Mankhwala Clopidogrel C3: malangizo ntchito

Kufotokozera kogwirizana ndi 28.01.2015

Dzina lachi Latin: Clop>

Piritsi la mankhwala Clopidogrel limaphatikizapo 75 mg ya zomwe zimagwiranso ntchito mwa hydrosulfate.

Zowonjezera: prosalv, lactose monohydrate, colloidal silicon dioxide, croscarmellose sodium, sodium fumarate.

Mapangidwe a Shell: pinki opadray II (hypromellose, lactose monohydrate, titanium dioxide, carmine, utoto wachikasu iron okusayidi, macrogol), silicone emulsion.

Kutulutsa Fomu

Mapiritsi okutira a pinki ndi biconvex mawonekedwe, oyera-achikasu padera.

Mapiritsi 14 pa paketi limodzi, 1 kapena 2 mapaketi mumapepala.
Mapiritsi 7 kapena 10 pa paketi iliyonse, 1, 2, 3 kapena 4 mumaphukusi.
Mapiritsi 7 kapena 10 pachimake; 1, 2, 3 kapena 4 matuza okhala mumapepala.
Mapiritsi 14 kapena 28 ali mu botolo la polymer, botolo limodzi mumapepala.
Mapiritsi 14 kapena 28 okhala mu polymer amatha, 1 mu phukusi.

Pharmacodynamics ndi pharmacokinetics

Mankhwalawa amathandizira kukhathamiritsa kuphatikizana kwa maselo a cellen ndi kusankha kumachepetsa kumangiriza kwa adenosine diphosphate (ADP) kwa mapuloteni othandizira, komanso amachepetsa kuthekera kwoyambitsa glycoprotein receptors pansi pa adenosine diphosphate. Mankhwalawa amachepetsa kulumikizana kwa mapulateleti, omwe amayamba chifukwa cha omwe amadana nawo, poletsa kutsegula kwawo ndi ADP yotulutsidwa. Ma mamolekyulu a mankhwalawa amaphatikizana ndi mapuloteni a ADP, pambuyo pake mapulateleti amalephera kudziwa kukondoweza kwa ADP.

Mphamvu yoletsa kuphatikizira kwa kupatsidwa zinthu za m'magazi kumachitika maola awiri itatha yoyamba mlingo. Mlingo wolekezera kuphatikizira umachuluka mkati mwa masiku 4-7 ndikufika pachimake kumapeto kwa nthawi ino. Pankhaniyi, kudya tsiku lililonse kuyenera kukhala 50-100 mg patsiku. Ngati kuwonongeka kwa mitsempha ya atherosclerotic kulipo, ndiye kuti kumwa mankhwalawa kumalepheretsa kupita patsogolo kwa matendawa.

Mukatha kumwa mankhwala munthawi yochepa imamwitsidwa m'matumbo. The bioavailability ya mankhwalawa ndi 50%; kudya zakudya sizikhudza mulingo uno. Kagayidwe ka mankhwala kumachitika mu chiwindi. M'magazi am'magazi, mphamvu zazikulu zimafikira ola limodzi mutatha kumwa mankhwalawa. Kuchotsa hafu ya moyo ndi maola asanu ndi atatu, amene impso zimatuluka m'matumbo.

Malangizo apadera

Kugwiritsa ntchito mankhwalawa kumalumikizidwa ndi kufunika kowunikira nthawi zonse wodwala. Zowonetsa zotsatirazi zilipo:

Odwala omwe zaka zawo zimaposa 75, ulamuliro wa kuchuluka kokwanira uyenera kuthetsedwera.
Pakukonzekera chithandizo, muyenera kutsatira zomwe zikuwonetsa mawonekedwe a heestatic dongosolo, kupenda magwiridwe antchito a chiwindi.
Gwiritsani ntchito mosamala odwala omwe ali ndi chiopsezo chowonjezeka magazi chifukwa cha kuvulala kapena zifukwa zina.
Pamaso pa matenda omwe amachitika ndi kuchepa kwa magazi, ziyenera kukumbukiridwa kuti mankhwalawa amawonjezera nthawi yotuluka magazi.
Mukamayendetsa magalimoto, zindikirani kuti clopidogrel ikhoza kuyambitsa chizungulire.

Pa nthawi yoyembekezera

Mpaka pano, palibe kafukufuku wokhudzidwa kwathunthu komanso kuyesa pazotsatira za clopidogrel pamimba komanso kukula kwa mwana wosabadwayo sikunayambike. Pachifukwa ichi, mankhwalawa saikidwa pa nthawi ya pakati. Palibe umboni wa kuchuluka kwa momwe mankhwalawa amadutsira mkaka wa m'mawere, chifukwa chake kutenga Clopidogrel osavomerezeka panthawi yoyamwitsa.

