Lopirel: analogues, kapangidwe, Mlingo, malangizo, ntchito, zikuonetsa

Yogwira pophika mankhwala posankha amalepheretsa molekyula ADP ndi zomata zomwe zili pansi kuchuluka kwa mapulateleti. Chifukwa chake, kuyambitsa kwa zovuta GPIIb / IIIa ndi kuphatikiza kupatsidwa zinthu za m'magazi zimakhala zosatheka. Komanso clopidogrel chimalepheretsa njira zosinthira zomwe zimayambitsa ena otsutsa. Mapulatazi amakhalabe oonongeka komanso osatha kukonza mpaka kumapeto kwa moyo wawo. kuphatikiza.

Pambuyo kulandira koyamba kwa mankhwala, njira yotsutsa imayamba kuchitika, mulingo wa leukocytes umakhazikitsidwa ndi masiku 3-7 oyang'anira. Pafupifupi, masiku 5 atasiya kulandira chithandizo, kuphatikizira kwa maselo ndi nthawi yotaya magazi kubwerera mgawo loyamba.

Mankhwalawa amatengeka mwachangu Matumbo. Komabe, ndende clopidogrelmu plasma ndi yochepa kwambiri, mayamwidwe ndi 50%. Mankhwalawa amamangidwa bwino ndi mapuloteni am'magazi.

Clopidogrel imapangidwa mu chiwindi, pafupifupi 80% ya metabolites yomwe imapezeka mu plasma imagwira ntchito. Yogwira metabolite, yomwe imapereka zofunikira anti-ophatikiza kanthu, opangidwa ndi makutidwe ndi okosijeni zochita isoenzyme ya cytochrome P450 - 2B6 ndi 3A4. Metabolite yokha imakambirana mwachangu mapulateleti ndipo sapezeka m'madzi am'magazi.

Hafu ya moyo ndi maola 6 ogwira ntchito ndi 8 chifukwa cha metabolite yake yogwira ntchito. Zogulitsa zimapakidwa makamaka ndi mkodzo ndi ndowe.

Anthu omwe akuvutika kwambiri ndi impso, kuchepa kwa mphamvu ya mankhwalawa ndi 25% poyerekeza ndi anthu athanzi.

Zisonyezero zogwiritsa ntchito Lopirel

Mankhwala amagwiritsidwa ntchito kupewa ochepa thrombosis mwa anthu omwe ali ndi vuto lodana ndi pachimake:

Zomwe zikuwonetsedwa kuti ndizogwiritsidwa ntchito atherothrombotic mavuto omwe akudwala omwe akuvutika myocardial infaration, sitirokokukhala matenda otumphukira ochepa. Mwanjira imeneyi, mankhwalawa amagwiritsidwa ntchito ngati prophylaxis.

Contraindication

Mankhwala sanatchulidwe:

• kwambiri kulephera kwa chiwindi,
• amayi apakati ndi othira pansi,
• at hemorrhagic syndrome,
• at intracranial hemorrhage, zilonda zam'mimbazosadziwika zilonda zam'mimba, zotupa zam'mapapo, chifuwa chachikulu ndi hyperfibrinolysis,
• ana ochepera zaka 18
• at chifuwa pazinthu za mankhwala,
• ndi tsankho galactose.

Kusamala kuyenera kuchitidwa pophatikiza mankhwalawa acetylsalicylic acid, NSAIDs, heparin, manga, ndi aimpso komanso kwa hepatic kusowa, musanachite opareshoni.

Lopirel, malangizo ogwiritsira ntchito (njira ndi Mlingo)

Mapiritsi amatengedwa pakamwa, ngakhale mtundu wa zakudya.

Malangizo ogwiritsira ntchito Lopirel (75 mg)

Monga lamulo, ndi myocardial infarationischemic stroke, odwala omwe ali ndi matenda oyambitsidwa ndi zotumphukira amapatsidwa piritsi 1 nthawi imodzi patsiku.

Kutalika kwa chilolezo pambuyo vuto la mtima - kuyambira 1 mpaka 25 tsiku, pambuyo sitiroko - Masiku 7 kapena miyezi isanu ndi umodzi.

Ngati wodwalacoronary syndrome popanda kukweza ST kapena unagwidwa kunjenjemera, ndiye kuti mankhwalawa amayamba ndi 300 mg, kenako 75 mg (piritsi limodzi) amapatsidwa kamodzi patsiku kwa miyezi itatu (maphunzirowa atha kupitilira chaka chimodzi). Mwa matenda, monga lamulo, kuwonjezera mankhwala komacetyl salicylic acidMlingo woyenera ndi 100 mg.

Kutulutsa mawonekedwe ndi kapangidwe kake

Lopirel imapezeka mu mawonekedwe a mapiritsi mu chipolopolo cha filimu: yozungulira, ya biconvex, yapinki, yokhala ndi "Ine" wolemba mbali imodzi (mapiritsi 7 kapena 10 mu paketi yonyamula: mu makatoni okhala ndi matuza 1, 2, 4 kapena 8, mapiritsi 7 kapena 1, 2, 3, 5, 6, 9 kapena 10 matuza a mapiritsi 10, pamakatoni okhala pachipatala 10, 20, 30 kapena 40 matuza).

Piritsi limodzi la Lopirel lili:

• yogwira mankhwala: clopidogrel - 75 mg,
• zotuluka: cellcrystalline cellulose, lactose, talc, glyceryl dibehenate, crospovidone (mtundu A),
• chipolopolo: Opadry II 85G34669 Pink talc, mowa wa polyvinyl, macrogol 3350, titanium dioxide (E171), utoto wa iron utayidi wofiira (E172), lecithin (E322).

Njira yamachitidwe

Clopidogrel ali m'gulu la opanga mankhwala osokoneza bongo. Imodzi mwa metabolites yake ndi inhibitor yogwira kuphatikizira kwa mapulateleti: imalepheretsa kumangika kwa adenosine diphosphate (ADP) ndi P2Y₁₂mapuloteni othandizira kutsatiridwa ndi ADP-mediated activation ya glycoprotein IIb / IIIa, yomwe imayambitsa kuponderezana kwa kuphatikiza mapulateleti. Njira yosasinthika imalola kuti ma cellulo azitha kugwira mphamvu za ADP pamoyo wawo wonse (pafupifupi masiku 7 mpaka 10). Ntchito yabwinobwino yamapulatifomu imabwezeretseka kutengera kuthamanga kwawo.

Mankhwala amalepheretsanso kuphatikiza kwa maselo ambiri chifukwa cha agonists ena osakhala a ADP. Mapangidwe a metabolite yogwira amayamba chifukwa cha zochita za isoenzymes za dongosolo P₄₅₀, ndipo popeza ma isoenzymes ena amatha kusiyanasiyana polymorphism kapena kuperekedwa ndi mankhwala ena, sikuti wodwala aliyense ali ndi zoletsa zokwanira za kuphatikizana kwa maselo a magazi.

