

Heparin. Dika ihe omumu a si di, clopidogrel achoghi mmezi onodu maka heparin ma agbanweghi nsonaazụ nke heparin na coagulation. Ojiji nke heparin emegharịghị ịgbanwe ihe mgbochi na clopidogrel na nchịkọta platelet. Ebe ọ bụ na mmekọrịta dị n'etiti clopidogrel na heparin ga-ekwe omume site n'ihe nwere ike ịba ọbara ọbara, ijikọ ya n'otu oge 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). Ojiji nke clopidogrel na naproxen nwere ike ime ka ọnụ ọgụgụ ọbara ọgbụgba dị nwayọ na-aga n'ihu. Agbanyeghị, n'agbanyeghị na enweghị data gbasara mmekọrịta ọgwụ a na ndị NSAID ndị ọzọ, ọnabeghị nke ọma ma ọ bụ ihe ọghọm nke ọbara ọgbụgba mgbe ejiri ya mee ihe na NSAID niile. Ya mere, ịkpachara anya dị mkpa mgbe ị na-eji NSAIDs, akpan akpan COX-2 inhibitors, na 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 ibute mbelata nke mkpokọta metabolite na-arụsi ọrụ ike nke clopidogrel na plasma ọbara, yana mbelata arụmọrụ nke ịgba ọgwụ. Ekwesịrị izere iji ọgwụ ndị na-egbochi ọrụ CYP2C19 n'otu oge.

Ọgwụ na-egbochi ọrụ CYP2C19 gụnyere omeprazole, esomeprazole, fluvoxamine, fluoxetine, moclobemide, voriconazole, fluconazole, ticlopidine, ciprofloxacin, cimetidine, carbamazepine, oxcarbazepol na chloramphen.

Ndị na-egbochi proton mgbapụta. Ọ bụ ezie na ihe akaebe na-egosi na ogo mgbochi nke ọrụ CYP2C19 n'okpuru ọrụ nke ọgwụ dị iche iche nke ndị otu proton pump inhibitors abụghị otu, enwere ihe akaebe na-egosi na enwere ike ịmekọrịta ihe fọrọ nke nta ka ọ bụrụ ọgwụ niile nke klas a. Ya mere, ekwesịrị ịhapụ imepụta proton pump inhibitors n'otu oge, belụsọ na ọ dị ezigbo mkpa. Enweghị ihe akaebe na ọgwụ ndị ọzọ na-ebelata mmepụta acid na afọ, dịka, dịka ọmụmaatụ, ndị na-egbochi H 2 (ma e wezụga cimetidine, nke bụ ihe mgbochi CYP2C9) ma ọ bụ ọgwụ antacids, na-emetụta ọrụ antiplatelet nke clopidogrel.

Site n’ọmụmụ ihe ndị ahụ, enweghị mkparịta ụka dị egwu na ụlọ ọgwụ gosipụtara site na iji clopidogrel n'otu oge na atenolol, nifedipine, ma ọ bụ ọgwụ abụọ. Na mgbakwunye, ọrụ ọgwụ nke clopidogrel nọgidere bụrụ ihe na-agbanweghị agbanwe mgbe a na-eji phenobarbital na estrogen.

Ngwakọta ọgwụ nke digoxin ma ọ bụ theophylline agbanweghị mgbe eji clopidogrel. Ihe antacids anaghị emetụta oriri nke clopidogrel.

Ihe omuma nyocha na-egosi na metabolites metabolic nke clopidogrel nwere ike igbochi ọrụ nke cytochrome P450 2C9. Nke a nwere ike ịbawanye ọkwa plasma nke phenytoin, tolbutamide na NSAIDs, nke cytochrome P450 2C9 bụ metabolized. N'agbanyeghị nke a, nsonaazụ nke ọmụmụ a na-egosi na enwere ike iji phenytoin na tolbutamide mee ihe n'otu oge iji clopidogrel.

Enweghị mmekọrịta dị egwu nke ọgwụ na diuretics, ndị na-egbochi beta, ndị na-egbochi ACE, ndị na-egbochi calcium, ndị na-ahụ maka arịa, antacids, hypoglycemic (gụnyere insulin), hypocholesterolemic, antiepilepti ọgwụ, GPIIb / IIIa antagonists, na antagonists nke GPIIb / IIIa.

Njirimara ngwa

Ọbara ọgbụgba na ọbara ọgbụgba. N'ihi ọghọm ọbara ọgbụgba na nsonaazụ ọbara na-adịghị mma, a ga-eme nyocha ọbara zuru ezu na / ma ọ bụ ule ndị ọzọ kwesịrị ekwesị ozugbo ma ọ bụrụ na achọpụtara mgbaàmà ọbara ọgbụgba n'oge ị na-eji ọgwụ ahụ (lee.