Zizindikiro zogwiritsidwa ntchito

Kupewa kwa zochitika za atherothrombotic mwa odwala pambuyo poyambira m'masiku ochepa mpaka masiku 35), matenda a ischemic (kuyambira masiku 7 mpaka miyezi 6) kapena omwe ali ndi matenda opatsirana a parterheral.

Kupewa kwa zochitika za atherothrombotic (kuphatikiza ndi acetylsalicylic acid) mwa odwala omwe ali ndi vuto la coralary syndrome:

- popanda kukweza gawo la ST (kusakhazikika kwa angina kapena kulowetsedwa kwa myocardial yopanda Q wave), kuphatikiza odwala omwe adakumana ndi vuto la kulowerera kwa mtima,

- ndi kuwuka kwa gawo la ST (pachimake myocardial infarction) ndi mankhwala osokoneza bongo komanso kuthekera kwa thrombolysis.

Contraindication

- kutuluka magazi kwambiri (mwachitsanzo, kutuluka magazi kuchokera ku zilonda zam'mimba kapena intracranial hemorrhage),

- kusowa kwa cholowa lactose tsankho, kuperewera kwa lactase ndi malabsorption a glucose-galactose,

- ana ndi achinyamata ochepera zaka 18 (chitetezo sichinakhazikitsidwe),

- Hypersensitivity to clopidogrel kapena aliyense wa okonda mankhwala.

- Kuchepa kwa chiwindi moyenera, komwe kumapangitsa chiyembekezo cha kutaya magazi (kuperewera kwakanthawi kachipatala)

- kulephera kwa aimpso (zochepa zomwe munakumana nazo)

- matenda omwe ali ndi chiyembekezo cha chitukuko cha magazi (makamaka m'mimba kapena ma intraocular),

- munthawi yomweyo mankhwala osapweteka a anti-kutupa, kuphatikiza kusankha COX-2 zoletsa,

- kugwiritsa ntchito munthawi yomweyo warfarin, heparin, glycoprotein IIb / IIIa zoletsa,

Momwe mungagwiritsire ntchito: Mlingo ndi njira ya chithandizo

Akuluakulu ndi odwala okalamba omwe ali ndi zochitika wamba za CYP2C19 isoenzyme

Clopidogrel-SZ iyenera kumwedwa pakamwa, mosasamala kanthu za kudya.

Myocardial infarction, ischemic stroke, ndipo wapeza matenda oopsa a ubongo

Mankhwala amatengedwa pa 75 mg 1 nthawi / tsiku.

Odwala omwe ali ndi myocardial infarction (MI), chithandizo chitha kuyambitsidwa kuchokera masiku oyamba mpaka tsiku la 35 la MI, komanso mwa odwala a ischemic stroke (II), kuyambira masiku 7 mpaka 6 miyezi MI itadutsa.

Acute coronary syndrome yopanda gawo la ST (kusakhazikika kwa angina, kulowetsedwa kwa myocardial popanda Q wave)

Kuchiza ndi Clopidogrel-SZ kuyenera kuyamba ndi mlingo umodzi wotsekera wa 300 mg, kenako ndikupitilira mlingo wa 75 mg 1 nthawi / tsiku (osakanikirana ndi acetylsalicylic acid ngati antiplatelet wothandizila pa Mlingo wa 75-325 mg / tsiku). Popeza kugwiritsa ntchito acetylsalicylic acid mu Mlingo wapamwamba kumalumikizidwa ndi chiopsezo chowonjezereka cha magazi, mlingo wolimbikitsidwa wa acetylsalicylic acid suyenera kupitirira 100 mg. Kwambiri achire zotsatira zimawonedwa ndi mwezi wachitatu wa mankhwala. Njira ya mankhwala mpaka 1 chaka.

Pachimake coronary syndrome ndi ST gawo kukweza (pachimake myocardial infarction ndi ST gawo kukweza)

Clopidogrel amalembedwa pa mlingo wa 75 mg 1 nthawi / tsiku ndi limodzi lokha mlingo wokhala ndi limodzi la acetylsalicylic acid ngati antiplatelet wothandizila ndi thrombolytics (kapena popanda thrombolytics). Kuphatikiza mankhwala kumayambira posachedwa pambuyo pa kuyamba kwa zizindikiro ndikupitilira kwa milungu inayi. Odwala opitirira zaka 75, chithandizo ndi Clopidogrel-SZ ziyenera kuyamba popanda kumwa mankhwala.

Odwala omwe ali ndi chibadwa cha CYP2C19 cha Isoenzyme

Kuchepa kwa kagayidwe kogwiritsa ntchito CYP2C19 isoenzyme kungayambitse kuchepa kwa mphamvu ya antiplatelet ya clopidogrel. Mlingo woyenera kwambiri wa odwala omwe ali ndi mphamvu yofooka pogwiritsa ntchito CYP2C19 isoenzyme sunakhazikitsidwebe.