Mankhwala a Pharmacodynamic

Kudya kwa tsiku ndi tsiku kwa clopidogrel pa 75 mg kumapereka kwambiri kuponderezedwa kwa mapulani am'magazi kuyambira tsiku loyamba la makonzedwe. Pang'onopang'ono, popita masiku 3-7, kuchuluka kwa kuponderezana kumawonjezeka, mpaka kufika pamlingo wokhazikika. Mukamamwa mlingo watsiku ndi tsiku wa 75 mg wofanana, kuphatikizika kwa maselo ambiri kumalimbikitsidwa ndi 40-60%. Pakupita kwa masiku 5 atayimitsa mankhwalawa, nthawi yakukha magazi ndi kuphatikizana kwa kupatsidwa zinthu za m'magazi pang'onopang'ono zimabweza gawo loyambira.

Mphamvu Yachipatala / Chitetezo

Clopidogrel imalepheretsa kukula kwa atherothrombosis kulikonse kwa atherosulinotic mtima zotupa (mwachitsanzo, ndi zotupa zam'mimba, zotumphukira kapena mitsempha ya mitsempha).

M'mayeso othandizira odwala a ACTIVE-A, adawonetsedwa kuti ngati pakhale ululu wamankhwala mwa odwala omwe ali ndi vuto limodzi kapena zingapo mwazovuta zam'mitsempha koma atha kutenga ma anticoagulants, kuphatikiza kwa clopidogrel ndi acetylsalicylic acid (poyerekeza ndi acetylsalicylic acid monotherapy) anatengedwa myocardial infarction, sitiroko, systemic thromboembolism kunja kwa chapakati mantha dongosolo kapena wamisala kufa, makamaka chifukwa kuchepa mu chiwopsezo cha stroko. Kuchita bwino kwa mgwirizano wa clopidogrel ndi acetylsalicylic acid kumawonekera koyambirira ndikupitilira zaka 5. Kuchepa kwa mwayi wokhala ndi vuto lalikulu la mtima kwa odwala omwe atenga acetylsalicylic acid ndi clopidogrel makamaka limaperekedwa ndi kuchepa kwakukulu kwa pafupipafupi kwamikwingwirima. Pogwiritsa ntchito mankhwalawa pogwiritsa ntchito mankhwalawa, chiopsezo chodwala choopsa chilichonse chochepetsedwa, palinso chizolowezi chakuchepa kwa zochitika za myocardial infarction, koma panalibe kusiyana kwakukulu pamafupipafupi a thromboembolism kunja kwa dongosolo lamanjenje lapakati kapena kufa kwamitsempha. Pamodzi ndi izi, kutenga clopidogrel ndi acetylsalicylic acid kunachepetsa nthawi yonse yakugonekedwa kwa odwala omwe ali ndi vuto la mtima.

Zogulitsa

Monga limodzi, komanso mlingo wa clopidogrel wa 75 mg patsiku, chinthucho chimatengedwa mwachangu. Pafupifupi, kuchuluka kwambiri kosasinthika kwa clopidogrel m'magazi am'magazi kumafika pafupifupi mphindi 45 pambuyo pakukonzekera kwapakamwa ndikuchokera ku 2.2 mpaka 2.5 ng / ml. The kuyamwa kwa clopidogrel ndi impso (malinga ndi kuchuluka kwa metabolites) ndi osachepera 50%.

Kupenda

The yogwira thunthu zimapukusidwa kwambiri mu chiwindi. Mu vivo ndi vitro, clopidogrel imapangidwira m'njira ziwiri: kudzera mwa esterase kutsatiridwa ndi hydrolysis, zomwe zimapangitsa kuti pakhale kupangika kwa mphamvu ya carboxylic acid (85%) kuchokera ku metabolites yomwe imazungulira mu systemic kufalitsidwa kudzera mu dongosolo la cytochrome P₄₅₀.

Pa gawo loyambirira, clopidogrel imapangidwa kwa metabolite wapakatikati - 2-oxoclopidogrel. Mapulogalamu amotsatira a oxoclopidogrel amachititsa mawonekedwe a metabolite, yogwira thiol. Njira iyi ya vitro metabolic imachitika ndikugawana kwa isoenzymes CYP2C19, CYP3A4, CYP2B6, ndi CYP1A2. Yogwira thiol metabolite yokhayokha mu vitro mosasinthika ndipo imamangiriza mwachangu ku mapulateleti othandizira, ndikulepheretsa kuphatikizika kwawo.

Mu gawo limodzi la clopidogrel pa mlingo wa 300 mg, pazipita mphamvu ya metabolite yogwira imachulukanso kuposa pamene mukumwa mankhwala a clopidogrel 75 mg kwa masiku anayi. Pazipita ndende ya yogwira metabolite wa clopidogrel adalembedwa 0.5-1 mawola atatha kumwa mankhwala.

Mwa anthu, atamwa pakamwa 14 C-cholembedwa clopidogrel kwa maola 120, pafupifupi 46% ya radioac imachotsedwa m'matumbo ndipo pafupifupi 50% ya radioac imachotsedwa kudzera mu impso. Pambuyo pa limodzi lokha la clopidogrel pa mlingo wa 75 mg, theka la moyo limakhala pafupifupi maola 6. Ndi kumwa kamodzi ndi kutalika kwa mankhwalawa, theka la moyo wa zinthu zomwe sizikuyenda bwino m'magazi ndi pafupifupi maola 8.

Mankhwala

Metabolite yogwira ya clopidogrel ndi yapakatikati metabolite 2-oxoclopidogrel imapangidwa pogwiritsa ntchito isoenzyme CYP2C19. CYP2C19 isoenzyme genotype imakhudza mphamvu ya antiplatelet ndi pharmacokinetics ya metabolite yogwira panthawi yophunzira.

Kuwala kwa CYP2C19 * 1 gene kumafanana ndi kagayidwe kogwira mokwanira, ndipo zonena za CYP2C19 * 3 ndi CYP2C19 * mitundu ya 2 sizigwira ntchito ndipo zimayambitsa kuchepa kwa metabolism mwa oyimira ambiri amtundu wa Mongoloid (99%) ndi Caucasoid (85%). Zina zomwe zimayambitsa kuchepa kapena kusowa kwa kagayidwe (kuphatikiza koma osati malire a CYP2C19 * 4, * 5, * 6, * 7, * 8 gen) sizachilendo. Odwala omwe ali ofooka metabolizer ayenera kukhala ndi mitundu iwiri yosonyezedwa ya geni ndikutayika kwa ntchito. Malinga ndi kufalitsa, kuchuluka kwa phenotypes of metabolites ofooka a CYP2C19 mwa anthu amtundu wa Negroid ndi 4%, mpikisano wa Caucasoid - 2%, ndi Wachinayi - 14%.

