Etu esi eji ọgwụ Zilt? > Ọgwụgwọ na mgbochi

Site na igbochi nnabata nke ADP n’ebe ndi n’ilebara anya di n’elu platelet na mmezi nke GP IIb / IIIa complex, clopidogrel na-egbochi agwagbu platelet ADP. Clopidogrel na - egbochikwa nchịkọta platelet site na ihe ndị ọzọ. Mmetụta nke clopidogrel na-adịgide n'oge ndụ platelet.
Site na iji clopidogrel ruo ogologo oge na ọgwụ ọgwụgwọ (75 mg / ụbọchị), mmachi akara nke platelet na-apụta ugbua n'ụbọchị 1 nke ọgwụgwọ, mgbe ahụ mmetụta antiplatelet ji nwayọọ nwayọọ na-abawanye ma rute karịa mgbe ụbọchị 3-7 nke iji ọgwụ ahụ eme ihe mgbe niile. Site n'iji Clopidogrel mee ihe ogologo oge na usoro ọgwụgwọ, nkezi nkwụsị nke platelet bụ 40-60%. Mgbe ọ kwụsịrị ọgwụgwọ, nsonaazụ nke Clopidogrel na nchịkọta yana oge ọbara ọgbụgba na-apụ n'anya, na-abụkarị mgbe ụbọchị ise gasịrị.
Mgbe nchịkwa ọnụ gachara, a na-etinye clopidogrel ngwa ngwa (oge ị ga-erute ịta ọkwa plasma kachasị bụ awa 0.7-0.8). Mgbe awa 2 gachara, a chọpụtaghị ọgwụ ahụ na plasma ọbara. Orhapụ iwere dị ihe dịka 50% ma ọ nọọrọ onwe ya na iri nri. Akụkụ bụ isi nke clopidogrel na metabolite ya bụ isi (dịka 98 na 94%) na-emegharị ọzọ na protein plasma.
Clopidogrel bụ prodrug. A na-agwakọta ya na imeju, ihe bụ isi metabolite bụ ọgwụ na-adịghị arụ ọrụ nke ọgwụ carbonlic acid. Ọta ya na ọbara ọbara bụ 85% nke ego ọgwụ niile. Oke ntinye uche na ọbara ọbara erutela ihe dịka otu elekere mgbe nchịkwa gachara. Na-arụ ọrụ metabolite na - arụ ọrụ - usoro mmalite nke thiol - bụ nke sitere na ọyị ịdọrọ nke clopidogrel ruo 2 - oxoclopidogrel, hydrolysis sochiri. Ngwurugwu a pụtara na ntinye cytochrome P450. Metabolite a na - arụ ọrụ nke nwere ike ịmata ọdịiche in vitro, ngwa ngwa na n'ụzọ dị mma na-ejikọ ndị nabatara platelet ma gbochie nchịkọta ha. Achọpụtaghị ya n'ọbara ọbara.
Mgbe nchịkwa otu ugboro ma ọ bụ ugboro ugboro na mmamịrị, a na-ewepụ 50%, yana ọnya ọgwụ - 46% nke nchịkwa clopidogrel. Ọkara ndụ nke nnukwu metabolite mgbe otu ọgwụ ma ọ bụ ugboro ugboro nke ọgwụ bụ 8 awa.

Ihe ngosiputa maka iji ọgwụ Zilt

Mgbochi ihe omume obi (ọrịa ischemic, infarction myocardial na ọrịa obi) na ndị ọrịa nwere ngosipụta nke akwara nke atherosclerosis: na ọrịa ischemic (site na ụbọchị 7 ruo ọnwa 6), infarction myocardial (site ọtụtụ ụbọchị ruo ụbọchị 35 mgbe obi nkụchi). ọnụnọ nke ọrịa nke akwara.

Ojiji ọgwụ Zilt

Ọgwụ ndị ọrịa maka ndị okenye (gụnyere ndị agadi) bụ 1 mbadamba (75 mg) kwa ụbọchị. Enwere ike iji ọgwụ a n'agbanyeghị nri nri.
E guzobeghi oge ọgwụgwọ ọ bụla, mana eji usoro ọgwụgwọ ruo ọnwa iri na abụọ, a na-ahụkarị mmetụta kachasị elu ka ọnwa atọ gachara ọgwụ a.

Usezọ iji Zilt na ụdị mbadamba

N'ime, n'agbanyeghị nri ị na-eri, otu ugboro n'ụbọchị.

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

Ọrịa infịction na-arịa myocardial infarction, ọrịa strok, ischemic strok, ma ọ bụ ọrịa metụtara ọrịa oghere oke.

A na-ewere Zilt® na ọgwụ nke 75 mg (1 mbadamba) otu ugboro n'ụbọchị.

Nnukwu akwara na-arịa ọrịa na-enweghị mgbatị nke ST (na-ejighi angina ma ọ bụ infịction myocardial na-enweghị ebili mmiri Q).

Ọgwụ ejiri Zilt® wee bido n ’otu ọgwụ (300 mg), wee soro n’iji 75 mg otu ugboro n’ụbọchị (ya na acetylsalicylic acid n’ime doses nke 75-325 mg kwa ụbọchị). Ebe ọ bụ na ojiji nke elu acreslsalicylic acid na-akpakọrịta nwere nnukwu nsogbu ọbara ọgbụgba, usoro a tụrụ aro acetylsalicylic acid ekwesịghị gafere 100 mg. Mmetụta kachasị bara uru na-ahụ na ọnwa nke atọ nke ọgwụgwọ. O bughị ụzọ kpebie ụdị ọgwụgwọ a ga-ekpebi nke ọma. Nsonaazụ nke ihe omumu ihe omumu gosiputara ohere nke iwere clopidogrel rue onwa iri na abuo ka mmepe nke akwara gbasara oria ghara ibupute ngalaba ST.

Ọrịa coronary aciki na elu ST nke elu (nnukwu myocardial infarction) yana ọgwụgwọ ọgwụ yana enwere ike ọgwụgwọ thrombolytic, yana Acetylsalicylic acid.

Ekwesịrị iburu Zilt® na ọgwụ nke 75 mg (1 mbadamba) otu ugboro kwa ụbọchị, na-amalite site na njikwa mbido, yana ngwakọta acetylsalicylic acid na ma ọ bụ na-enweghị thrombolytics. Maka ndị ọrịa gbagoro afọ 75, a ga-eme ọgwụgwọ na Zilt® na-ejighi ọgwụ eji eme ihe. A na-amalite ọgwụgwọ njikọta ozugbo enwere ike mgbe mmalite nke mgbaàmà ma na-aga n’ihu ma ọ dịkarịa ala izu anọ. Ayochabeghị ịdị mma nke ọgwụgwọ njikọta na clopidogrel na acetylsalicylic acid nke na-adịgide karịa izu anọ amụbeghị na ndị ọrịa dị otú ahụ.

Atrial fibrillation (atrial fibrillation)

Edere ọgwụ Zilt® na ọgwụ nke 75 mg otu ugboro n'ụbọchị. Na ntinye ya na clopidogrel, ekwesiri ibido usoro ọgwụgwọ wee were nweta acetylsalicylic acid na ọgwụ nke 75-100 mg kwa ụbọchị.

Ọ bụrụ na onye ọrịa ahụ atụfuru ọgwụ ọzọ:

- oburu na erughi awa iri na abuo agachapula ogwu ozo, ikwesiri kwa ihe Zilt® ozugbo ahuru, were were ozo ozo n’oge oge ahu,

- ọ bụrụ na ihe karịrị elekere iri na abụọ agafeela mgbe ịwụsịrị usoro ọzọ, mgbe ahụ, a ga-ewere dose ọzọ n’oge ọ na-emebu, mgbe a na-ekwesịghị okpukpu abụọ.

Ndị okenye na ndị ọrịa agadi nwere ebumnuche sitere na mkpụrụ ndụ ihe nketa belata nke CYP2C19 isoenzyme

A na-ejikọ ọrụ dị ala nke CYP2C19 isoenzyme na mbelata mmetụta antiraplet nke clopidogrel. Ojiji nke Zilt® na usoro onyonyo dị elu (nke na-eburu 600 mg, mgbe ahụ 150 mg otu ugboro kwa ụbọchị) na ndị ọrịa nwere obere ọrụ nke CYP2C19 isoenzyme na-eduga na mmụba na mmetụta antiplatelet nke clopidogrel (lee mpaghara "Pharmacokinetics"). Agbanyeghị, na nnwale ụlọ ọgwụ iji mụọ nsonaazụ ụlọ ọgwụ, ezigbo usoro usoro ọgwụgwọ clopidogrel na ndị ọrịa nwere metabolism ruru na mkpụrụ ndụ ihe mepụtara nke CYP2C19 isoenzyme emebeghi.

Ndị otu ọrịa pụrụ iche

Ndị okenye na-arịa ọrịa

N'ime ndị ọrụ afọ ofufo agadi (ihe karịrị afọ 75), ma e jiri ya tụnyere ndị ọrụ afọ ofufo na-eto eto, e kpughere ọdịiche dị na nchịkọta platelet na oge ọbara ọgbụgba. Ọchọghị ime mgbanwe na ndị ọrịa agadi.