Zotsatira za pharmacological

Antiplatelet wothandizira. Clopidogrel ndi mankhwala osokoneza bongo, amodzi mwa metabolites yogwira yomwe imalepheretsa kuphatikizana kwa maselo ambiri. Yogwira clopidogrel metabolite mosamala imalepheretsa kumangiriza kwa adenosine diphosphate (ADP) ku P2Y12 platelet receptor ndi AdP-mediated activation ya GPIIb / IIIa zovuta, zomwe zimayambitsa kukakamiza kwa kupatsidwa zinthu zam'magazi. Chifukwa chomangirira osasinthika, mapulateleti amakhala osakhudzidwa ndi ADP kwa moyo wawo wonse (pafupifupi masiku 7-10), ndipo ntchito yantchito yamapulatifumu imabwezeretsedwa pamlingo wofanana ndi kukonzanso kwa mapulateleti. Kuphatikizana kwa mapulateleti chifukwa cha agonists ena osakhala a ADP kumalepheretsanso chifukwa cha kuchuluka kwa mapulatifomu opangidwa ndi ADP. Chifukwa Kupangika kwa metabolite yogwira kumachitika pogwiritsa ntchito P450 isoenzymes, ina yomwe imatha kusiyana polymorphism kapena imatha kuletsedwa ndi mankhwala ena; si odwala onse omwe amatha kuponderezana kwa chakudya cham'magazi.

Zotsatira zoyipa

Kuchokera pakati ndi potumphukira mantha dongosolo: pafupipafupi - kupweteka mutu, chizungulire ndi paresthesia, kawirikawiri - vertigo, kawirikawiri - kuphwanya kwamawonekedwe a kukoma.

Pa mbali ya mtima dongosolo: kawirikawiri - vasculitis, chizindikiro kuchepa magazi, intracranial hemorrhage, ocular hemorrhage (conjunctival, mu minofu ndi retina), hematoma, nosebleeds, magazi ochokera kupuma thirakiti, kupweteka kwam'mimba, magazi obwezeretsanso magazi. Zotsatira, zotupa mu minofu ndi mafupa, hematuria.

Kuchokera kupuma dongosolo: kawirikawiri - bronchospasm, interstitial pneumonitis.

Kuchokera pamatumbo am'mimba: pafupipafupi - kutsekula m'mimba, kupweteka kwam'mimba, dyspepsia, pafupipafupi - zilonda zam'mimba ndi zilonda zam'mimba, gastritis, kusanza, nseru, kudzimbidwa, kusagona mwachangu, kawirikawiri - pancreatitis, colitis (kuphatikizapo zilonda zam'mimba kapena zam'mimba. stomatitis, pachimake chiwindi kulephera, hepatitis.

Kuchokera kwamikodzo dongosolo: kawirikawiri - glomerulonephritis.

Kuchokera pakupanga kwamagazi magazi: pafupipafupi - kukulitsa nthawi yotuluka magazi.

Kuchokera pa hemopoietic system: infrequent - thrombocytopenia, leukopenia, neutropenia ndi eosinophilia, kawirikawiri - thrombocytopenic thrombohemolytic purpura, thrombocytopenia (kupatsidwa zinthu za m'magazi ochepera kapena ofanana ndi 30 × 109 / l), agranulocytosis, granulocytopenia.

Pa khungu ndi subcutaneous zimakhala: kawirikawiri - zotupa pakhungu ndi kuyabwa, kawirikawiri - angioedema, urticaria, erythematous zidzolo (zimagwirizanitsidwa ndi clopidogrel kapena acetylsalicylic acid), kawirikawiri - bulous dermatitis (erythema multiforme, Stevens-Johnson syndrome, poizoni, poizoni ), eczema ndi lichen planus.

Kuchokera ku minculoskeletal system: kawirikawiri - arthralgia, nyamakazi, myalgia.

Pa mbali ya chitetezo chamthupi: kawirikawiri - anaphylactoid zimachitika, seramu matenda.

Kuchita

Ntchito munthawi yomweyo ndi clopidogrel zimatha kuwonjezera kuchuluka kwa magazi, chifukwa chake kuphatikiza sikulimbikitsidwa.

Kugwiritsa ntchito kwa IIb / IIIa receptor blockers molumikizana ndi clopidogrel kumafuna kusamala kwa odwala omwe ali ndi chiopsezo chowonjezeka magazi (ndi kuvulala ndi kulowererapo kapena njira zina za pathological).