Kuyesa pharmacokinetics ndi antiplatelet zotsatira mutatenga koyamba mlingo wa clopidogrel 300 mg ndikutsatira okwanira 75 mg patsiku, komanso mukamamwa mlingo woyambirira wa Clopidogrel 600 mg ndi kudya kwa 150 mg patsiku kwa masiku 5 (kufikira kufanana ) kafukufuku wokhudzana ndi mtanda adachitidwa wophatikiza odzipereka 40 m'magulu anayi a anthu 10 omwe ali ndi 4 subtypes a CYP2C19 isoenzyme (ultrafast, kwambiri, ofooka kapena apakatikati othandizira). Zotsatira zake, mu ma processor, apakati, komanso a ultrafast metabolites, panalibe kusiyana kwakukulu pakudziwitsidwa kwa metabolite yogwira ntchito, komanso muyezo wapakati pazolepheretsa kuphatikizana kwa mapulateleti (anachititsa ADP). Kuwonekera kwa yogwira metabolite mu metabol metabol ofooka poyerekeza ndi ma metabol metabolites amachepetsa ndi 63-71%. Pankhani ya ma 300 mg / 75 mg regimen, mphamvu ya ma antiplatelet ya metabolites ofooka yachepa ndi mitengo yolumikizira ya maselo ambiri, yomwe inali 24% (pambuyo pa maola 24) ndi 37% (patsiku la 5) poyerekeza ndi pulatifomuyo yolumikizira maselo mu kwambiri (39% - atatha maola 24 ndi 58% - patsiku la 5) komanso apakatikati (37% - atatha maola 24 ndi 60% - patsiku la 5) metabolizer. Pankhani yogwiritsira ntchito chiwembu 600, mtundu wa CYP2C19 * 1 gene umapereka kagayidwe kokwanira ka mg / 150 mg, kuwonetsa kwa metabolite yogwira mu metabol metabol ofooka anali apamwamba kuposa momwe anali 300 mg / 75 mg. Zomwe zimapangitsa kuti maselo a cellplation asungidwe anali 32% (pambuyo pa maola 24) ndi 61% (patsiku la 5), ​​zomwe zinali zochuluka kuposa mtengo womwewo wa 300 mg / 75 mg regimen, koma anali ofanana ndi magulu a odwala omwe anali ndi CYP2C 19- kagayidwe, amene analandira chithandizo malinga ndi chiwembu 300 mg / 75 mg. Tiyenera kudziwa kuti phunziroli, poganizira zotsatira zamatenda a gulu lino, njira ya Clopidogrel sizinakhazikitsidwebe.

Kuwunikira kwa meta kwa maphunziro asanu ndi limodzi, komwe kumaphatikizapo deta kuchokera kwa odzipereka 335 omwe adalandira malo okhala ofanana ndende, adawonetsa kuti kuwonetsa kwa metabolite yogwira mu metabolites ofooka kunachepetsedwa ndi 72%, komanso mu ma metabolites apakati - ndi 28%, ngakhale kuli kwakuti mtengo wolepheretsa kuphatikizira kwa mapulateleti anali kuchepetsedwa poyerekeza ndi ma metabolizer amphamvu ndi 21.4 ndi 5.9%, motero.

Chiyanjano pakati pa CYP2C19 genotype ndi zotsatira zamankhwala mwa odwala omwe alandila clopidogrel sizinawunikidwe poyesa, kuyang'anira, mayesero osasinthika, komabe, mpaka pano, pali kusanthula kambiri kwakubwezeretsa. Zosindikizidwa kuchokera ku maphunziro angapo a cohort, komanso zotsatira za genotyping m'maphunziro azachipatala: CHARISMA (n = 2428), CURE (n = 2721), TRITON-TIMI 38 (n = 1477), CLARITY-TIMI 28 (n = 227), ACTIVE- A (n = 601).

Maphunziro atatu a cohort (Giusti, Collet, Sibwing) ndi kafukufuku wa zamankhwala TRITON-TIMI 38 mwa odwala ophatikizika ndi ofooka komanso apakatikati a metabolism adalemba kuchuluka kwa zovuta zamtima (infrction ya myocardial, stroke, kufa) kapena stent thrombosis poyerekeza ndi ofanana zambiri zokhudzana ndi ma metabol metabolites.

Mu kafukufuku wa Simon cohort komanso kafukufuku wa CHARISMA, kuchuluka kwa zovuta zamtima zam'mimba kumanenedwa pokhapokha ngati metabol metabol ofooka (poyerekeza ndi kwambiri).

Mu Phunziro la Trenk cohort ndi maphunziro a CLARITY, CURE, ACTIVE-A, panalibe kuyanjana kwa mtima ndi kuchuluka kwa CYP2C19 metabolism.

Kafukufuku wamankhwala omwe adachitika mpaka pano ali ndi zitsanzo zosakwanira kuti azindikire kusiyana kwa zotsatira zamankhwala kwa odwala omwe ali ndi CYP2C19 isoenzyme yotsika.

Milandu Yapadera Yachipatala

The pharmacokinetics ya yogwira metabolite ya clopidogrel yamagulu payokha sipanaphunzire.

M'maphunziro okhudza odzipereka okalamba (zaka 75), poyerekeza ndi kuchuluka kwa odzipereka achichepere, kusiyana kwa nthawi yakukha magazi ndi kuphatikizira kwa mapulateleti sikunapezeke. Zochizira odwala okalamba, kusintha kwa Lopirel sikofunikira.

The pharmacokinetics of clopidogrel mwa odwala osakwana zaka 18 sizinaphunzire.

Kuwonongeka kwambiri kwa impso (ndi creatinine chilolezo kuyambira 5 mpaka 15 ml / min) chifukwa chogwiritsa ntchito mobwerezabwereza clopidogrel pa 75 mg patsiku, kuchuluka kwa kuyambitsidwa kwa kuphatikizira kwa mapulani a ADP kunali 25% kutsika kuposa komwe kunadziperekabe amoyo wathanzi, komabe, nthawi yowukha magazi idatsalira zofanana ndi chizindikiro ichi cha odzipereka athanzi omwe amalandira tsiku lililonse Clopidogrel 75 mg. Mankhwalawa anali ololedwa bwino ndi odwala onse.

Kuwonongeka kwakukulu kwa chiwindi chifukwa chotenga clopidogrel pa mlingo wa 75 mg patsiku kwa masiku 10, kuchuluka kwa zoletsa kuphatikizira kwa mapulani a ADP kunali kofanana ndi kwa odzipereka athanzi.Magulu onse awiriwa adafanizidwanso m'njira yakutuluka magazi.