Renrụ ọrụ na-arụ ọrụ na ụlọ

Mgbe iji clopidogrel ugboro ugboro na dose nke 75 mg kwa ụbọchị na ndị ọrịa nwere nnukwu nsogbu akụrụ (CC 5-15 ml / min), ogo nke inhibition nke nchịkọta ADP na - eweta platelet dị 25% dị ala karịa ndị ọrụ afọ ofufo nwere ahụ ike. Agbanyeghị, ogo ịgbatị oge ọbara ọgbụgba yiri nke ndị ọrụ afọ ofufo ahụ siri ike nke natara clopidogrel na ọgwụ nke 75 mg kwa ụbọchị. Nkwekọrịta ọgwụ dị mma n’ebe ndị ọrịa niile nọ. Ọrụ imeju na-arụ ọrụ

Mgbe iji clopidogrel na-etinye 75 mg kwa ụbọchị maka ụbọchị 10 n'ime ndị ọrịa nwere ọrụ imeju na-agwụ ike, ogo nke inhibition ADP na-eweta nchịkọta platelet na nkezi ọnụego oge ịgba ọbara bụ ndị tụnyere ndị ọrụ afọ ofufo ahụ siri ike.

Ọnụ ọgụgụ agbụrụ nke CYP2C19 mkpụrụ ndụ isoenzyme jikọtara ya na metabolism dị n'etiti ma ọ bụ belata metabolism dị iche n'etiti ndị nnọchite nke agbụrụ / agbụrụ dị iche iche (lee subsection Pharmacogenetics). Enwere akwụkwọ data ole na ole iji nyochaa mkpa nke CYP2C19 isoenzyme na nsonaazụ ụlọ ọgwụ maka ndị ọrịa agbụrụ Mongoloid.

Mgbe ị na-atụnyere ogwugwu ọgwụ nke clopidogrel n'ime ụmụ nwoke na ụmụ nwanyị, ụmụ nwanyị gosiri ntakịrị mgbochi nke ADP na-eweta nchịkọta platelet, mana enweghị ọdịiche na ịgbatị oge ọbara ọgbụgba. Mgbe ị na-atụnye clopidogrel na acetylsalicylic acid n’ebe ndị ọrịa nọ n’ihe ize ndụ nke ịmalite nsogbu ischemic, ugboro ole nsonaazụ a na-adakarị ahụ, mmetụta ndị ọzọ na nhazigharị gbasara ụkpụrụ ụlọ ọgwụ na laabu bụ otu na ụmụ nwoke na ụmụ nwanyị.

Nsonaazụ nke ọgwụ Zilt

Mmeghachi omume izugbe: obi mgbu, ike ọgwụgwụ, asthenia.
Site na sistemụ ụjọ: isi ọwụwa, dizziness, paresthesia, cramps ụkwụ, hypesthesia, neuralgia.
Si na akuko obi: akụkụ ụbụrụ, ọbara mgbali elu (mgbali elu akwara), nkụchi obi, tachycardia.
Site na eriri afọ: mgbu afọ, dyspepsia, afọ ọsịsa, ọgbụgbọ, afọ ntachi, ọgbụgbọ, flatulence, ọgba aghara uto, ọnya afọ, ọnya afọ, ọnya afọ.
N'akuku nke imeju na akụkụ biliary: ọrụ na-arịwanye elu nke transminases ịba ọcha n'anya, hyperbilirubinemia, ịba ọcha n'anya, steatosis imeju.
Site na sistemu ọbara: thrombocytopenia, anaemia (aplastic or hypochromic), agranulocytosis, granulocytopenia, leukocytosis, leukopenia, neutropenia.
Site na usoro coagulation ọbara: ọnya afọ, ọbara afọ, ọbara ọgbụgba, ọbara ọbara nke akwara, ọbara ọgbụgba, ọbara ọgbụgba, ọbara ọgbụgba, ọbara ọgbụgba, ọnya ọbara na anya, hemothorax, ọbara ọgbụgba, prọfesọ nfụkasị, thrombocytopenic purpura.
Site na usoro mọzụlụ: azu mgbu, ogbu na nkwonkwo, ogbu na nkwonkwo.
Site n'akụkụ nke usoro ụjọ ahụ: ịda mba
Site na sistem iku ume: mbufụt elu akụkụ okuku ume, mkpirisi iku ume, rhinitis, bronchitis, ụkwara, oyi baa, sinusitis.
Akụkụ anụ ahụ: ihe nfụkasị, itching, eczema, ọnya anụ ahụ, bulmat dermatitis, erythematous rash, maculopapular france, urticaria.
Site na anụ ahụ anụ ahụ: cataract, conjunctivitis.
Site na usoro mkpụrụ ndụ ihe nketa: ọrịa urinary tract, cystitis, hypermenorrhea, ihe dịpụrụ adịpụ nke ọrịa hemolytic uremic syndrome na membranous nephropathy.
Mmeghachi omume nfụkasị ahụ: Okwu ndị dịpụrụ adịpụ nke mmeghachi omume hypersensitivity (angioedema, bronchospasm, anafilais).

Ntụziaka pụrụ iche maka iji ọgwụ Zilt

N'ime ndị ọrịa nwere myocardial infarction, a naghị atụ aro ka ịmalite ọgwụgwọ na clopidogrel na ụbọchị ole na ole mgbe obi ọgụ gasịrị. Clopidogrel na-abawanye oge ị na-agba ọbara. Ekwesịrị iji ọgwụ ahụ mee ihe na nlezianya na ndị ọrịa nwere nnukwu ọbara ọgbụgba n'ihi trauma, ihe ịwa ahụ ma ọ bụ ọnọdụ ndị ọzọ, yana ndị ọrịa nwere ọbara ọgbụgba (ọbara ọgbụgba, ọnya ọbara). Ekwesịrị ịkwụsị ọgwụgwọ Clopidogrel ọ dịkarịa ala ụbọchị 7 tupu usoro ịwa ahụ (nke gụnyere usoro eze).
E kwesiri ịdọ ndị ọrịa ọdụ na oge iji clopidogrel gwọọ ọrịa, ohere dị n'ọbara na-abawanye nakwa na ọbara ọgbụgba nwere ike ịdị ogologo oge karịa ka ọ dị na mbụ, wee kwụsịtụ na mberede. Site na obere mbe (mgbe ị na-akpụ afụ ọnụ) ma ọ bụ mmerụ ahụ ndị ọzọ dị na ụlọ, a naghị achọkarị usoro pụrụ iche iji kwụsị ọbara ọgbụgba. N'ọnọdụ ọghọm ma ọ bụ mmerụ ahụ dị mkpa, ọ dị mkpa ka ịgụọ ọgwụ maka ọgwụgwọ ngwa ngwa.
N'ihi ahụmịhe ezighi ezi na clopidogrel n'ime ndị ọrịa nwere ọrụ ezumike nká, a ga-akpachara anya mgbe ị na-eji ọgwụ ahụ.
Site na mmebi dị ukwuu nke ọrụ imeju, ihe ize ndụ nke ọbara ọgbụgba na-abawanye, yabụ, na ndị ọrịa a, ekwesịrị iji akọ mee ihe.
Ewubeghi nchekwa na ịdị mma nke clopidogrel na ụmụaka na ndị nọ n'afọ iri na asatọ ka edobebeghị ya, yabụ, edebeghị ọgwụ a maka ndị ọrịa nke afọ a.
N'ihi ụkọ data, anaghị atụ aro maka clopidogrel maka ime n'oge afọ ime na lactation.
Ọgwụ ahụ nwere ike imetụta ọnọdụ psychophysical, nke nlebara anya na-egosipụta, mbelata nke mmeghachi omume psychomotor ma chọọ nlezianya mgbe ị na-anya ụgbọ ala ma jiri usoro ndị nwere ike ibute egwu.

Ọgwụ mmekọrịta ọgwụ Zilt

N'ihi ịba ụba nke ọbara ọgbụgba, a naghị atụ aro maka ojiji nke clopidogrel na warfarin n'otu oge. N'iji oge Clopidogrel na heparin ma ọ bụ ndị ọzọ thrombolytic mee ihe, ọghọm ọbara nwere ike ịba ụba, yabụ ijikọ ọgwụ ndị a chọrọ ịkpachara anya. Ojiji nke clopidogrel na NSAIDs na-abawanye n'ihe ize ndụ nke ime ulcerogenic na mmepe nke ọbara ọgbụgba site na ọnya, yabụ iji clopidogrel na NSAIDs chọrọ ịkpachara anya.
Site na iji clopidogrel na-eme n'otu oge na atenolol, nifedipine, digoxin, phenobarbital, cimetidine, estrogen ma ọ bụ theophylline, enweghị mmekọrịta mmekọrịta dị ịrịba ama ama. Enwere ihe akaebe banyere nchekwa nke clopidogrel n'otu oge na phenytoin na tobutamide.
Ihe antacids anaghị emetụta oriri nke clopidogrel.

Doụbiga ọgwụ ókè Zilt, akara na ọgwụgwọ

A kọwara ikpe nke ị intentionụbiga mmanya ókè nke Clopidogrel mgbe nwanyị dị afọ 34 nwere ebumnuche igbu onwe ya weere ọgwụ 1050 (mbadamba 14) nke clopidogrel. Onweghị akara ngosi nke ịdoụbiga mmanya ókè ma ọ bụ nsogbu, enweghị ọgwụgwọ ọpụrụiche.
Mgbe ha natasịrị ndị ọrụ afọ ofufo ahụ siri ike, 600 mg nke clopidogrel egosighi mmetụta ọ bụla (ewezuga mmụba nke ugboro 1.7 oge ọbara ọgbụgba).
Enweghị ọgwụ mgbochi akọwapụtara. Enwere ike iwepu nsonaazụ nke clopidogrel site na mmịnye nke platelet mass.