Acetylsalicylic acid sasintha zotsatira za clopidogrel, zomwe zimalepheretsa kuphatikizika kwa magazi kwa ADP, koma Clopidogrel imayambitsa zotsatira za acetylsalicylic acid pa collagen-ikiwayambitsa kuphatikizira kwa mapulateleti. Komabe, munthawi yomweyo makonzedwe acetylsalicylic acid okhala ndi antipyretic wothandizila 500 mg 2 nthawi / tsiku 1 tsiku silinayambitse kuwonjezeka kwambiri kwa magazi nthawi yoyambitsidwa ndi clopidogrel makonzedwe. Pakati pa clopidogrel ndi acetylsalicylic acid, kuyanjana kwa pharmacodynamic ndikotheka, komwe kumayambitsa chiopsezo chowonjezereka cha magazi. Chifukwa chake, pogwiritsa ntchito munthawi yomweyo, kusamala kuyenera kuchitidwa, ngakhale mu maphunziro azachipatala, odwala adalandira chithandizo cha ophatikizana ndi clopidogrel ndi acetylsalicylic acid kwa chaka chimodzi.

Malinga ndi kafukufuku wachipatala omwe adachitika ndi odzipereka athanzi, atatenga clopidogrel, palibe chifukwa chosinthira mlingo wa heparin ndipo zotsatira zake za anticoagulant sizinasinthe. Kugwiritsa ntchito kwa nthawi imodzi kwa heparin sikunasinthe mphamvu ya antiplatelet ya clopidogrel. Pakati pa clopidogrel ndi heparin, kuyanjana kwa pharmacodynamic ndikotheka, komwe kumatha kuwonjezera ngozi, kotero kugwiritsa ntchito mankhwalawa pamafunika kusamala.

Malangizo ogwiritsira ntchito

Clopidogrel amagwiritsidwa ntchito mwa odwala akuluakulu 1 nthawi patsiku (asanadye chakudya chamadzulo, atatha kudya masana), osasamala chakudya. Piritsi siyenera kutafunidwa. Imwani madzi ambiri (osachepera 70 ml). Njira yovomerezeka yovomerezeka ya mankhwalawa ndi 75 mg patsiku (piritsi limodzi).

Njira yogwiritsira ntchito matenda owopsa a mtima: akulu mu dipatimenti ya mtima yoyang'aniridwa ndi achipatala amatchulidwa 300 mg ya clopidogrel. Pambuyo pake, mankhwalawa amapitilizidwa pokonza Mlingo wa 75 mg, nthawi zambiri osakanikirana ndi asidi acetylsalicylic acid kuchokera ku 0,075 mpaka 0,325 g.

Zofunika! Popewa kutuluka magazi, musatenge oposa 100 mg a acetylsalicylic acid.

Nthawi yovomerezedwa sichidziwika bwinobwino. Kumwa mankhwalawa kumapitirirabe mpaka mkhalidwe wa wodwalayo ubwerere mwakale pakubala kwa dokotala.

Njira ya mankhwalawa panthawi ya vuto la mtima: Mlingo wa clopidogrel ndi 75 mg patsiku, kuphatikizapo mlingo woyamba wa 300 mg osakanikirana ndi acetylsalicylic acid ndi mankhwala a thrombolytic.

Zofunika! Ndikofunika kuti odwala atatha zaka 75 asamachotsere ntchito yogwiritsa ntchito mankhwala.

Nthawi ya regimen imakhala mwezi umodzi.

Ngati zosiyidwa, zotsatirazi ziyenera kuchitidwa:

Ngati maola opitilira 12 atsala musanamwe piritsi lotsatira, imwani mapiritsi nthawi yomweyo.
Ngati musanagwiritse ntchito mlingo wotsatira wa clopidogrel wochepera maola 12 - tengani mlingo wotsatira nthawi yoyenera (musakule mlingo).

Ndi zoletsedwa kudziyimira pawokha komanso mwadzidzidzi kuletsa kugwiritsa ntchito clopidogrel, popeza vuto la wodwalayo likhoza kukulirakulira, kuyambiranso matenda omwe akudwala angayambike.

Bongo

Kugwiritsa ntchito mankhwala osavomerezeka a Clopidogrel akhoza kutsatiridwa ndi izi:

magazi
kuchuluka kwa magazi.

Chithandizo chachikulu cha mankhwala osokoneza bongo ndichizindikiro. Chothandiza kwambiri ndikuthiridwa kwa mankhwalawa chifukwa cha maselo ambiri.

Ndi mowa

Pankhani yokhudzana ndi zakumwa zoledzeretsa, mwayi wokhumudwitsa m'mimba ndi matumbo awonjezeka, chifukwa chomwe magazi amatha kutuluka. Chifukwa chake, kuphatikiza kwa clopidogrel ndi mowa sikuyenera kuyikidwa kunja chifukwa chogwirizana kwambiri.