Kuchulukana kwa ma supples amtundu wa CYP2C9 isoenzyme, omwe amachititsa kuti metabolism achepetse komanso apakatikati, amasiyanasiyana pakati pa oimira magulu osiyanasiyana. Kwa oimira mpikisano wa a Mongoloid, pali zochepa zomwe sizimalola kuwunika kwa mtundu wa CYP2C19 isoenzyme pokhudzana ndi zovuta za ischemic.

Zotsatira za pharmacological

Yogwira pophika mankhwala Lopirel mosankha amalepheretsa molekyula wa ADP ku ma receptors omwe ali pamwamba pa mapulateleti. Chifukwa chake, kuyambitsa kwa GPIIb / IIIa zovuta ndi kuphatikizira kwa mapulateleti kumakhala kosatheka. Clopidogrel imalepheretsanso njira zosinthika zomwe zimatsutsana ndi ena otsutsa. Mpaka kumapeto kwa moyo, mapulateleti amakhalabe owonongeka komanso osakanikirana.

Pambuyo kulandira koyamba kwa mankhwala, njira yotsutsa imayamba kuchitika, mulingo wa leukocytes umakhazikitsidwa ndi masiku 3-7 oyang'anira. Pafupifupi, masiku 5 atasiya kulandira chithandizo, kuphatikizira kwa maselo ndi nthawi yotaya magazi kubwerera mgawo loyamba.

Mankhwalawa amatengeka mosavuta m'mimba. Komabe, kuchuluka kwa clopidogrel mu plasma ndikotsika kwambiri, kuyamwa ndi 50%. Mankhwalawa amamangidwa bwino ndi mapuloteni am'magazi.

Clopidogrel imapangidwa mu chiwindi, pafupifupi 80% ya metabolites yomwe imapezeka mu plasma imagwira ntchito. Metabolite yogwira, yomwe ili ndi antiaggregatory kwenikweni, imapangidwa ndi oxidation reaction, ndikuchita nawo cytochrome P450 isoenzyme 2B6 ndi 3A4. Metabolite yokha imakhudzana ndi mapulateleti ndipo simapezeka m'madzi a m'magazi.

Hafu ya moyo ndi maola 6 ogwira ntchito ndi 8 chifukwa cha metabolite yake yogwira ntchito. Zogulitsa zimapakidwa makamaka ndi mkodzo ndi ndowe.

Anthu omwe akuvutika kwambiri ndi impso, kuchepa kwa mphamvu ya mankhwalawa ndi 25% poyerekeza ndi anthu athanzi.

Malangizo ogwiritsira ntchito

Mapiritsi a Lopirel amayenera kumwedwa pakamwa, mosasamala kanthu za kudya.

Odwala omwe adadwala matenda a stroke ischemic / myocardial infarction kapena omwe ali ndi vuto losakanikirana ndi mitsempha ya m'mimba ayenera kumwa 75 mg kamodzi patsiku. Pambuyo vuto la mtima, mankhwalawa amayamba kuyambira masiku oyamba ndipo amakhala mpaka masiku 35, ndipo atadwala matenda a sitiroko - kuyambira sabata limodzi mpaka miyezi isanu ndi umodzi.

Pamaso pa pachimake coronary syndrome popanda kukwera kwa ST (kuphatikiza odwala omwe ali ndi vuto la kulowerera mkati mwa zotupa), mankhwalawa amayambitsidwa ndi kuchuluka kwa 300 mg (kugwiritsa ntchito kamodzi), kenako amasinthana ndi 75 mg maola 24 mu kipimo 1 (kuphatikiza ndi acetylsalicylic acid mu kipimo pamwamba 100 mg). Maphunzirowa ali mpaka chaka 1.

Mu pachimake coronary syndrome ndi ST gawo kukweza (osakanikirana ndi aspirin ndi thrombolytic zinthu, mapiritsi amayikidwa kamodzi pa mlingo wa 75 mg pa maola 24 pa 1 ntchito ndi kugwiritsidwa ntchito koyambirira kwa kuchuluka kwake (kamodzi, ndi thrombolytics ndi aspirin). Chithandizo chimayamba molawirira ndipo chimapitilira kwa mwezi umodzi osachepera. Mlingo woyendetsa pambuyo pa zaka 75 sugwiritsidwa ntchito.

Zotsatira zoyipa

• dongosolo la lymphatic ndi circulatory system: infrequently - eosinophilia, leukopenia, thrombocytopenia, kawirikawiri neutropenia (kuphatikizapo kwambiri neutropenia), kawirikawiri aplasic anemia, thrombotic thrombocytopenic purpura, agranulocytosis, pancytopenia, strombocytopenia, kali thrombocytopenia, strombocytopenia, kali thrombocytopenia, kali thrombocytopenia
• chitetezo chamthupi: kawirikawiri - anaphylactoid zimachitika, seramu matenda, pafupipafupi sizikudziwika - kukula kwa zochita zamkati mwa hypersensitivity ndi thienopyridines (mwachitsanzo, ndi ticlopidine ndi prasugrel),
• minofu: mafupa a minofu ndi mafupa: kawirikawiri - nyamakazi, hemarthrosis (hemorrhage mu musculoskeletal system), myalgia, arthralgia,
• dongosolo lamanjenje: pafupipafupi - kupweteka mutu, intracranial hemorrhage (zina zakupha), chizungulire, paresthesia, kawirikawiri - kukoma kosokoneza,
• khungu ndi subcutaneous minofu: zambiri - kuvulaza, pafupipafupi - kuyabwa, zidzolo, purpura, kawirikawiri - angioedema, oxous dermatitis (erythema multiforme, Stevens-Johnson syndrome, poyizoni epermermal necrolysis), mankhwala hypersensitivity syndrome, erythematic kapena exfoliative syrup zidzolo ndi zizindikiro za eicinophilia, urticaria, lichen planus, chikanga,
• masomphenya: pafupipafupi - zotupa za m'maso (m'matumbo amaso, conjunctiva, retina),
• chiwindi ndi kwamikodzo thirakiti: kawirikawiri - chiwindi, kuperewera kwa chiwindi, zosabereka mu maphunziro a labotale a chiwindi,
• maphunziro othandizira ndi a labotale: pafupipafupi - kuchepa kwa chiwerengero cha neutrophils, kuchuluka kwa nthawi yotulutsa magazi, kuchepa kwa kuchuluka kwa mapulateleti,
• Matenda a malo a jakisoni ndi zovuta zina: kawirikawiri - magazi ochokera kumalo opumira, kawirikawiri - malungo.
• kumva: kawirikawiri - vertigo,
• psyche: kawirikawiri - chisokonezo, kuyerekezera zinthu m'maganizo,
• m'mimba thirakiti: Nthawi zambiri kutsekula m'mimba, kutaya kwa m'mimba, kupweteka kwa m'mimba, kupweteka kwam'mimba, zilonda zam'mimba komanso duodenal, nseru, kusanza, kugonja, kusowa kwa magazi pafupipafupi, kusowa kwambiri kwa m'mbuyomu komanso m'mimba. magazi am'matumbo owopsa, colitis (kuphatikizapo zamitsempha kapena zilonda zam'mimba), kapamba, stomatitis,
• kupuma dongosolo: Nthawi zambiri - nosebleeds, kawirikawiri - bronchospasm, magazi ochokera kupuma dongosolo (pulmonary hemorrhage, hemoptysis), chibayo eosinophilic, chibayo cham'mimba,
• impso ndi kwamikodzo thirakiti: pafupipafupi - hematuria, osowa - kuwonjezeka kwa kuchuluka kwa creatinine m'magazi, glomerulonephritis,
• Mitsempha yamagazi: Nthawi zambiri - hematomas, osowa kwambiri - magazi ochokera ku bala, opaleshoni yayikulu, magazi ochepa, vasculitis.