Usoro onunu ogwu:

Mbadamba ụrọ gbara agba nwere

isi: ihe eji arụ ọrụ: clopidogrel hydrosulfate 97.875 mg, gbakọrọ dị ka clopidogrel 75,000 mg, ndị mgbe ochie: lactose, anhydrous 108.125 mg, microcrystalline cellulose 30,00 mg, pregelatinized stachi 12.00 mg, macrogol 6000 8.00 mg, castor oil, hydrogenated 4.00 mg,

shei: hypromellose 6av 5.60 mg, titanium dioxide (E171) 1.46 mg, talc 0.50 mg, dye iron oxide red (E 172) 0.04 mg, propylene glycol 0.40 mg.

Gburugburu, mbadamba biconvex dị ntakịrị, kpuchie ya na mkpuchi pink.

* Nlere mpaghara: na-acha ọcha ma ọ bụ nke na-acha ọcha ike na-acha uhie uhie na fim ịcha.

Mlọ ọgwụ:

Clopidogrel bụ prodrug, otu n'ime metabolites na - arụ ọrụ nke bụ ihe na - egbochi mkpokọta platelet. Arụ ọrụ metabolite na-arụ ọrụ nke clopidogrel ahọrọ na-egbochi njikọ
adenosine diphosphate (ADP) na P2Y_I2 Ndị na - anabata platelet na ADP nke na - agbagha agbagha nke mgbakwunye glycoprotein GPIIb / IIIa, nke na - eduga na mgbochi nke nchịkọta platelet.

Mgbanwe nke agwakọta platelet bụ nke a na - atụgharịgharị ma na - aga n'ihu na usoro ndụ niile nke sel (ihe dịka ụbọchị 7-10), yabụ, ọnụego mweghachi nke ọrụ platelet nkịtị kwekọrọ na ọnụego mmelite ha. Ndị gbochiri mgbakwunye platelet na-abụghị ADP na-egbochikwa n'ihi mgbochi nke mmalite platelet na-abawanye site na ADP.

A na-etolite metabolite nọ n'ọrụ n'okpuru CYP450 isoenzymes, ụfọdụ n'ime ha nwere ike ịdị iche na polymorphism ma ọ bụ ọgwụ ndị ọzọ na-egbochi ya, yabụ, ọ bụghị ndị ọrịa niile nwere mgbochi zuru oke nke nchịkọta platelet.

Na usoro ọgwụgwọ na clopidogrel na ọgwụ nke 75 mg kwa ụbọchị site na ụbọchị mbụ nke ọgwụgwọ, enwere nnukwu mwepu nke nchịkọta ADP na - akpata platelet, na - eji nwayọọ nwayọọ na - abawanye karịa ụbọchị 3-7 wee rute n'ogo mgbe niile (na - erute nha anya). Na ọkwa ha, ogo nke igbochi nchịkọta platelet mgbe ị na-eji clopidogrel na ọgwụ nke 75 mg kwa ụbọchị, na nkezi, sitere na 40% ruo 60%. Ọ kwụsịrị clopidogrel, nchịkọta platelet na oge ọbara ji nwayọọ nwayọọ laghachi na ụkpụrụ mbụ ha, na nkezi, karịa ụbọchị 5.
Clopidogrel nwere ike igbochi mmepe nke nsogbu atherothrombotic n'ahụ ndị ọrịa nwere ọnya ọnya atherosclerotic nke ọnọdụ ọ bụla, ọkachasị ndị nwere ọrịa akwara, akwara ma ọ bụ akwara ozi.

Mlọ ọgwụ:

Mgbe otu onye nchịkwa a na-ekwu okwu ugboro ugboro na 75 mg kwa ụbọchị
a na-etinye clopidogrel ngwa ngwa. Nkezi ogo nke itinye uche kacha (C_m_ah) Akwukwo ọbara na-agbanweghi agbanwe na plasma ọbara (2.2-2.5 ng / ml mgbe inwetara otu iko nke 75 mg) mezuru mgbe ihe dị ka nkeji iri anọ na ise gachara. Dika ihe omumu banyere akpo nke clopidogrel metabolites, ogo ogosi di ihe ruru 50%.

Clopidogrel na metabolites ya na-arụ ọrụ na-ekesa ọbara na plasma ọbara na-agbanwegharị na protein plasma nke mmadụ n'okpuru ọnọdụ in vitro (98% na 94%, otu isi). Ejikọtaghi nkekọ a n'ọtụtụ nchịkọta.

Clopidogrel na-agbasi mbọ ike n'imeju. Na ọnọdụ in vitro na na vivo
clopidogrel bụ metabolized n'ụzọ abụọ: nke mbụ bụ esterases na-edugharị ma na-eduga hydrolysis site na nguzobe metabolite na - adịghị arụ ọrụ - ihe sitere na carbonxylic acid (85% nke metabolites na-agagharị), nke ọzọ na-ejikwa ọnụnọ iche iche nke cytochrome P450. Na mbido
A na-agbanye clopidogrel ka ọ bụrụ ọgwụ metabolites na - etiti-2-oxo-clopidogrel. 2-oxo-clopidogrel na-esote metabolism nke clopidogrel na-esote na-eduga na ịmalite nke metabolite na-arụ ọrụ nke clopidogrel - usoro nke thiol nke clopidogrel. Na vitro, okporo ụzọ a bụ nke isoenzymes CYP3A4, CYP2C19, CYP1A2 na CYP2B6. Ọrụ metabolite nke clopidogrel dịpụrụ adịpụ n'okpuru ọnọdụ in vitro, ngwa ngwa na n'ụzọ na -agbanwe mmekorita ya na ndị na-anabata platelet, na-egbochi nchịkọta ha.

Na_m_ah metabolites na-arụ ọrụ na plasma ọbara mgbe ị aụchara ọgwụ (300 mg) nke clopidogrel dị okpukpu abụọ karịa nke C_m_ah emechaa ụbọchị 4 nke iji clopidogrel na usoro mmezi (75 mg / ụbọchị). Na_m_ah n'ọbara plasma na-enweta ihe dị ka nkeji iri atọ na iri isii na isii mgbe ị theụsịrị ọgwụ.

Mgbe abatasịrị Clopidogrel akara C nke 14 pụtara, ihe dị ka 50% nke mkpokọta redio bụ mepụtara akụrụ na ihe dịka 46% eriri afọ n'ime 120 awa mgbe ọ gbasachara. Mgbe otu nchịkọtara ọnụ nke clopidogrel na ọgwụ nke 75 mg, ọkara ndụ (T_1/2) odika ihe dika awa 6. T_1/2 isi metabolites na-adịghị ejekwa ozi na-emegharị n’ime ọbara plasma ọbara n’otu oge a na-eme ya ugboro ugboro.

The isoenzyme CYP2C19 na-ekere òkè na nguzobe nke ma na-arụ ọrụ metabolite na metabolite dị n'etiti - 2-oxo-clopidogrel. Mmetụta ọgwụ na antiplatelet nke clopidogrel metabolite na-arụpụta, yana nsonaazụ nke ntule nke nchịkọta platelet n'okpuru ọnọdụ vi vivo, dịgasị iche na genotype nke CYP2C19 isoenzyme.

Ulo olu nke CYP2C19 * 1 isoenzyme dakọtara na metabolism nke arụ ọrụ ọfụma, ebe allele nke CYP2C19 * 2 na CYP2C19 * 3 isoenzyme mkpụrụ ndụ anaghị arụ ọrụ. Allles nke CYP2C19 * 2 na CYP2C19 * mkpụrụ ndụ 3 isoenzyme bụ ndị kpatara mbelata metabolism na ọtụtụ ndị nnọchite Caucasoid (85%) na Mongoloid (99%). Allezọ ndị ọzọ metụtara na enweghi ma ọ bụ ibelata metabolism adịkarịghị ala ma na-agụnye, mana ọnweghị oke, alleles nke CYP2C19 * 4, * 5, * 6, * 7 na * 8 isoenzyme mkpụrụ ndụ.

Ndị ọrịa nwere obere ọrụ CYP2C19 isoenzyme kwesịrị ịnwe arụmọrụ ọrụ abụọ akpọrọ aha n'elu na enweghị ọrụ. Dabere na ọmụmụ ndị e bipụtara, ugboro ole nke genotypes nwere obere ọrụ CYP2C19 isoenzyme, yana mgbakwunye na metabolism, bụ ihe dịka 2% na ndị nnọchi agbụrụ Caucasoid, 4% na ndị mmadụ nke agbụrụ Negroid na 14% na ndị agbụrụ Mongoloid. Enwere ule iji chọpụta genotype nke CYP2C19 isoenzyme. Dabere na ọmụmụ na meta-analysis, nke gụnyere ndị nwere oke, oke, etiti na obere ọrụ CYP2C19 isoenzyme, ọdịiche dị ukwuu na mkpughe nke metabolite na-arụ ọrụ na ogo ogo inhibition ADP na-eweta nchịkọta platelet na ndị ọrụ afọ ofufo na-arụ ọrụ dị elu, ịdị elu na nke etiti. CYP2C19 anọghị. N'ime ndị ọrụ afọ ofufo nwere obere ọrụ nke isoenzyme a, ikpughe nke metabolite na-arụ ọrụ belatara ma e jiri ya tụnyere ndị ọrụ afọ ofufo nwere nnukwu ọrụ nke isoenzyme CYP2C19.