Makampani opanga mankhwala opanga Clopidogrel m'malo mwake:

Agrel,
Gridoklein,
Atherocard,
Avix,
Clopidogrel opanga osiyanasiyana - Izvarino, Tatkhimpharmpreparaty, Canon Pharma, Severnaya Zvezda (SZ), Biocom (Chithunzi cha ku Russia cha Clopidogrel), Teva, Gideon Richter, Ratiopharm, Zentiva,
Atrogrel
Cardogrel
Diloxol
Sylt,
Kukhazikika,
Deplatt
Noclot,
Clopact,
Clorelo
Clopix
Clopidal
Lodigrel
Orogrel
Thonje,
Placep
Lopirel
Plavix,
Reodar,
Trombix,
Plaglir,
Trombeks,
Palat
Pingel
Reomax
Trombone,
Clopidex
Plavigrel
Chikalak.

Mankhwalawa onse alibe kusiyana pakapangidwe ndi Mlingo wa chinthu chomwe chikugwira. Kusiyanaku kumangokhala opanga ndi mtengo.

Pharmacokinetics

Mafuta Pambuyo pa Mlingo wowonjezera kamodzi komanso mobwerezabwereza wa 75 mg patsiku, clopidogrel imatengedwa mwachangu. Pafupifupi kuchuluka kwa plasma ya phata yayikulu (pafupifupi 2.2-2.5 ng / ml pambuyo pa kamwa imodzi ya 75 mg) imawonedwa pafupifupi mphindi 45 pambuyo pa kuperekedwa.Kutengera clopidogrel metabolites omwe amuchotsa mkodzo, mayamwidwe ali osachepera 50%.

Kugawa. Clopidogrel ndi main (osagwira) ozungulira metabolite mobwerezabwereza omwe amamangilira mapuloteni a plasma muvitro (98 ndi 94%, motsatana). Chomangira ichi sichikhala chosakwaniritsidwa. muvitro pamitundu yambiri.

Kupenda. Clopidogrel imapangidwa mwachangu mu chiwindi. Muvitro ndi muvivo Clopidogrel imapukusidwa m'njira ziwiri zazikulu: imodzi imayendetsedwa ndi ma esterases ndipo imatsogolera ku hydrolysis kupita ku carboxylic acid (85% ya metabolites yomwe imazungulira m'magazi), ina (15%) imakhala yolumikizidwa ndi ma cytochromes ambiri a P450. Choyamba, clopidogrel imapangidwira kwa yapakatikati metabolite, 2-oxo-clopidogrel. Pambuyo kagayidwe kachakudya kagayidwe kachakudya 2 - oxo-clopidogrel kumabweretsa mapangidwe yogwira metabolite, thiol yotengera Clopidogrel. Muvitro njirayi ya metabolic imayendetsedwa ndi CYP3A4, CYP2C19, CYP1A2 ndi CYP2B6. Acth thiol metabolite omwe adzipatula muvitro mwachangu komanso mosasinthika, zimakumana ndi maselo am'magazi, potero zimalepheretsa kuphatikizika kwa maselo ambiri.

Ndi_max yogwira metabolite ndi iwiri pawiri pambuyo limodzi mlingo wa katundu 300 mg wa clopidogrel kuposa masiku anayi yokonza mlingo wa 75 mg. Ndi_max anati 30-60 pambuyo kumwa mankhwala.

Kuthetsa. Pafupifupi 50% ya mankhwalawa amuchotsa mkodzo ndipo pafupifupi 46% ndi ndowe mkati mwa maola 120 pambuyo pa kuwongolera. Pambuyo pakamwa kamodzi pa 75 mg, kuchotsedwa kwa theka-moyo wa clopidogrel ndi maola 6. Hafu ya moyo wa metabolite yayikulu yozungulira ndi maora 8 pambuyo pa kayendetsedwe kamodzi komanso mobwerezabwereza.

Mankhwala. CYP2C19 imathandizira pakupanga metabolite yogwira komanso yapakatikati metabolite, 2-oxo-clopidogrel. Pharmacokinetics ndi antiplatelet zotsatira za yogwira metabolite wa clopidogrel monga anayeza mu mayeso exvivo, zimasiyana kutengera mtundu wa CYP2C19.