Malangizo apadera

Kulephera kwa chiwindi: pamlingo woyenera - mosamala, kwambiri - kumatsutsana.

Mankhwala osokoneza bongo amadziwika ndi kuwonjezeka kwa nthawi ya magazi. Mothandizidwa ndi mankhwalawa, mankhwalawa amaphatikizidwa ndi kupakidwa magazi ambiri, chifukwa palibe mankhwala.

• Milandu ya magazi kwambiri panthawi yomwe amagwiritsidwa ntchito limodzi ndi Lopirel acetylsalicylic acid, komanso heparin, adalembedwa.
• Kulephera kwa impso: mankhwalawa amachitika mosamala ndi matenda ena ake.
• Kusamala ndikofunikira kwa odwala omwe ali pachiwopsezo chotaya magazi pazifukwa zosiyanasiyana kapena omwe amagwiritsa ntchito mankhwala ena.
• Mankhwala opangira opaleshoni, pamene antiplatelet ufanisi ndi osafunika, maphunzirowa amayimitsidwa sabata 1 tsiku lisanafike la opaleshoni.
• Odwala amayang'aniridwa pafupipafupi kuti magazi abise.
• Kuyendetsa zoyendetsa ndi zida zovuta: sizikhudzidwa.
• Clopidogrel amatha kuletsa ntchito ya CYP2C9 isoenzyme, kotero pali mwayi wakuwonjezeka kwa kuchuluka kwa magazi a tolbutamide ndi phenytoin. Makonzedwe amodzi a awa ndi Lopirel ndi otetezeka.
• Wodwala ayenera kudziwa kuti nthawi yomwe magazi amayamba kutuluka kwambiri, choncho dokotala aliyense ayenera kudziwa zamankhwala.
• Mu pachimake ischemic stroke, mankhwalawa osavomerezeka kuti agwiritse ntchito (osakwana sabata 1).
• Osakwana zaka 18, mankhwala ndi oletsedwa.
• Mankhwalawa odwala omwe ali ndi vuto lalikulu la infrction (ndi kuchuluka kwa gawo la ST), mankhwalawa samayamba masiku ochepa pambuyo poti myocardial infarction.

Pa magazi, magazi ndi chiwindi zimayang'aniridwa.

Kuyanjana kwa mankhwala osokoneza bongo

Mankhwalawa amatha kuphatikizidwa ndi atenolol, phenobarbital, estrogens, cimetidine kapena nifedipine.

Zimatsimikiziridwa kuti kudya kwa tsiku ndi tsiku kwa acetylsalicylic acid (mpaka 1000 mg patsiku) ndi clopidogrel sizikhudza kuchuluka kwa mankhwala omwe amapezeka. Komabe, nthawi ya mgwirizano wa mankhwalawa sayenera kupitirira chaka chimodzi (chisamaliro chiyenera kumwedwa).

• Akaphatikizidwa ndi ma anticoagulants amkamwa, makamaka warfarin, mwayi womwe umachitika komanso nthawi yotuluka kwa magazi imatha kuchuluka.
• Kuphatikiza kwa mankhwalawa ndi thrombolytics sikulimbikitsidwanso, popeza chitetezo chotere sichinakhazikitsidwe ndendende.
• Ngakhale zotsatira zabwino za maphunziro azachipatala a kulumikizana kwa mankhwalawa ndi heparin, kusamala kuyenera kugwiritsidwa ntchito mukamawamwa nthawi yomweyo.
• Mwa anthu omwe ali pachiwopsezo chotaya magazi komanso kumwa Lopirel, sizikulimbikitsidwa kuti atenge glycoprotein IIb / IIaa zoletsa.
• Mwina kuphatikiza kwa mankhwala ndi digoxin, theophylline, antacid.

Mankhwala amalepheretsa kagayidwe kamankhwala omwe magawo ake a pharmacokinetic amadalira CYP2C9 isoenzyme. Makamaka, mankhwala amatha kuwonjezera plasma ndende ya phenytoin ndi tolbutamide. Chisamaliro chiyenera kutengedwa.

Zimatsimikiziridwa kuti kuphatikiza kwa clopidogrel - naproxen kumawonjezera mwayi wokhala ndi magazi obwera m'mimba. Komabe, pankhani ya NSAID ena, mawonekedwe otere sanatsimikizidwe. Pankhaniyi, kuphatikiza kwa mankhwalawa kuyenera kusamala.

Mndandanda wa mankhwala Lopirel

Kapangidwe kamene kamayimira fanizo:

1. Plavix,
2. Aggregal
3. Sylt,
4. Fluder,
5. Fagot,
6. Chizindikiro
7. Deplatt 75,
8. Thonje,
9. Detrombe
10. Ndasokoneza
11. Cardutol,
12. Targetek
13. Klopile,
14. Clapitax
15. Clopidogrel,
16. Lirta
17. Mndandanda wa 75,
18. Muthana,
19. Cardogrel
20. Lopirel
21. Plogrel,
22. Klopirel.