Mgbe ị na-eji clopidogrel na usoro onunu ogwu nke 600 mg, nguzogide nguzo / nha nke nlebara anya 150 mg (600 mg / 150 mg) na ndị ọrịa nwere metabolism dị ala, ikpughere metabolite nọ n'ọrụ ka dị elu karịa usoro ọgwụgwọ 300 mg / 75 mg. Na mgbakwunye, ogo nke igbochi nchịkọta platelet yiri nke ahụ na otu ndị ọrịa nwere nnukwu ọrụ CYP2C19 isoenzyme na-anata.
clopidogrel dị ka atụmatụ nke 300 mg / 75 mg. Agbanyeghị, usoro onunu ogwu nke clopidogrel n’otu ndị ọrịa nwere obere ọrụ nke CYP2C19 isoenzyme amabeghị na ọmụmụ metụtara nyocha nke nsonaazụ nyocha. Udiri nlebara anya nke ulo ogwu emere rue oge a enweghi otutu ihe nlele iji choputa ihe di iche na ihe nlere ogwu n’enwe ndi oria nwere obere ihe omumu CYP2C19.

Pharmacokinetics nke ndị ọrịa ọrịa pụrụ iche

Emebeghị ụlọ ọgwụ ọgwụ nke metabolite na-arụsi ọrụ ike nke clopidogrel na ìgwè ndị ọrịa pụrụ iche (ndị agadi mere agadi, ụmụaka, ndị ọrịa nwere nsogbu gbasara akụrụngwa na-agwọ ọrịa).

Ndị okenye na-arịa ọrịa

Renrụ ọrụ na-arụ ọrụ na ụlọ

Mgbe iji clopidogrel ugboro ugboro na dose nke 75 mg kwa ụbọchị na ndị ọrịa nwere nnukwu nsogbu akụrụ (CC 5-15 ml / min), ogo nke inhibition nke nchịkọta ADP na - eweta platelet dị 25% dị ala karịa ndị ọrụ afọ ofufo nwere ahụ ike. Agbanyeghị, ogo ịgbatị oge oge ọbara na-adị ka ọ dị na ndị ọrụ afọ ofufo ahụ siri ike natara
clopidogrel na ọgwụ nke 75 mg kwa ụbọchị.

Ọrụ imeju na-arụ ọrụ

Ihe ngbanwe

- Hypersensitivity na clopidogrel ma ọ bụ ndị ọ bụla buru ibu na-eme ọgwụ ahụ,

- nnukwu nsogbu nke imeju,

ọbara ọgbụgba, dị ka ọbara ọgbụgba site na ọnya afọ ma ọ bụ ọbara ọgbụgba n'ime intracranial,

- ụkọ lactase, nnagide nri nke lactose, ọrịa glucose-galactose malabsorption,

- afọ ime na oge inye ara,

- undermụaka na-erubeghị afọ 18 (nchekwa na arụmọrụ edozighi).

Iji nlezianya:

- Imeju na-arụ ọrụ nke ọfụma nwere oke agwa ka ọ nwee ọbara ọgbụgba (ahụmịhe nwere)

- arụrụ arụzi gbasara ọrụ

- ọnya ọrịa na - eme ka nsogbu ọbara ọgbụgba dịkwuo elu (gụnyere trauma, ịwa ahụ (lee akụkụ "ntuziaka pụrụ iche")),

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

- iji otu oge eji ọgwụ mgbochi na - abụghị ọgwụ steroidal (NSAIDs), gụnyere cyclooxygenase-2 inhibitors (COX-2),

- oge nke warfarin, heparin ma ọ bụ glycoprotein IIb / IIIa inhibitors,

- ndị ọrịa na-arụ ọrụ dị ala nke CYP2C19 isoenzyme (mgbe ị na-eji clopidogrel na usoro onyonyo akwadoro, a na-ehibe metabolite nke clopidogrel na mmetụta antiplatelet ya bụ obere, yabụ, mgbe ị na-eji clopidogrel na usoro ọgwụgwọ a na-atụ aro maka ọnya na-arịa nnukwu ọrịa ma ọ bụ itinye aka na-emetụta akwara coronary, enwere ike inwe obi obi dị elu karịa na ndị ọrịa nwere ọrụ nkịtị nke isoenzyme CYP2C19),

hypersensitivity na thienopyridines ndị ọzọ (dịka ọmụmaatụ.
ticlopidine, prasugrel) (lee akụkụ "ntuziaka pụrụ iche").

Ime na lactation:

Ebe ọ bụ na enweghi data ụlọ ọgwụ banyere ojiji nke clopidogrel n'oge afọ ime, a naghị atụ aro ọgwụ a maka iji ya n'oge ime. Akwukwo anumanu ekpuputaghi uzo ojoo na adighi ime n’oge uto, ntuputa ime n’afọ, n’iru oru ma obu imu nwa.

Ihe omumu banyere anum gosiputara nke a
A na-ahụkarị clopidogrel na / ma ọ bụ metabolites ya na mmiri ara. Ya mere, ọ bụrụ na ọ dị mkpa, ọgwụ
clopidogrel om tụrụ aro ịkwụsị ị stopụ ara.

Usoro onunu ogwu na nhazi

N'ime, n'agbanyeghị nri ị na-eri, otu ugboro n'ụbọchị.

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

Ọrịa infịction na-arịa myocardial infarction, ọrịa strok, ischemic strok, ma ọ bụ ọrịa metụtara ọrịa oghere oke.

A na-ewere Zilt® na ọgwụ nke 75 mg (1 mbadamba) otu ugboro n'ụbọchị.

Nnukwu akwara na-arịa ọrịa na-enweghị mgbatị nke ST (na-ejighi angina ma ọ bụ infịction myocardial na-enweghị ebili mmiri Q).

Ọrịa coronary aciki na elu ST nke elu (nnukwu myocardial infarction) yana ọgwụgwọ ọgwụ yana enwere ike ọgwụgwọ thrombolytic, yana Acetylsalicylic acid.

Atrial fibrillation (atrial fibrillation)

Ọ bụrụ na onye ọrịa ahụ atụfuru ọgwụ ọzọ:

- oburu na erughi awa iri na abuo agachapula ogwu ozo, ikwesiri kwa ihe Zilt® ozugbo ahuru, were were ozo ozo n’oge oge ahu,

Ndị okenye na ndị ọrịa agadi nwere ebumnuche sitere na mkpụrụ ndụ ihe nketa belata nke CYP2C19 isoenzyme

Ndị otu ọrịa pụrụ iche

Ndị okenye na-arịa ọrịa

Renrụ ọrụ na-arụ ọrụ na ụlọ

Mgbe iji clopidogrel ugboro ugboro na dose nke 75 mg kwa ụbọchị na ndị ọrịa nwere nnukwu nsogbu akụrụ (CC 5-15 ml / min), ogo nke inhibition nke nchịkọta ADP na - eweta platelet dị 25% dị ala karịa ndị ọrụ afọ ofufo nwere ahụ ike. Agbanyeghị, ogo nke ịgbatị oge ọbara dị ka nke ndị ọrụ afọ ofufo ahụ siri ike natara
clopidogrel na ọgwụ nke 75 mg kwa ụbọchị. Nkwekọrịta ọgwụ dị mma n’ebe ndị ọrịa niile nọ. Ọrụ imeju na-arụ ọrụ

Mmetụta akụkụ

Enyochala nchekwa nke clopidogrel n'ime ndị ọrịa natara ọgwụgwọ clopidogrel ruo otu afọ ma ọ bụ karịa. Nchedo nke clopidogrel na ọgwụ nke 75 mg kwa ụbọchị dị ka nke ahụ site na iji acetylsalicylic acid na dose nke 325 mg kwa ụbọchị, n'agbanyeghị afọ, okike na agbụrụ. Edere mmeghachi omume ojoo na ule ụlọ ọgwụ dị n'okpuru. Na mgbakwunye, a na-egosi ịkọwa nke mmeghachi omume ọjọọ.

N'ime ihe omumu ihe omumu na ihe banyere ire ahia, Clopidogrel na-akukokariri mmepe obara, kariri n’oge onwa mbu.

Nhazi oge nke ọghọm mmetụta nke Healthtù Ahụ Ike (wa (WHO): ọtụtụ mgbe? 1/10, ọtụtụ mgbe site na 1/100 ruo 1/10000 ruo

Mwepụta wepụtara ya na ihe mejupụtara

Mpempe usoro onunu ogwu - mbadamba ihe eji eme ihe nkiri: okirikiri, biconvex, pink, ihe dị na mbadamba ụrọ nwere akụkụ ọcha ma ọ bụ nke na-acha ọcha (7 na blisters, na ngwugwu kaadi nke 2, 4 ma ọ bụ 12 blisters).

Ihe na-arụ ọrụ bụ clopidogrel hydrosulfate, na mbadamba 1 - 97.875 mg, ma ọ bụ clopidogrel - 75 mg.

Ngwa inye aka: microcrystalline cellulose, lactose anhydrous, pregelatinized sitara, mmanụ hydrogenated castor, macrogol 6000.