CYP2C19 * 1 allele ikufanana ndi metabolism yogwira ntchito mokwanira, pomwe ma CYP2C19 * 2 ndi CYP2C19 * 3 maulendowa sagwira ntchito. Nkhaniyi CYP2C19 * 2 ndi CYP2C19 * 3 imafotokoza ambiri mwa anthu amatsenga omwe ali ndi khungu loyera (85%) ndi aku Asia (99%) omwe ali ndi metabolism osakwanira. Zovomerezeka zina zomwe zimasowa kapena kuchepetsedwa zimaphatikizapo, mwa ena, CYP2C19 * 4, * 5, * 6, * 7 ndi * 8. Odwala omwe amachepetsa metabolic ntchito amakhala onyamula ziwiri zopanda ntchito. Malinga ndi zomwe zasindikizidwa, pafupipafupi kupezeka kwa genotype kochita kuchepa kwa CYP2C19 kuli pafupifupi 2% mu liwiro la Caucasoid, 4% mu liwiro la Negroid ndi 14% mu liwiro la Mongoloid.

Kuchuluka kwa maphunziro omwe adachitika sikokwanira kuzindikira kusiyana kwa zotsatira za odwala omwe ali ndi vuto losakwanira la clopidogrel metabolism.

Matenda aimpso. Kuphatikizika kwa metabolite yayikulu yozungulira yozungulira m'magazi am'magazi mutatenga 75 mg ya clopidogrel patsiku inali yotsika kwa odwala omwe ali ndi vuto lalikulu la impso (creatinine chilolezo kuyambira 5 mpaka 15 ml / min) poyerekeza ndi odwala omwe kupezeka kwa creatinine ndi 30-60 ml / min ndi anthu athanzi. Nthawi yomweyo, mphamvu yoletsa kuphatikizira kwa mapulani am'magazi a ADP-odwala omwe ali ndi matenda oopsa a impso idachepetsedwa (25%) poyerekeza ndi zofanana ndi anthu athanzi, nthawi yotulutsa magazi inakulitsidwa kufikira mulingo wofanana ndi mwa anthu athanzi omwe adalandira 75 mg clopidogrel patsiku. Kuphatikiza apo, kupirira kwachipatala kunali kwabwino kwa odwala onse.

Kuwonongeka kwa chiwindi. Odwala omwe ali ndi vuto lolemera la hepatic, akamamwa tsiku lililonse la 75 ml ya clopidogrel kwa masiku 10, zomwe AdP-suppression supplication ya kupatsidwa kwa maselo othandizira zinali zofanana ndi za anthu athanzi. Kuchulukitsa kwa nthawi yotuluka magazi kudalinso chimodzimodzi m'magulu awiriwo.

Mtundu. Kuyang'anira kwa CYP2C19, komwe kumayambitsa kupangika kwapakati komanso kusauka kwa metabolism komwe kumakhudza CYP2C19, kumasiyanasiyana ndi mtundu kapena mtundu. Zambiri zokhala ndi kuchuluka kwa anthu ku Asia zomwe zimapezeka m'mabuku kuti azitha kudziwa kufunikira kwa mtundu wa CYP pa zotsatira zamankhwala.

Mimba komanso kuyamwa

Kafukufuku wokhudzana ndi zotsatira za kubadwa kwa magazi m'mimba mwa mayi m'mimba sizinawonetse vuto pa kutenga pakati, kukulira kwa mluza, chiberekero ndi ntchito yakukula kwa m'mimba.

Kuyamwitsa. Sizikudziwika ngati clopidogrel imadutsa mkaka wa m'mawere a anthu. Kafukufuku wazinyama atsimikizira kuti mankhwalawa amadutsa mkaka wa m'mawere. Monga kusamala, kuyamwitsa kuyenera kutha nthawi ya mankhwalawa ndi clopidogrel.

Popeza mankhwalawa amachotsedwa mkaka wa m'mawere, komanso chifukwa chakukula kwakukulu m'makanda oyamwitsa, lingaliro la kusiya kumwa mankhwalawa kapena kusiya kuyamwitsa liyenera kupangidwa, chifukwa chofunikira chithandizo cha clopidogrel mwa amayi oyamwitsa.

Ntchito yobereka. Mu maphunziro a nyama, clopidogrel sizinawononge ntchito yakubereka.

Mlingo ndi makonzedwe

Clopidogrel adapangira pakamwa pakamwa kamodzi patsiku, mosasamala kanthu za kudya.

Mlingo

Akuluakulu ndi okalamba

Mlingo wa tsiku lililonse ndi 75 mg pamlomo kamodzi patsiku.

Pachimake coronary syndrome:

- pachimake coronary syndrome popanda gawo kukweraST(osakhazikika angina kapena myocardial infarction popanda dzinoQ): Chithandizo cha Clopidogrel chiyenera kuyambitsidwa ndi muyeso umodzi wokweza 300 mg, kenaka ndikupitiliza ndi mlingo wa 75 mg kamodzi patsiku (ndi acetylsalicylic acid pa mlingo wa 75-325 mg patsiku. Sitikulimbikitsidwa kupitilira muyeso wa acetylsalicylic acid wa 100 mg, chifukwa milingo yapamwamba ya ASA imalumikizidwa ndi chiopsezo chowonjezeka magazi. Kutalika kokwanira kwa chithandizo sikunakhazikitsidwe mwadongosolo. Zotsatira zamayesero azachipatala zimatsimikizira kugwiritsidwa ntchito kwa regimen kwa miyezi 12, ndipo phindu lalikulu limawonedwa pambuyo pa miyezi itatu.