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 ịgwa dọkịta (gụnyere dọkịta ezé) na ha na-eji clopidogrel, tupu edepụta usoro ịwa ahụ ọ bụla, ma ọ bụ tupu iji 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 ma ọ bụ yana 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 ogologo 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 bu onodu ojoo nwere ike igbu mmadu, ya mere choro ọgwụgwọ ozugbo, tinyere plasmapheresis.

Inweta haemophilia. Ekpesa maka mmepe nke hemophilia enwetara mgbe ejiri Clopidogrel mee ihe. N'ihe gbasara nkwalite nkwuputa dịpụrụ adịpụ na APTT (oge akụkụ ọkara nke thromboplastin), nke a na-eso ma ọ bụ na-eso ya na-agba ọbara, a ga-echebara ajụjụ banyere ịchọpụta enweta hemophilia echiche. Ndị ọrịa nwere nkwenye siri ike nke haemophilia kwesịrị ịnọ n'okpuru nlekọta nke dọkịta ma nata ọgwụgwọ, ekwesịrị ịkwụsị ọrụ nke clopidogrel.

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 2 C19 (CYP2C19). Pharmacogenetics N'ime ndị ọrịa nwere ọrụ CYP2C19 nwere mkpụrụ ndụ ihe na-ebelata, enwere ntakịrị mkpokọta nke metabolite na-arụ ọrụ nke clopidogrel na plasma ọbara na mmetụta mgbochi antiplatelet dị ala. Ugbu a enwere ule iji mata CYP2C19 genotype na onye ọrịa.

Ebe ọ bụ na clopidogrel na-agbanwe na metabolite ya na-arụ ọrụ na akụkụ nke CYP2C19, ojiji nke ọgwụ ndị na-ebelata ọrụ nke enzyme a nwere ike iduga na mbelata nke mkpokọta metabolite na-arụ ọrụ nke clopidogrel na plasma ọbara. Kaosinadị, abatabeghị ịdị mkpa nke mmekọrịta a. Yabụ, nha ahụ bụ wezuga ihe ndị ọzọ na-egbochi CYP2C19 inhibitors (lee anya)

Ọrụ mmeghari mmekọrịta n'etiti thienopyridines. A ga-enyocha akụkọ gbasara onye ọrịa banyere ịgwọ ọrịa na ọrịa ndị ọzọ (dịka ticlopidine, prasugrel) n'ihi na enweela akụkọ banyere nfụkasị ọgbụgba n'etiti thienopyridines (lee mpaghara “Mmeghachi omume ọjọọ”). Ojiji nke thienopyridines nwere ike ibute mmeghachi omume nfụkasị nke nro ruo na nnukwu nhụsianya, dịka nchapu, edere Quincke, ma ọ bụ mmeghachi omume hematological dịka thrombocytopenia na neutropenia. Ndị ọrịa nwere akụkọ mmeghachi omume nfụkasị na / ma ọ bụ mmeghachi omume hematological otu thienopyridine nwere ike ịnwe ohere dị elu nke ịmalite ụdị otu ahụ ma ọ bụ mmeghachi omume ọzọ na thienopyridine. A na-atụ aro ka ịghachị mmegharị mmegharị.

Renrụ ọrụ na-arụ ọrụ na ụlọ. Ahụmahụ ọgwụgwọ nke iji clopidogrel na ndị ọrịa nwere ọrịa akụrụ nwere oke, ya mere, a ga-eji nlezianya dezie ndị ọrịa ahụ (lee Nkebi "Usoro Ọgwụ na Nchịkwa").

Ọrụ imeju na-arụ ọrụ. Ahụmahụ nke iji ọgwụ ahụ eme ihe na ndị ọrịa nwere ọrịa imeju na-agafe agafe na ohere nke hemorrhagic diathesis nwere mmachi, yabụ, ndị ọrịa dị otú ahụ kwesịrị ka ejiri aha mkpachara anya kọwaa clopidogrel (lee Nkebi "Usoro Ọgwụ na Nchịkwa").

Ndị pụrụ iche. Aterocardium nwere lactose. Ndị ọrịa nwere ọrịa ọrịa akụrụngwa dịka ụyọkọ galactose, ụkọ Lappase ma ọ bụ ndị nwere nsogbu glucose-galactose malabsorption ekwesịghị iji ọgwụ a.