Ihe mejupụtara nke shei fim ahụ: propylene glycol, hypromellose 6cp, talc, titanium dioxide (E171), sọks iron oxide na-acha ọbara ọbara (E172).

Emeputa na ọnụahịa

Companylọ ọrụ na-emepụta ọgwụ na-arụ ọrụ na mmepụta ọgwụ Zilt na Russia KRKA. Ọzọkwa, n'ahịa ụlọ, ị nwere ike ịhụ mgbe ụfọdụ ọgwụ si na Slovenia wetara site na Slovenia.

Ọ bụ "Zilt", ọ dị mwute ikwu, dị oke ọnụ. Ọnụahịa ọgwụ a dabere, nke mbụ, na ọnụọgụ blisters akwakọtara na igbe. Dịka ọmụmaatụ, mbadamba 14 nke ngwaahịa a na-efu 500-600 r, dabere na onye na-eweta ya. Maka blisters 12, ị ga-akwụ ụgwọ karịa 2000 p. N'ọnọdụ ọ bụla, a na-enye ọgwụ a n'ụlọ ọgwụ ka ọ bụrụ naanị ndenye ọgwụ.

Omume ọgwụ

N'ebe mmebi vaskụla n'ahụ ahụ mmadụ, platelet na-amalite ịchịkọtaba mgbe niile. N'otu oge, ha na-arapara n'ahụ ibe ha, na-arapara n'ahụ anụ ahụ. Usoro a ga - ejedebe na ịmepụta ụdọ ọbara.

Ọgwụ "Zilt", ntuziaka maka ojiji nke dị mfe, na-amalite imere onye ọrịa ahụ ihe ngwa ngwa - ihe dị ka nkeji iri atọ mgbe ọ nwesịrị nchịkwa. Mgbe ọ batara n'ahụ mmadụ, mgbochi nke platelet na - eme. Iji ọgwụ a mgbe niile mgbe ihe dị ka ụbọchị 4-7 gasịrị, ọgwụgwọ kachasị na-apụta.

Nleta kachasị elu nke ọgwụ a na ahụ na-apụta ọtụtụ awa mgbe nchịkwa gasịrị. Ọzọkwa, ọdịnaya ya na ọbara ọbụna n'oge a na-adịkarị ala.

Ọgwụ ahụ weputara n'ahụ ya site na akụrụ ya na eriri afọ ya. Nkera nke ndụ mgbe ị aụchara otu oge ruru ihe dịka awa 6-8.

Ọgwụ "Zilt": ntuziaka maka ojiji

Ọgwụ a dị, dị ka anyị kwurula, naanị n'ụdị mbadamba. N'ihi ya, ha na-ewere ya nanị ọnụ. Mbadamba iko 75 mg "Zilt" ntuziaka maka ojiji na-enye ohere tupu nri, na mgbe emesịrị ma ọ bụ n'oge ya. Ofzọ ị takingụ ọgwụ a si emetụta ọrịa a kapịrị ọnụ.

A na-enyekarị onye ọrịa nwere ọrịa myocardial otu mbadamba 75 mg kwa ụbọchị. Edepụtara otu usoro onunu ogwu a maka ndị ọrịa nwere ọghọm ụbụrụ na ischemic cerebrovascular and art art occlusion. N'okwu a, maka ndị ọrịa nwere ọrịa myocardial infarction, enwere ike ịkọ ọgwụ a oge site na ụbọchị 1 ruo 35 nke mmepe nke ọrịa ahụ. A na-enyekarị ndị ọrịa nwere ischemic strok "Zilt" site ụbọchị asaa ruo ọnwa isii.

Na nkwonkwo akwara na nkwonkwo ụkwụ ST, a na-enyekwa ọgwụ a ọnụego ya ruru 75mg kwa ụbọchị. Mana na nke a, onye ọrịa ahụ na - eburu otu obubu otu ọgwụ yana aspirin na thrombolytics.

Na nkwonkwo akwara na-enweghị nkwalite ST, a na-eji usoro ọgwụgwọ dịtụ iche. N'okwu a, a na-ewere ọgwụ ahụ ka ndị a:

na-a aụ ihe ọ loadingụ aụ 300 mg otu ugboro

were ọgwụ ahụ kwa ụbọchị na mbadamba 1 kwa ụbọchị.

Ọzọkwa, yana ọgwụ ị withụ ọgwụ aspirin na 75-325 mg, ọgwụ Zilt kwa ụbọchị kwesịrị ịbụ 100 mg. Site na usoro a, a na-ahụkarị mmetụta kachasị na ndị ọrịa mgbe ọnwa atọ gachara. Usoro ọgwụgwọ ya na-abụkarị ọnwa iri na abụọ.

Edere ụdị ọgwụgwọ a n'ọtụtụ oge naanị ndị okenye nwere afọ-erubeghị afọ 75.

Ntuziaka maka iji ọgwụ "Zilt": contraindications

Maka ndị na-eto eto na-erubeghị afọ 18, 'ekwenyeghi' Zilt 'maka mgbochi nke thrombosis. A naghị akwadoro ị takeụ ọgwụ a n’ebe ụmụ nwanyị na-ehi ụra na ndị dị ime nọ. Clopidogrel nwere ike ịbanye, gụnyere, n'ime mmiri ara.

N'ezie, ịnweghị ike ị takeụ ọgwụ a na ndị ahụ nwere ike ịmalite mmeghachi ahụ nfụkasị akụkụ akụkụ ya niile. Bụ contraindications iji "Zilt":

Dabere na ntuziaka maka ojiji, "Zilt" kwesịrị iji nlezianya debe ya n'ihu nsogbu ndị dị ka:

hypersensitivity na thienopyridines,

ọrụ dị ala nke CYP2C19,

imeju na akụrụ arụ,

ọrịa nke ọbara ọgbụgba ga-ekwe omume,

Arụ ọrụ ịwa ahụ na mmerụ ahụ nwere ike ibute ọbara ọgbụgba.

Mmekorita

Na mgbakwunye, iji mkpachapụ anya kwesịrị iwere, dịka ntuziaka maka ojiji, "Zilt" 75 mg n'out oge na ụzọ dị ka:

Otu a na-emetụta ọgwụgwọ siri ike na ọgwụ mgbochi mbufụt nke Zilt na-abụghị steroidal.

Mmetụta ị thisụ ọgwụ a nwere ike ibelata ma ọ bụrụ na a patientara onye ọrịa site na iji:

"Ticlopidine" na ụfọdụ ọgwụ ndị ọzọ.

Ihe ndị ọrịa kwesịrị ịma

Ndị ọrịa na-ewere Zilt kwesịrị ịgbaso ndụmọdụ ndị a:

A ga-eme ka onye dọkịta mara banyere ọnọdụ nsonaazụ pụrụ iche ma ọ bụ oge ọbara ruru,

Ekwesịrị ịgwa ndị dọkịta banyere ndị dọkịta ezé na ndị dọkịta na-ahụ maka usoro ọgwụgwọ iji zilt ma ọ bụrụ na akpọtụrụ ha.

Kedu ihe ọghọm dị na ya nwere ike ime

Dịka ọgwụ ọ bụla ọzọ, Zilt nwere ike inwe mmetụta na-adịghị mma n'ahụ ahụ onye ọrịa. Ọtụtụ mgbe, mgbe ị na-eji ọgwụ a eme ihe, a na-ahụkarị mmetụta ndị ọzọ na-eso ndị ọrịa:

afọ mgbu na afọ ọsịsa,

Mgbe ụfọdụ, ndị na-a thisụ ọgwụ a nwekwara ike igosipụta onwe ha:

itching ma ọ bụ purpura

mbufụt ke enyịn,

N'ime nyocha ọbara nyocha nke ọbara nyocha, mbelata ọnụ ọgụgụ platelet na neutrophils nwere ike ịchọpụta mgbe ụfọdụ na ndị ọrịa.

Ya mere enwere otutu nsogbu ndi ozo na ogwu a. Ya mere, ntuziaka maka ojiji "Zilt" 75 mg kwesịrị ka ekwesịrị idobe ya. Dodoụ ọgwụ a Overụdoụ bara ụba, n'ezie, enweghị ike ịnagide ya. Ọ bụrụ na onye ọrịa ahụ echezọ ị theụ ọgwụ ahụ na otu ụbọchị, a gaghị atụ aro ị onụ okpukpu abụọ nke na-esote ụbọchị ọ bụla.

Dabere na ntuziaka maka ojiji, mbadamba Zilt, dị ka ndị ọzọ ọ bụla, ekwesịghị ị drunkụ mmanya ma ọ bụrụ na ị nwere ihe nfụkasị ọ bụla n'ime ngwa ha. Mmeghachi omume ndị dị otú a mgbe ị na-eji ọgwụ a adịkarịghị. Mana mgbe ụfọdụ enwere ike ịchọpụta ihe nfụkasị n'ahụ ndị ọrịa na-anwale ọgwụgwọ a. Ihe mmeghachi omume kachasị bụ:

hypersensitivity na thienopyridines.

Ihe ị ga - eme ma a ofụbiga ya ókè

Iji ọgwụ ahụ eme ihe na mwepu ntuziaka maka iji "Zilt" na-eduga na mbibi nke nsogbu ndị dị ka:

obara nke odidi ozo,

mmụba nke ọbara ọgbụgba.