- pachimake myocardial infarction ndi gawo kukweraST: Clopidogrel ndi mankhwala kamodzi patsiku la 75 mg yogwiritsira ntchito mankhwala oyamba a 300 mg osakanikirana ndi acetylsalicylic acid osakanikirana ndi kapena wopanda thrombolytics. Kwa odwala omwe ali ndi zaka zopitilira 75, chithandizo cha clopidogrel chikuyenera kuchitika popanda kugwiritsa ntchito mlingo wokulitsa. Kuphatikiza mankhwalawa kumayambira posachedwa pambuyo pa kuyamba kwa zizindikiro ndikupitilira kwa milungu inayi. Ubwino wophatikiza Clopidogrel ndi ASA patadutsa milungu inayi sunaphunziridwe pankhaniyi.

Fibrillation yoyeserera: 75 mg clopidogrel kamodzi patsiku. Perekani ASA (75-100 mg / tsiku) ndikupitilirabe kuphatikiza ndi clopidogrel.

Mukadumpha mlingo:

- osapitirira maola 12 kuchokera nthawi yokhazikika yomwe wavomerezedwa: ndikofunika kumwa msangawo nthawi yomweyo, mlingo wotsatira uyenera kumwedwa nthawi yoyenera,

- Opitilira maola 12 kuchokera nthawi yovomerezeka: Mlingo wotsatira uyenera kumwedwa nthawi yoyenera, osaneneka katatu.

Ana ndi achinyamata

Chitetezo ndi kufunika kwa clopidogrel mwa ana sichinakhazikitsidwe.

Odwala ndi mkhutu aimpso ntchito

Zochitika pochiritsa odwala omwe ali ndi vuto laimpso ndilochepa.

Odwala omwe ali ndi vuto la chiwindi

Zochitika pochiza odwala omwe ali ndi matenda a chiwindi omwe hemorrhagic diathesis imatheka ndiyochepa.

Njira zopewera kupewa ngozi

Kupuma ndi hematologic mavuto

Ngati zizindikiro zamankhwala zikuwoneka nthawi ya chithandizo chomwe chikuwonetsa kukula kwa magazi ndi zovuta za hematological, kuyezetsa magazi kuyenera kuchitidwa nthawi yomweyo. Chifukwa cha kuchuluka kwa magazi, muyenera kusamala mukamayang'anira coopidogrel ndi warfarin.

Clopidogrel iyenera kugwiritsidwa ntchito mosamala odwala omwe ali pachiwopsezo chotaya magazi ambiri chifukwa cha zoopsa, opaleshoni kapena zovuta zina zam'magazi, komanso kuphatikiza kwa clopidogrel ndi acetylsalicylic acid, mankhwala osapweteka a antiidal, kuphatikizapo COX-2 inhibitors, heparin, glycoprotein inhibitors IIb / IIIa, kusankha kwa mankhwala a serotonin reuptake inhibitors (SSRIs) kapena mankhwala ena omwe ali pachiwopsezo chotaya magazi, monga pentoxifylline. Kuwunikira mosamala mawonetseredwe am'magazi otuluka magazi, kuphatikizapo magazi omwe amatuluka, amafunika, makamaka masabata oyambilira a chithandizo ndi / kapena pambuyo panjira ya mtima kapena ya opaleshoni. Kugwiritsira ntchito kophatikizana kwa clopidogrel ndi anticoagulants sikulimbikitsidwa, popeza kuphatikiza koteroko kungakulitse kuchuluka kwa magazi.

Ngati kuchitapo kanthu pochita opaleshoni, ngati antiplatelet zotsatira zosakomera, njira ya mankhwalawa ndi clopidogrel iyenera kusiyidwa masiku 7 asanachitike opaleshoni. M'pofunika kudziwitsa dokotala komanso wamano kuti amwe mankhwala ngati wodwalayo akufuna kuchitidwa opaleshoni kapena ngati dokotala amupangira wodwala mankhwala ena atsopano.

Clopidogrel iyenera kugwiritsidwa ntchito mosamala odwala omwe ali pachiwopsezo cha kutaya magazi (makamaka m'mimba ndi intraocular). Mukamamwa clopidogrel, samalani pogwiritsa ntchito mankhwala omwe angayambitse matenda am'mimba (mwachitsanzo, acetylsalicylic acid ndi NSAIDs).