Jiri n’oge ime ma ọ bụ n’ịra

N'ihi enweghi data nyocha banyere iji clopidogrel n'oge afọ ime, ekwenyeghị ọgwụ ahụ nye ụmụ nwanyị dị ime (dị ka akpachara anya). Nnwale ụmụ anụmanụ egosighi mmetụta ọjọọ nke clopidogrel na afọ ime, ẹmbrayo / afọ nwa ebu n’afọ, na ịmụ nwa na mmepe nne.

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

Ọmụmụ. N'oge ọmụmụ na anụmanụ anụmanụ, ọ nweghị mmetụta ọjọọ nke clopidogrel na ọmụmụ nwere achọpụtara.

Dodoụbiga ya ókè

Mgbaàmà: oge ọbara gbatịpụrụ ruo ogologo oge yana nsogbu ndị a.

Ọgwụgwọ bụ Symptomatic. Ọ bụrụ na ọ dị mkpa, mgbazi ngwa ngwa nke oge ọbara na-adị ogologo, enwere ike iwepụ nsonaazụ ọgwụ ahụ site na mmịnye ọbara platelet. A maghị ọgwụ mgbochi nke ọrụ ọgwụ ọgwụ nke clopidogrel.

Mmeghachi omume ọjọọ

N'akụkụ nke ọbara na sistemụ lymphatic: thrombocytopenia, leukopenia, eosinophilia, neutropenia, gụnyere neutropenia, thrombotic thrombocytopenic purpura (TTP) (lee mpaghara “Peculiarities of use”), aplastic anemia, pancytopenia, agranulocybotopia granulocytopenia, anaemia.

Site n'akụkụ akụkụ ahụ ji alụso ọrịa ọgụ: ọrịa serum, mmeghachi omume anaphylactoid, nkwụchi hyperensitivity n'etiti thienopyridines (dịka ticlopidine, prasugrel) (lee

Site na usoro ụjọ ahụ: ọbara ọgbụgba intracranial (n'ọnọdụ ụfọdụ - egbu egbu), isi ọwụwa, paresthesia, dizziness, mgbanwe na ụzọ ụtọ.

Site n'akụkụ akụkụ ahụ nke ọhụụ: ọbara ọgbụgba dị na mpaghara anya (conjunctiva, visual, retinal).

N’akụkụ akụkụ anụ ahụ nke ịnụ ihe na ime ka ihe ghara imezi: ike ọgwụgwụ.

Site na usoro vaskụla: hematoma, ọbara ọgbụgba siri ike, na-agba ọbara site na ọnya ịwa ahụ, vasculitis, hypotension arterial.

Site na akwara afọ: ọbara ọgbụgba, ọnya afọ, mgbu nke afọ, dyspepsia nke ọnya afọ na ọnya afọ, gastritis, ọgbụgbọ, ọgbụgbọ, afọ ntachi, ọnya afọ, ọbara ọgbụgba, eriri afọ na azụ na -akwụ ala, ọnya afọ (karịchaa, ọnya afọ ma ọ bụ lymphocytic), stomatitis.

Site na usoro digestive: ọrịa imeju na-akpata oke ala, ịba ọcha n'anya, nsonaazụ na-adịghị mma nke ndị na-egosi ọrụ imeju.

N’akụkụ anụ ahụ na ọnya subcutaneous: ọbara ọgbụgba, ọnya ụzarị, pruritus, ọbara intradermal (purpura), oke ụjọ dermatitis (necrolysis na-egbu egbu, Stevens-Johnson syndrome, erythema multiforme), angioneurotic edema, erythematous fasharia, pania, ọrịa, na eosinophilia na ngosipụta nke sistemụ (ọrịa DRESS), eczema, lichen planus.

N’akụkụ nke usoro akwara ọkpụkpụ, njikọta yana akwara ọkpụkpụ: akwara ọkpụkpụ, akwara na-arịa ọrịa ogbu na nkwonkwo, ọrịa ogbu na nkwonkwo, ọrịa ogbu na nkwonkwo.

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

Ọrịa ụbụrụ: hallucinations, ọgba aghara.

Ọkpụkpụ ume, thoracic na mediaastinal: imi imi, ọbara na-efe efe (ọbara ọgbụgba, ọbara ọgbụgba), bronchospilisia, ọrịa obi na-efe efe, nkụ na-efe efe.

Ọrịa nkịtị: ahụ ọkụ.

Ọmụmụ ụlọ nyocha: oge ọbara gbatịpụrụ agbatị, mbelata ọnụ ọgụgụ nke neutrophils na platelet.