Gulu la antiplatelet agents limaphatikizapo analogues:

1. Zabwino
2. Aggregal
3. Pentilin
4. Agrenox
5. Ayferol
6. Thonje,
7. Clopidogrel,
8. Clapitax
9. Cardutol,
10. Parsedil
11. Kuphatikiza
12. Lirta
13. Agrilin,
14. Lopirel
15. Tiklo
16. Aklotin,
17. Curantyl
18. Chizindikiro
19. Pentomere
20. Persantine
21. Methylethylpyridinol,
22. Klopile,
23. ZOLEMA
24. Radomin
25. Brilinta
26. Fluder,
27. Targetek
28. Cardiomagnyl
29. Thomakomanda,
30. Cardioxypine
31. Eifitol
32. Acetylsalicylic acid
33. Trental
34. Coplavix,
35. Vixipin
36. Agapurin
37. Doksilek,
38. Akonol,
39. Yothandiza
40. Emoxibel
41. Klopirel,
42. Alprostan,
43. Madandaulo
44. Ginkio
45. Aspinat
46. Colpharite
47. Ginos
48. Emoxipin
49. Ibustrin
50. Tiklid,
51. Mikristin
52. Fagot,
53. Pentoxifylline
54. Tagren
55. Plavix,
56. Cilostazol
57. Mndandanda wa 75,
58. Monafram
59. Wotsogola
60. Muse
61. Kuzindikira
62. Ticagrelor,
63. Xanthinol Nicotinate,
64. Pentamon
65. Ralofect,
66. Cardogrel
67. Supombital
68. Ventavis.

Bongo

Ndi mankhwala osokoneza bongo ochulukirapo, kuwonjezeka kwa kutalika kwa magazi ndi kuwonongeka kwina kwa zinthu kumatha.

Chithandizo - malingana ndi zizindikiro.

Zapadera mankhwala mankhwalawo alibe. Mochulukirapo, kutha kwa mankhwalawo mwa kumuwonjezera wodwalayo ndikotheka. maselo ophatikizira.

Kuchita

Akaphatikizidwa ndi anticoagulants pamlomomakamaka warfarin, kuthekera kwadzidzidzi ndi kutalika kwa magazi kungachuluke.

Mwa anthu omwe ali ndi chiwopsezo chakutulutsa magazi ndipo akutenga Lopirel, osavomerezeka kuti atenge glycoprotein IIb / IIІa zoletsa.

Kuphatikizidwa clopidogrel – naproxen kumawonjezera chiopsezo chakutuluka magazi m'matumbo. Komabe, pankhani ya ena NSAIDs dongosolo lotere silinatsimikizidwe. Pankhaniyi, kuphatikiza kwa mankhwalawa, kusamala kuyenera kuchitidwa.

Ngakhale zotsatira zabwino zamaphunziro a zamankhwala othandizana ndi mankhwala ndi heparin, pakulandila kwawo munthawi yomweyo ndikofunikira kusamala.

Kuphatikiza kwa mankhwalawa manga, popeza chitetezo chamtundu wotere sichikukhazikitsidwa.

Kutsimikiziridwa kudya tsiku lililonse acetylsalicylic acid(mpaka 1000 mg patsiku) ndi clopidogrel sizikhudza onjeza katundu wa mankhwala. Komabe, nthawi ya mgwirizano wa mankhwalawa sayenera kupitirira chaka chimodzi (chisamaliro chiyenera kumwedwa).

Mankhwala ziletsa kagayidwe kachakudya mankhwala, pharmacokinetic Zizindikiro zomwe zimatengera isoenzyme CYP2C9. Makamaka, mankhwala akhoza kuwonjezera plasma ndende phenytoin ndi tolbutamide. Chisamaliro chiyenera kutengedwa.

Mwina kuphatikiza kwa zida ndi digoxin, theophylline, Maantacid okhala.

Analogs Lopirela

Analogs a mankhwalawa: Clopidogrel, Avix, Atrogrel, Deplat, Zilt, Karum Sanovel, Clopidale, Klopikor, Lopigrol, Orogrel, Plavigrel, Plagril, Reodar, Tessiron, Trombone, Flamogrel 75, Aterocardium, Gridoklein, Deplatt, Padrendrendrendre, Padrendrendrendrendrendrendrendrendrendrendrendrendrendrerendrendrendrendrendrendrendrendrendrendrendrendrendrendrendrendrendrendrendrendrendrere Neo, Plavix, Platogril, Reomax, Trombeks.

Mlingo ndi makonzedwe

Pofuna kupewa matenda a ischemic odwala atadwala matenda amisempha, matenda a ischemic ndipo apezeka posachedwapa matenda otupa, akuluakulu (kuphatikizapo odwala okalamba) amapatsidwa 75 mg 1 nthawi / tsiku, mosasamala za kudya. Kuchiza kuyenera kuyambira masiku ochepa mpaka masiku 35 pambuyo poti myocardial infarction yapangidwe ndi ma pathological Q wave ndipo kuchokera masiku 7 mpaka miyezi 6 pambuyo pa matenda a ischemic.

Gwiritsani ntchito mwa akulu ndi odwala okalamba omwe ali ndi zochitika wamba za CYP2C19 isoenzyme

Ndi myocardial infarction, ischemic stroke, ndikupeza matenda oopsa a ochepa ma occlusion, 75 mg ya Lopirel ndi mankhwala kamodzi patsiku.

Mu pachimake coronary syndrome popanda kukwezeka kwa gawo (myocardial infarction popanda Q wave, osakhazikika angina), chithandizo chiyenera kuyamba ndi gawo limodzi lokweza (300 mg), pambuyo pake 75 mg ndi mankhwala kamodzi patsiku (limodzi ndi tsiku la 75-325 mg acetylsalicylic acid ) Popeza kugwiritsa ntchito acetylsalicylic acid yambiri kumachulukitsa magazi, mlingo wa acetylsalicylic acid wolimbikitsidwa pachizindikirochi suyenera kupitilira 100 mg. Kutalika kokwanira kwa mankhwala sikunadziwikebe mwamalemba. Malinga ndi maphunziro azachipatala, mankhwalawa amayenera kumwedwa mpaka chaka chimodzi. Zopindulitsa kwambiri zimawonedwa ndi miyezi 3 ya chithandizo.

Mu pachimake coronary syndrome yokhala ndi ST-segment elevation (pachimake myocardial infarction yodziwika ndi ST-gawo kukweza), mlingo wokulimbitsa wa 300 mg umayikidwa kamodzi, kenako 75 mg kamodzi patsiku palimodzi ndi acetylsalicylic acid (osakanikirana ndi kapena wopanda thrombolytics). Mankhwala a odwala azaka zapakati pa 75 ndi kupitirira, chithandizo cha Lopirel chikuyenera kuchitika popanda kumwa mankhwala. Kuphatikiza mankhwala kumayambira atangoyamba kumene zizindikiro ndipo amatha kwa masabata anayi. Kuchita bwino kwa kuphatikiza kwa acetylsalicylic acid ndi clopidogrel ndikuwonetsa izi kwa masabata anayi sikunaphunzire.