Ọgwụgwọ maka ịdoụbiga ọgwụ ike ókè. A na-enyefe ndị ọrịa n'ọbara platelet.

Analogues nke ọgwụ

Ọ na - efu "Zilt", dịka anyị kwurula, ọ dị oke ọnụ. Ya mere, ọtụtụ ndị ọrịa, n'ezie, nwere mmasị n'ihe ọgwụ dị ọnụ ala karịa nwere ike dochie ọgwụ a ma ọ bụrụ na ọ dị mkpa.

Mmegharị ọgwụ a "Zilt" bụ ọmụmaatụ:

Ego ndị a na mmezi ha nwere otu ihe arụ ọrụ dịka Zilt. Ọ bụrụ na achọrọ, enwere ike dochie ọgwụ a n'oge ọ bụla na iji otu n'ime analogues na listi ahụ. Ntuziaka maka iji Zilt na ya bụ mmechi drọkọrịrị. Ọgwụ ndị a na-ebelata ịmịnye ọbara ọbara nke ọma. Agbanyeghị, a na-ahapụ ya ka ọ gbanwee Zilt ka ọ bụrụ ụdị analogues ndị a naanị naanị mgbe ha na ndị dọkịta kpachara anya.

Ọkpụkpọ mkpụrụ ndụ ihe omimi nke Zilt bụ ọgwụ Clopidogrel (ọnụ ahịa 190 p. Maka elekere 14) na Clopidogrel Richter (292 p).

Analogues nke ọgwụ a, na-egbochikwa ọbara ọbara, bụ ndị a:

Edere "Phenilin" nye ndị ọrịa na 0.025-0.1 g 1-3 ugboro n'ụbọchị. Ndị ọrịa nwere ike iji Dicumarin na usoro onunu ogwu si 0.05 ruo 0.1 g ugboro abụọ kwa ụbọchị. Dọkịta na-enye Heparin ka ndị ọrịa n’okpuru, n’enweghị nsogbu ma ọ bụ intramuscularly.

Ọzọkwa, ọgwụ "Plavix" na-ezo aka analogues nke ọgwụ a. "Zilt", ntuziaka maka ojiji nke anyị tụlere n'elu, n'eziokwu, bụ onwe ya ka ọ ga - eji dochie ọgwụ a. Ọtụtụ ndị ọrịa, ka enyere ego zuru ezu, ka a gwara ka ha họrọ Plavix maka mgbochi nke thrombosis. N'ihe banyere ịdị irè, Zilt dị ala na ọgwụ a akpọrọ aha.

Ọnọdụ nchekwa

N'ezie, iji gbochie egbochi mkpụkọ ọbara kwesịrị ịbụ ọgwụ a na-edeghị ede "Zilt". A na-atụ aro ịchekwa ọgwụ a na okpomọkụ ruo +25 Celsius. Nke ahụ bụ, n'oge ọkọchị ọ na-achọsi ike itinye mbadamba nkume ndị a na friji. Ndụ nchekwa nke ọgwụ a na mkpuchi dị bụ afọ 3.

Nyocha banyere usoro ọgwụgwọ sitere n'aka ndị ọrịa

Ndị ọrịa nwere ezigbo echiche gbasara ọgwụ a. Ndị ọrịa metụtara uru ya:

enweghi mmetụta ojoo n’afọ.

Ọgwụ a na -emelata ọbara, dịka ọtụtụ ndị ọrịa siri dị mma karịa otu ọgwụ aspirin. Nke ahụ bụ, ihe ọghọm nke nkụchi obi ugboro ugboro ma ọ bụ ọrịa strok mgbe ejiri ya na ntuziaka maka ojiji, Zilt, nyocha nke nke a dị mma naanị, belata nke ukwuu.

Fọdụ ọghọm nke ọgwụ a, ndị ọrịa na-atụle:

adighi nma.

Ọria obi na ọrịa strok na-eme, n’etiti ndị agadi. Ma ọtụtụ mgbe, ndị agadi ka na-eche nsogbu a ihu. N’ezie, ịzụrụ ọgwụ ezumike nká dị oke ọnụ na-esikarị ike.

A na-etinye mbadamba mbadamba n'ụzọ n'ime blisters nke dabara n'ụzọ nkịtị n'aka. Ikekwe onye nrụpụta ahụ si otú a chọọ ime ka ọgwụ a kwa ụbọchị dịkwuo mfe. Agbanyeghị, dị ka ọtụtụ ndị ọrịa si kwuo, ọ ga-akacha mma ịhapụ ọgwụ ndị a na blisters siri ike n'akụkụ usoro mgbaji.

Ihe ọghọm ọzọ nke ọgwụ Zilt bụ na ọtụtụ ndị ọrịa na-ewere ya na ọ nwere mmetụta dị mma karịa imeju. Ọtụtụ ndị ọrịa na-enye ndụmọdụ ị takingụ ọgwụ a naanị n'okpuru nlekọta nke dọkịta.

Kedu ihe ndị dọkịta chere gbasara ọgwụ

Ndị dọkịta n'onwe ha na-ewere Zilt dị ka ụzọ dị mma iji belata coagulation ọbara. Ihe mgbakwunye nke ọgwụ a, ndị dọkịta kwuru na ọ bụ eziokwu na ọtụtụ ndị ọrịa nabatara ya nke ọma. Na-ekpe ikpe site na nyocha, ọbara ọgbụgba n'oge eji ya dị obere.

Ihe akaebe na-egosi banyere nchekwa na ike nke ọgwụ a, dịka ọtụtụ ndị dọkịta kwuru, dị mma. Agbanyeghị, ha kwenyere na ọgwụ ahụ n'ọnọdụ ọ bụla dị oke njọ. Ndị dọkịta na-akwado onwe ha ka ịghara ịgwọ onwe ha ọgwụ na iji ya.

Ntuziaka maka iji Zilt: usoro na usoro onunu ogwu

Ana mburu mbadamba nkume ndị ahụ ọnụ, n'agbanyeghị nri ahụ.

Usoro a tụrụ aro maka ndị ọrịa nwere ọrụ nkịtị nke CYP2C19 isoenzyme, gụnyere ndị ọrịa agadi:

Myocardial infarction, ọrịa strok nke ischemic ma ọ bụ ọrịa metụtara ọrịa oghere: 75 mg otu ugboro kwa ụbọchị,
Ọrịa coronary na-enweghị nhịahụ ST akụkụ (angina na-ejighi ike na myocardial infarction na-enweghị nkwaghari Q): ịkwanye dose - otu ugboro 300 mg, mgbe ahụ 75 mg otu ugboro kwa ụbọchị yana mgbakwunye na acetylsalicylic acid na dose 75-325 mg kwa ụbọchị. Mgbe ị na-ede akwụkwọ, ekwesịrị iburu n'uche na a na-ejikọ ọnụ ọgụgụ nke acetylsalicylic acid nke dị ihe karịrị 100 mg na nnukwu ọbara ọgbụgba. Mmetụta ọgwụgwọ na-apụta na ọnwa nke 3 nke ọgwụgwọ, maka nsonaazụ kachasị mma, ọ ga-adị mma ka ị nọgide na-eji clopidogrel ruo ọnwa 12,
Nnukwu myocardial infarction (nnukwu ọrịa coronary syndrome na mpaghara ST): otu ibu na-ebugharị, mgbe ahụ, 75 mg otu ugboro kwa ụbọchị yana mgbakwunye na acetylsalicylic acid na thrombolytics. Ọ naghị atụ aro ka iji ọgwụ were bulie ya mgbe ọ na-agwọ ndị ọrịa karịrị afọ 75. Ekwesịrị ịmalite ọgwụgwọ mgbe mgbaàmà mbụ nke ọrịa ahụ pụtara wee gaa n'ihu ọ dịkarịa ala izu anọ,
Atrial fibrillation (atrial fibrillation): 75 mg otu ugboro kwa ụbọchị yana mgbakwunye na acetylsalicylic acid na dose 75-100 mg kwa ụbọchị.

Ọ na-atụ aro ka ị were mbadamba ihe n'otu oge ahụ, ọ bụrụ na ị ga-egbu oge n'ihe na-erughị awa iri na abụọ, ị kwesịrị ị takeụ ọgwụ ahụ efunahụ ya na nke ọzọ na oge a na-emebu ya, na etiti oge a na-ewe ihe karịrị awa iri na abụọ - a na-ewere mmiri ọzọ na-enweghị obi abụọ.

N'ime ndị ọrịa nwere usoro ọrụ afọ ofufo gbara afọ nke CYP2C19 isoenzyme mgbe ị na-ewere Zilt na usoro onyonyo akwadoro, nguzobe nke metabolite na-arụ ọrụ nke clopidogrel pụtara obere na mmetụta antiplatelet ya apụtaghị. E guzobeghị ezigbo usoro ịgwọ ọrịa maka ndị ọrịa ụdị a, ọ na-abụkarị, etinyere ọgwụ a n'ọtụtụ ọnụọgụ nwere otu ntụtụ nke 600 mg yana 150 mg otu ugboro kwa ụbọchị.

Ọrịa anaghị eme mgbanwe ọ bụla maka ndị okenye.