Mukuyenera kudziwa kuti kuyambira kukhetsa magazi mukamamwa clopidogrel (nokha kapena mukusakanikirana ndi ASA) kumafuna nthawi yambiri, muyenera kudziwitsa dokotala za vuto lililonse losatulutsa (mwa malo ndi / kapena kutalika) magazi.

Thrombotic Thrombocytopenic Purpura (TTP)

Milandu yachilendo kwambiri ya thrombotic thrombocytopenic purpura (TTP) pambuyo poti clopidogrel yanenedwa. Izi zimadziwika ndi thrombocytopenia ndi microangiopathic hemolytic anemia kuphatikiza ndi mwina ndi minyewa, kuvulala kwaimpso, kapena kutentha thupi. Kukula kwa TTP kumatha kukhala pachiwopsezo cha moyo ndipo kungafunike kuchitapo kanthu mwachangu, kuphatikiza plasmapheresis.

Milandu yokhudzana ndi kupezeka kwa hemophilia adanenedwa atatenga clopidogrel. Pankhani ya kuwonjezereka kokhazikika kwa nthawi yokhazikitsidwa ndi gawo la thromboplastin nthawi kapena popanda magazi, mwayi wokhala ndi hemophilia woyenera uyenera kuganiziridwanso. Odwala omwe ali ndi vuto lowonetsa kuti ali ndi hemophilia ayenera kuyang'aniridwa ndikuthandizidwa ndi akatswiri, chithandizo cha clopidogrel ziyenera kusiyidwa.

Chifukwa cha kusowa kwa data, clopidogrel sayenera kutumizidwa masiku 7 oyamba atatha kupweteka kwa ischemic.

Odwala ndi kuchepetsedwa kagayidwe kachakudya ntchito CYP2C19, clopidogrel mu analimbikitsa Mlingo wochepa wa yogwira metabolite wa clopidogrel ndipo wocheperanso antiplatelet kwenikweni. Odwala omwe amachepetsa metabolic ntchito ndi pachimake coronary syndrome kapena omwe adatha kulowerera kwamitsempha yamagazi ndi kulandira chithandizo cha clopidogrel pa Mlingo woyenera atha kukhala pachiwopsezo chachikulu cha kukhala ndi vuto la mtima kuposa odwala omwe ali ndi ntchito yofanana ya CYP2C19.

Popeza clopidogrel imapukusidwa ku metabolite yogwira gawo limodzi ndi CYP2C19, zikuyembekezeka kuti mankhwala omwe amachepetsa ntchito ya enzymeyi adzatsogolera kuchepa kwa kuchuluka kwa mankhwala a metabolite a clopidogrel. Kufunika kwachipatala pakuyanjanaku sikunaphunzire. Kugwiritsa ntchito nthawi yomweyo kwa ma CYP2C19 zolimba kapena zolimbitsa thupi ziyenera kutayidwa.

Chenjezo limafunikira kwa odwala omwe amalandila limodzi ndi mankhwala a clopidogrel - magawo a CYP2C8 isoenzyme.

Allergic Cross Reacaction

Wodwala ayenera kukhala ndi mbiri ya hypersensitivity kwa thienopyridine ena (mwach. Ticlopidine, prasugrel), popeza pali milandu yodziwika yokhudzana ndi kugawanika kwa thienopyridines. Odwala omwe ali ndi mbiri ya hypersensitivity kwa thienopyridine ayenera kuthandizidwa mosamala pakumwa mankhwala a hypersensitivity kuti clopidogrel. Thienopyridines angayambitse kukula kwa matupi amtundu wosiyanasiyana, monga zotupa, edema ya Quincke, kapena masinthidwe amtundu wa hematological, monga thrombocytopenia ndi neutropenia. Odwala omwe adakumana ndi zovuta zam'mbuyomu komanso / kapena masinthidwe amtundu wina wa thienopyridine akhoza kukhala ndi chiopsezo chotenga chotengera chimodzi kapena chosiyana ndi thienopyridine wina.

Kuphatikizika kwa mankhwalawa kumaphatikizapo utoto wa karmuazin (E-122), womwe umatha kuyambitsa mavuto.

Matenda aimpso

The achire zinachitikira ndi clopidogrel odwala mkhutu aimpso ntchito ndizochepa. Mankhwala ayenera kugwiritsidwa ntchito mwa odwala mosamala.

Kuwonongeka kwa chiwindi

Clopidogrel iyenera kugwiritsidwa ntchito mosamala odwala omwe ali ndi vuto la chiwindi cholimbitsa, lomwe lingayambitse hemorrhagic diathesis.

Kukopa pa kuyendetsa magalimoto ndi njira zina zowopsa. Clopidogrel siyimakhudzanso kapena imakhala yovuta pang'ono pakutha kuyendetsa magalimoto ndi zina njira.