Ndi atrive fibrillation (atria fibrillation), 75 mg ya Lopirel imakhazikitsidwa kamodzi patsiku. Kuphatikiza ndi clopidogrel, kugwiritsa ntchito acetylsalicylic acid kuyenera kuyambitsidwa ndikupitilizidwa (tsiku ndi tsiku mlingo wa 75-100 mg).

Ngati mukuphonya mulingo wotsatira wa Lopirel, muyenera kutsatira zotsatirazi:

• Ngati maola opitilira 12 adatha kulumpha mlingo, muyenera kumwa mlingo wa Lopirel kamodzi, ndikutenga Mlingo wotsatira wa mankhwalawa mwachizolowezi.
• Ngati maola opitilira 12 adatha kulumpha mlingo, mlingo wotsatira wa Lopirel uyenera kutengedwa mwachizolowezi.

Zolemba zogwiritsira ntchito

Kuyesedwa kwa magazi kuyenera kuchitika sabata yoyamba yamankhwala ngati kuphatikiza kwa clopidogrel ndi acetylsalicylic acid, NSAIDs, heparin, IIb / IIIa glycoprotein inhibitors kapena fibrinolytics, komanso kwa odwala omwe ali ndi chiopsezo chowonjezeka magazi (kuvulala, kulowererapo kapena njira zina zam'magazi).

Chifukwa cha chiwopsezo chakutulutsa magazi komanso mavuto obwera ndi hematological, ngati zizindikiro zakuchipatala zomwe zikuwonetsa izi zikuwoneka pakumwa, kuyezetsa magazi (APTT, kuwerengetsa kupatsidwa zinthu zam'magazi, kuyesa kwam'magazi a ziwalo zam'magazi) ndi ntchito ya chiwindi iyenera kuchitidwa nthawi yomweyo.

Pankhani yopangira opaleshoni, ngati anti-aggregation athari ndi yosafunika, clopidogrel iyenera kuyimitsidwa masiku 7 asanafike opaleshoni.

Clopidogrel iyenera kugwiritsidwa ntchito mosamala odwala omwe ali ndi vuto lotaya magazi (makamaka m'mimba komanso intraocular).

Odwala ayenera kuchenjezedwa kuti ayenera kudziwitsa dokotala za vuto lililonse lotuluka.

Chifukwa cha kusakwanira kwa deta, clopidogrel sayenera kufotokozedwa panthawi yovuta ya ischemic stroke (m'masiku 7 oyambirira).

Njira zopewera kupewa ngozi

Amalembedwa mosamala kwa odwala omwe ali ndi chiopsezo chotaya magazi (kuvulala, kulowererapo, ndi zina zotere) komanso ndi vuto lalikulu laimpso ndi kwa chiwindi (hemorrhagic diathesis imatha kupezeka).

Chitetezo ndikuwonetsetsa kwa odwala osakwanitsa zaka 18 sizinakhazikitsidwe.

Mankhwalawa ali ndi lactose, chifukwa chake sayenera kumwedwa ndi anthu omwe ali ndi majini okhala ndi lactose.

Clopidogrel ndi mankhwala osokoneza bongo omwe amatulutsa michere ya chiwindi. Kukhazikika kwa munthawi yomweyo kwamankhwala omwe amalepheretsa ntchito ya chiwindi CYP2C19 kungayambitse kusintha kwa mapangidwe achangu a metabolite, motero, kuchepa kwamankhwala othandizira. Kulandila kwa clopidogrel ndi proton pump blockers nthawi zosiyanasiyana zamasiku sikukhudza kukula kwa kuyanjana.

The munthawi yomweyo kuphatikiza kwa clopidogrel okhala ndi proton pump blockers kuyenera kuwonongedwa, chifukwa pali umboni wa kuthekera kwawo kufooketsa luntha la Clopidogrel, mwachitsanzo, omeprazole.

Ngati wodwala akufunika kumwa ma blockon pump blockers pomwe akutenga clopidogrel, mankhwalawa a gululi omwe ali ndi kuthekera kocheperako ayenera kuyikidwa. Chimodzi mwa mankhwalawa ndi pantoprazole.

Kutulutsa mafomu ndi kapangidwe kake

Mankhwalawa amapezeka m'mapiritsi omwe ali ndi 1 yogwira (clopidogrel hydrosulfate) ndi maipi omwe alibe mphamvu ya antiplatelet. Momwe zimakhalira pazomwe zimakhazikitsidwa ndi 97.87 mg. Ndalamayi ikufanana ndi 75 mg ya clopidogrel. Mapiritsiwo ali ndi chipolopolo chapadera, chifukwa chomwe mankhwalawo amayamba kuwuma. Pankhaniyi, chinthu chogwira ntchito chimamasulidwa pang'onopang'ono, kuyamwa kumachitika m'matumbo. Zinthu zazing'ono:

• crospovidone
• lactose
• cellcrystalline mapadi,
• glyceryl dibehenate
• Opadry II 85 G34669 pinki,
• talcum ufa.

Phukusili lili ndi mapiritsi 14, 28 kapena 100.

Mankhwalawa amapezeka m'mapiritsi omwe ali ndi 1 mankhwala othandizira.

Pharmacokinetics

Mankhwalawa amayamba kuchitapo kanthu pamtunda wa makonzedwe - atatha maola 2 pali kuchepa kwamphamvu kwa kuphatikizana kwa mapulosi. Kukula kwakukulu kwa mankhwalawo, kumathandizira kusintha. Zizindikiro zopweteka za matendawa zikachotsedwa, mankhwalawa amachepa. Zotsatira zake, mutatenga kukonzekera Mlingo wa Lopirel kwa masiku 4-7, chiwopsezo chachikulu cha mankhwalawa chimafikiridwa. Zomwe zimapezeka zimasungidwa nthawi yayitali yamagazi (masiku a 5-7).

Kuthana kwa clopidogrel kumathamanga, pomwe kumangiriza mapuloteni a plasma ndiokwera kwambiri (98%). Kutembenuka kwa chinthuchi kumachitika m'chiwindi. Imadziwika mu njira ziwiri: kudzera pamagawo ndikumaperekedwa kwa carboxylic acid (sikuwonetsa zochita), ndikuchita nawo cytochrome P450. Njira yomangirizira ku ma cell a platinamu imachitika mothandizidwa ndi metabolites.

Tiyenera kukumbukira kuti kumwa mankhwalawa muyezo waukulu (300 mg kamodzi) kumabweretsa kuwonjezeka kwakukulu. Mtengo wa chizindikirochi ndiwokwera kwambiri kuposa kawiri pazovuta ngati milandu ikukonzedwa kwa masiku anayi.

Kukula kwa zinthu zomwe zimapangidwa ndi mankhwalawa kumachitika kudzera mu impso.