Nsonaazụ

Site na sisitemu obi: otutu mgbe - hematoma, nke a na adighi ike - hypotension artorial, vasculitis,
Site na sistemu na hematopoietic: ugboro ugboro - leukopenia, thrombocytopenia, eosinophilia, na - adịkarịghị neutropenia, tinyere ụdị siri ike, ọria akwara ngwa ngwa, thrombotic thrombocytopenic purpura (TTP), pancytopenia, thrombocytopenia, agranulocytosis, anaemanotosis
Site na usoro digestive: oge mgbe - mgbu afọ, ọbara ọgbụgba, afọ ọsịsa, dyspepsia, infrequently - ọgbụgbọ, ọgbụgbọ, afọ ntachi, gastritis, flatulence, ọnya afọ na / ma ọ bụ duodenal ọnya, adịkarịghị - retroperitoneal hemorrhage, adịkarịghị - pancreatitis, retroperitoneal na eriri afọ na -akpata ọbara (gụnyere ihe na-egbu egbu), colitis (gụnyere lymphocytic), nnukwu imeju na-ada, ịba ọcha n'anya, nsogbu nke imeju, stomatitis,
Site n'akụkụ akụkụ akwara: obere oge - isi ọwụwa, ọbara ọgbụgba n'ime intracranial (gụnyere nsonaazụ na-egbu egbu), akpịrị, paresthesia, ọ na - adịkarịghị - ọgba aghara, hallucinations,
Site na mọzụlụ: dịkarịsịrị ala - hemarthrosis, ọbara ọgbụgba, ogbu na nkwonkwo, myalgia, ogbu na nkwonkwo,
Site na sistem iku ume: oge - imi imi, ọ na - adịkarịkarị - bronchospasm, na - agba mmee site na okuku ume (akwara ọbara, hemoptysis), ọrịa palọonotis,
Site na usoro mkpụrụ ndụ: ugboro ugboro - hematuria, ọ na - adịkarịghị - glomerulonephritis, mụbara ịba ụba creatinine,
N’akụkụ anụ ahụ: ọtụtụ mgbe - hematomas subcutaneous, infrequently - herching skin, fash, herorrhages skin (purpura), very slight - bulrem dermatitis (Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme), urticaria, erythematous fash, lichen planus, amu amu
Site na anụ ahụ anụ ahụ: ugboro ugboro - ọnya azụ ma ọ bụ ọbara ọgbụgba, na - adịkarịghị - vertigo, ọ na - adịkarịghị - ụtọ pathologies,
Ihe ngosi ulo oru: otutu oge - mbelata nke otutu platelet na neutrophils, na - eme ka oge obara di ogologo.
Mmeghachi omume nfụkasị: dịkarịsịrị - eczema, angioedema, mmeghachi omume anaphylactoid, ọrịa serum, ugboro ole amaghi - ọgwụ ọkụ nwere usoro mgbaàmà nke ọrịa MGBE Ọrịa na eosinophilia, hyperensitivity transpausia nke ogwu ọgbụgba na-akpata ọrịa,
Ndị ọzọ: oge - ọbara ọgbụgba na ọnya ahụ, ọ na - adịkarịghị - ọbara ọgbụgba sitere ọnya ịwa ahụ, ahụ ọkụ.

Ime na lactation

Dịka ntuziaka ahụ si dị, a naghị akwadoro Zilt maka oge a dị ime, ebe ọ bụ na enweghi data ụlọ ọgwụ banyere ojiji nke clopidogrel n'ime ụmụ nwanyị dị ime. Ọmụmụ anụmanụ anaghị ekpughe mmetụta ọjọọ ọ bụla na ọgwụ ọjọọ na-enwe na afọ ime, mmepe nwa ebu n’afọ, na ịmụ nwa, ma ọ bụ mmepe nwa mgbe amụ nwa.

Na nyocha anụmanụ, a chọpụtara na clopidogrel na metabolites ya banye n'ime mmiri ara, yabụ, ọ bụrụ na ọ dị mkpa iji Zilt na ụmụ nwanyị na-enye ara, a ga-akwụsị inye ya ara.

Na arụ ọrụ ezumike ọrụ

Site na iji Zilt ugboro ugboro na ọgwụ nke 75 mg kwa ụbọchị na ndị ọrịa nwere nnukwu ọrụ ezigharị arụmọrụ (mwepụta creatinine - 5-15 ml / min), ogo mwepu nke nchịkọta platelet bụ 25% ala karịa na ogo nke igbochi nchịkọta platelet ma e jiri ya tụnyere ndị ọrụ afọ ofufo nwere ahụ ike. Agbanyeghị, ogologo oge ọgbụgba ahụ dị ka nke ndị ọrụ afọ ofufo ahụ siri ike natara ọgwụ ahụ na ọgwụ nke 75 mg kwa ụbọchị. Nnabata ndị mmadụ na-anabata onwe ha dịkwa mma maka ndị ọrịa niile.

Mkparịta ụka ọgwụ ọjọọ

N'ihi oke ọbara ọgbụgba, a naghị atụ aro ka ịkọ ọgwụ ahụ n'otu oge na warfarin, na mgbe ejikọtara ya na heparin na ndị ọzọ thrombolytic, ekwesịrị ilebara anya pụrụ iche.

NSAIDs na - ebute oke ọnya afọ na ọbara ọgbụgba na eriri afọ.

Enweghi mmekorita di omimi nke ulo ogwu ka ahuru na atenolol, angiotensin-eningme enzyme (ACE) inhibitors, ogwu ndi cholesterol di ala, digoxin, nifedipine, phenobarbital, estrogens, cimetidine, theophylline.

Clopidogrel nwere ike iwelie mmetụta nke acetylsalicylic acid na nchịkọta platelet na-ebute. Mkpakọrịta ọgwụ ọgwụ na acetylsalicylic acid na-eme ka ohere ịwụ ọbara dịkwuo ike, yabụ ojiji nke njikọ a ga-ekwe omume naanị 1 afọ.

Ntinye nke clopidogrel bụ ọgwụ antacids anaghị emetụta.

Nchikota ya na tolbutamide, phenytoin na-abawanye oke nke itinye uche ha na plasma ọbara.

Ihe atụ nke Zilt bụ: Lopirel, Clopidogrel, Clopidogrel-SZ, Plavix, nchịkọta, Detromb, Cardutol, Clopidex, Clopilet, Listab 75, Deplatt-75, Cardogrel, Clopigrant, Lirta, Targetek, Plagril, Egithrombrel, Troken.

Nyocha banyere Zilt

Ndị ọrịa na-anabata ọgwụ ahụ nke ọma, na-arịba ama ọ bụghị naanị ịdị irè ya, kamakwa ọnụahịa a na-anabata nke ọma (ma e jiri ya tụnyere ụfọdụ ndị ogbo ọzọ dị ọnụ). Dika nyocha, Zilt dị irè mgbe nkụchi obi na usoro nkwado. Ndị ọrịa chọpụtara ọganihu dị mma n'ọdịdị nke mkpụmkpụ, nkwụsị nke ọgụ angina, yana enweghị akwara na akwara nke akwara ozi.

Mgbe ụfọdụ ndị ọrịa na-eme mkpesa maka ihe ndapụta na-akpata ya (urticaria, ụkwara ume ọkụ), mana ọ bụrụ na ị gaa n'ihu na ọgwụgwọ, mgbe ahụ mmetụta ndị na-adịghị mma na-apụ n'anya n'onwe ha.

Ọnụ ahịa zachara na ọgwụ

Ruo taa, ọnụ ahịa ego maka Zilt dị n'ụlọ ọgwụ dị ka ndị a:

Mbadamba ihe eji eme ihe nkiri, 75 mg (pcs iri na anọ na ise) - 470-530 rubles,
Mbadamba ihe eji eme ihe nkiri, 75 mg (28 pcs. paaki obula) - 830-1200 rubles,
Mbadamba ihe eji eme ihe nkiri, 75 mg (mkpụrụ ego 84 kwa mkpọ) - 1875-2030 rubles.

Egwu

Mgbe otu onye na-ekwugharị otu ugboro ma ọ bụ ugboro ugboro na ọgwụ nke 75 mg kwa ụbọchị, clopidogrel na-abanye ngwa ngwa. Nkezi ogo nke mkpokọta mkpo (Cmax) nke clopidogrel na - agbanweghi agbanwe na plasma ọbara (2.2-2.5 ng / ml mgbe abali otu 75 mg) ruru ihe dị ka nkeji iri anọ na ise. Dika ihe omumu banyere akpo nke clopidogrel metabolites, ogo ogosi di ihe ruru 50%.

Metabolism

Clopidogrel na-agbasi mbọ ike n'imeju. Na vitro na vivo, clopidogrel bụ metabolized n'ụzọ abụọ: nke mbụ bụ esterases na-eduga ma na-eduga na hydrolysis site na ịmalite nke metabolites na-adịghị arụ ọrụ - ihe sitere na carbonxylic acid (85% nke na-ekesa metabolites), nke ọzọ na-ejikwa siteon iche iche nke cytochrome P450. Na mbu, clopidogrel na-agbanwezi na metabolite nke etiti - 2-oxo-clopidogrel. 2-oxo-clopidogrel na-esote metabolism nke clopidogrel na-esote na-eduga na ịmalite nke metabolite na-arụ ọrụ nke clopidogrel - usoro nke thiol nke clopidogrel. Na vitro, okporo ụzọ a bụ nke isoenzymes CYP3A4, CYP2C19, CYP1A2 na CYP2B6. Ihe na-arụ ọrụ metabolite nke clopidogrel, dịpụrụ adịpụ na vitro, ngwa ngwa na mmekọrịta onwe ya na ndị na-anabata platelet, na-egbochi nchịkọta ha.

Cmax nke metabolite na-arụ ọrụ na plasma ọbara mgbe ị nwesịrị ịkwa ụgwọ (300 mg) nke clopidogrel dị okpukpu abụọ karịa nke Cmax mgbe ụbọchị 4 nke iji clopidogrel na usoro mmezi (75 mg / ụbọchị). A ga-enweta Cmax na plasma ọbara n'ihe dị ka nkeji iri atọ na isii-60 mgbe ị .ụsịrị ọgwụ ahụ.

Mgbe abatacidogrel akara akara 14C, ihe dị ka 50% nke mkpokọta redio bụ mepụtara site na akụrụ ya na ihe dịka 46% site na eriri afọ ahụ n'ime awa 120 mgbe a gbasasịrị. Mgbe otu mkpụrụ ọgwụ clopidogrel na-ejikwa otu ọgwụ nke 75 mg, ọkara ndụ (T1 / 2) bụ ihe dị ka awa 6. T1 / 2 nke metabolite na-adịghị arụ ọrụ na-agagharị na plasma ọbara mgbe otu ugboro na ugboro ugboro bụ 8 awa.

Mgbochi nke nsogbu atherothrombotic:

n'ime ndị okenye okenye nwere ọrịa infarction myocardial (site na ụbọchị ole na ole ruo ụbọchị 35), yana ọrịa ischemic (site na ụbọchị 7 ruo ọnwa 6), ma ọ bụ nchoputa nke ọrịa artlusion occlusion,
na okenye ọrịa nwere nnukwu ọrịa obi: ọrịa na-enweghị ST akụkụ elu (ejighị n'aka angina ma ọ bụ myocardial infarction na-enweghị Q efe), gụnyere ndị ọrịa nwere stenting na percutaneous coronary ጣልቃ, na mgbakwunye na acetylsalicylic acid, na ST nkebi elu (nnukwu myocardial infarction) na ọgwụ ị andụ ọgwụ na ị possibilityụ ọgwụ thrombolytic, yana acetylsalicylic acid.

Mgbochi nke atherothrombotic na nsogbu nke thromboembolic, gụnyere ọrịa ọnya, nwere ọnya fibrillation (atrial fibrillation)

Ndị ọrịa toro eto nwere ọrịa ọnya (atrial fibrillation), ndị nwere opekata mpe otu ihe ga - eme ka nsogbu ọgbụgba, enweghị ike ịnya anticoagulants na - enwekarị ọbara ọgbụgba (yana yana acetylsalicylic acid).

Nnukwu akwara na-arịa ọrịa na-enweghị nnukwu ngalaba ST

Nnukwu akwara na-arịa ọnụnọ na oke ngalaba ST

Atrial fibrillation (atrial fibrillation)

Ọ bụrụ na onye ọrịa ahụ atụfuru ọgwụ ọzọ:

ọ bụrụ n’ihe na-erughị elekere iri na abụọ agafeela mgbe ị gụsịrị ọgwụ ọzọ, ị kwesịrị ị takeụ ọgwụ Zilt® echefuru ozugbo, wee were usoro nke ọzọ n’oge a na-emebu,
ọ bụrụ na ihe karịrị elekere iri na abụọ agafeela mgbe ịwụsịrị usoro ọzọ, mgbe ahụ, a ga-ewere dose ọzọ n’oge ọ na-emebu, mgbe a na-ekwesịghị okpukpu abụọ.

Renrụ ọrụ na-arụ ọrụ na ụlọ

Jiri n'oge ime na lactation

Nnyocha ụmụ anụmanụ egosila na clopidogrel na / ma ọ bụ metabolites ya dị na mmiri ara. Yabụ, ọ bụrụ na ọgwụgwọ na clopidogrel dị mkpa, a na-atụ aro ịkwụsị ị breastụ ara.

Anticoagulants maka nchịkwa ọnụ

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

Ojiji nke clopidogrel na ọgwụ nke 75 mg kwa ụbọchị adịghị agbanwe ọgwụ ọgwụ nke warfarin (mkpụrụ nke CYP2C9 isoenzyme) ma ọ bụ ihe jikọrọ mba ụwa (INR) na ndị ọrịa na-anara ọgwụgwọ ogologo oge na warfarin. Agbanyeghị, iji oge a na warfarin na-amụba ohere nke ọbara ọgbụgba n'ihi nsonaazụ ọzọ na-akwụghị ọtọ na coagulation ọbara. Ya mere, a ga-akpachara anya mgbe ị na-eji warfarin na clopidogrel.

Acetylsalicylic acid

Acetylsalicylic acid anaghị emetụta mmachi nke nchịkọta platelet na - akpata site na Clopidogrel nke ADP na - eweta, mana clopidogrel na - enwe mmetụta nke acetylsalicylic acid na nchịkọta nchịkọta platelet. Agbanyeghị, nchịkwa nke 500 mg nke acetylsalicylic acid ugboro abụọ n'ụbọchị maka otu ụbọchị anaghị agbatị oge ọbara ọgbụgba nke Clopidogrel kpatara. Mkparịta ụka ọgwụ na ọgwụ dị n'etiti clopidogrel na acetylsalicylic acid nwere ike ịbawanye ihe egwu ọbara ọgbụgba. Nyere nke a, akpachara anya kwesịrị ị whilea mgbe ị na-a drugsụ ọgwụ ndị a, ọ bụ ezie na n'ọmụmụ ihe banyere ụlọ ọgwụ, ndị ọrịa weere ọgwụgwọ na clopidogrel na acetylsalicylic acid otu afọ.

Dika nyocha nke ulo ogwu na ndi mmadu di nma, mgbe ha na-ewere Clopidogrel, odighi mkpa igbanwe onodu heparin, na anticoagulant uto nke heparin agbanweghi. N'otu oge a, iji heparin emetụtaghị mkpochapụ nchịkọta platelet site na clopidogrel. Mkparịta ụka ọgwụ na-eme n'etiti clopidogrel na heparin ga-ekwe omume, na-eduga n'ịba ụba ọbara ọgbụgba. Ya mere, n’otu oge eji ọgwụ ọgwụ ndị a chọrọ nlezianya.

Thrombolytics

A na-enyocha nchekwa nke ojiji nke clopidogrel, fibrin-ma ọ bụ thrombolytics kpọmkwem nke hebarin na ndị ọrịa nwere nnukwu myocardial infarction. Ọnọdụ nke ọbara ọgbụgba dị oke egwu bụ nke a tụnyere ya n'otu oge iji thrombolytics, heparin na acetylsalicylic acid.

Ọgwụ ndị na-alụso ọrịa ọgụ ọgụ (NSAIDs)

Dabere na nnyocha nyocha nke ndị ọrụ afọ ofufo nwere ahụ ike, ojiji nke oge clopidogrel na naproxen na-abawanye ọbara ọgbụgba n'oge. Agbanyeghị, n'ihi enweghị ọmụmụ gbasara mmekọrịta ya na ndị NSAID ndị ọzọ ugbu a, amabeghị ma ihe ọghọm ọ ga-ebute ọbara ọgbụgba na-abawanye mgbe ejiri ya na ndị NSAID ndị ọzọ. Ya mere, ekwesịrị ime NSAIDs n'otu oge, gụnyere ndị na-egbochi COX-2, na clopidogrel (lee akụkụ "ntuziaka pụrụ iche").

Ndị na-egbochi CYP2C19 Isoenzyme

Clopidogrel bụ metabolized ka usoro nke metabolite dị ike na-arụ ọrụ, akụkụ ya n'okpuru ikike nke isoenzyme CYP2C19. Ya mere, ọgwụ na-egbochi ichebe a nwere ike ime ka mbelata nke ịba uru nke clopidogrel. Amaghi ogwu banyere nmekorita a. Ikwesiri iji oge a na-egbochi ndị nwere CYP2C19 isoenzyme. Ndị na-egbochi CYP2C19 isoenzyme gụnyere omeprazole na esomeprazole, fluvoxamine, fluoxetine, moclobemide, voriconazole, fluconazole, ticlopidine, ciprofloxacin, cimetidine, carbamazepine, oxcarbazepol na chloramphen.

Ndị na-egbochi proton mgbapụta

Ojiji nke omeprazole na ọgwụ nke 80 mg otu ugboro kwa ụbọchị na clopidogrel ma ọ bụ n ’awa iri na abụọ n’etiti ị twoụ ọgwụ abụọ belatara mkpughe sistemụ (AUC) nke clopidogrel dị pasent 45 (mgbe ị aụchara clopidogrel) na 40% (mgbe ị nwesịrị mmezi doses nke clopidogrel). Mbelata nke AUC nke metabolite na-arụsi ọrụ ike nke clopidogrel nwere njikọ na mbelata ogo nke egbochi mkpokọta platelet (39% mgbe ị aụsịrị ọgwụ clopidogrel na 21% mgbe ị nwesịrị mmezi nke clopidogrel). A na-atụ aro ka enwere mmekọrịta chiri nke clopidogrel na esomeprazole. N'ime nyocha na nyocha, a na-edekọ data dị iche iche na ngosipụta nke akụrụngwa nke usoro akụrụngwa gbasara mmekọrịta ọgwụ a / ọgwụ ọgwụ. Ekwesịrị izere iji otu omeprazole ma ọ bụ esomeprazole.