Kutupa kwa zinthu zomwe zimapangidwa ndi mankhwalawa kumachitika kudzera mu impso ndi matumbo (ofanana). Izi zimachitika pang'onopang'ono. Kuchotsa kwathunthu kwa zinthu zogwira ntchito kumachitika kawiri patsiku la 5 mutatha kumwa kwa Lopirel komaliza.

Ndi chisamaliro

Ngati opaleshoni yakonzedwa, mankhwalawa sanatchulidwe chifukwa choika magazi. Zochitika zina zamatenda zomwe zimaphatikizidwa ndi gulu la zotsutsana:

• Matenda omwe magazi amatha kutulutsa kwambiri, mwachitsanzo, kuwonongeka kwa ziwalo zam'maso kapena m'mimba,
• mbiri ya ziwengo kwa thienopyridines.

Pa matenda am'mimba, kutenga Lopirel ndi zotsutsana.
Lopirel amaletsedwa kuchulukitsa kwa zilonda zam'mimba.
Ndi kuwonongeka kwa chimbudzi, Lopirel iyenera kumwedwa mosamala.

Momwe mungatenge Lopirel

Nthawi zambiri, 0,075 g ndi zotchulidwa kamodzi patsiku. Malangizo ogwiritsira ntchito mankhwalawa nthawi zina:

• coronary syndrome yotsatana ndi kukwera kwa ST: pa 0,075 g patsiku kuchokera tsiku lachiwiri, mlingo woyamba ndi 0,3 g kamodzi, nthawi yayitali ya chithandizo sichitali milungu 4, chithandizo chamankhwala chachitali sichinakhazikitsidwe,
• coronary syndrome yopanda zizindikiro za kukwera kwa ST: mawonekedwe ake ndi ofanana, koma nthawi ya maphunzirowa imatha kukhala yayitali (mpaka miyezi 12),
• Fibrillation yoyeserera: 0,075 g patsiku.

Munthawi zonsezi, kugwiritsa ntchito ASA ndikofunikira. Komabe, pali malire: osapitirira 0,1 mg patsiku.

Kumwa mankhwala a shuga

Ndizovomerezeka kugwiritsa ntchito mankhwala ochizira matendawa, koma muyenera kusamala chifukwa cha lactose yomwe ili mbali yake. Kuphatikiza apo, motsutsana ndi maziko a matenda ashuga, chiopsezo chokhala ndi stroke, myocardial infarction imakulanso. Mankhwala othandizira antiplatelet ndi gawo lofunikira pakuchiza matendawa, mlingo wokhawo womwe umatsimikiziridwa payekhapayekha, poganizira momwe thupi liliri.

Chovomerezeka kugwiritsa ntchito mankhwalawa matenda a shuga, koma muyenera kusamala mukamamwa mankhwalawo.

Matumbo

Kudzimbidwa, kupweteka pamimba, kusintha kwa chopondapo kumawonetsedwa nthawi zambiri, mseru ungachitike. Pafupipafupi, kukula kwa kukokoloka m'mimba kumadziwika, kutulutsa kwanyumba kumakhala kovuta, kapangidwe ka mpweya kumakulirakulira. Nthawi zina chilonda chimapezeka, kusanza kumachitika. Colitis ndi kapamba ndizochepa kwambiri.

Pakati mantha dongosolo

Chizungulire, kupweteka mutu, kusokonezeka kwa kukoma, kutayika kwake kwathunthu. Kuwona. Kusokonezeka kwa chikumbumtima kumadziwika.

Pa mankhwala ndi Lopirel, nseru ndi kusanza zitha kuchitika.
Chizungulire ndi mbali imodzi ya mankhwala Lopirel.
Lopirel imatha kupweteketsa mutu.
Mukumwa Lopirel, ululu m'mimba umatha kuoneka.
Zotsatira zoyipa za mankhwala Lopirel ndi mawonekedwe a chiwindi.
Khungu la Itchy ndi mbali ya mankhwala Lopirel.
Kuwala kwapakati kumatha kuchitika nthawi ya mankhwala ndi Lopirel.

Zotsatira zoyipa

Malinga ndi malangizo, Lopirel 75 mg ali ndi zoletsa kutenga:

1. Eosinophilia (nthenda yomwe imachulukitsa kuchuluka kwa ma eosinophils).
2. Leukopenia (kuchepa kwa kuchuluka kwa maselo oyera amwazi m'magazi).
3. Thrombocytopenia (mkhalidwe womwe umadziwika ndi kuchepa kwa maselo am'magazi m'munsimu wabwinobwino, womwe umayendetsedwa ndi magazi komanso mavuto amtundu wa magazi.
4. Neutropenia (kuchepa kwa neutrophilic granulocytes m'mwazi).
5. Otupa kapena kupeza magazi a m'magazi chifukwa cha kuwonongeka kwa maselo a tsinde.
6. Thrombotic thrombocytopenic purpura (matenda oopsa omwe amadziwika ndi microangiopathic hemolytic anemia).
7. Chizungulire
8. Granulocytopenia (ochepa maselo oyera a m'magazi).
9. Anemia
10. Intracranial hemorrhage.
11. Anapeza hemophilia (matenda achilendo obadwa nawo omwe amaphatikizana ndi kusokonekera kwa chiwopsezo).
12. Anaphylactoid zimachitika.
13. Chisokonezo.
14. Zizindikiro.
15. Migraine
16. Paresthesia (vuto lakumverera kwadzuwa, lomwe limadziwika ndi mosadziwikanso bwino.
17. Kuphwanya kukoma.
18. Kutupa kwa diso.
19. Hematomas.
20. Kutulutsa magazi kwambiri.
21. Kutsitsa magazi.
22. Vasculitis (gulu la matenda kutengera kutupa kwa mitsemopathological).
23. Epistaxis.
24. Bronchospasm (njira yomwe imachitika pamene minyewa yosalala ya bronchi ikalumikizidwa ndipo lumen yake imachepetsedwa).
25. Pulmonary hemorrhage.

Malinga ndi malangizo a Lopirel, zimadziwika kuti, kuphatikiza pa zovuta zomwe tafotokozazi, mankhwalawa atha kuyambitsa zotsatirazi:

1. Chibayo eosinophilic (matenda omwe ma eosinophils amadziunjikira mu pulmonary alveoli).
2. Kutsekula m'mimba (mkhalidwe wam'mbuyomu womwe munthu amachotsa mwachangu, pomwe chopondacho chimakhala chamadzi).
3. Interstitial pneumonitis (kuwonongeka kwa m'mapapo, pomwe njira yotupa imakhudzira interstitium).
4. Zilonda za Duodenal (chilonda chifukwa cha acid ndi pepsin pa mucous membrane wa duodenum mwa anthu omwe ali ndi acidity yayikulu).
5. Kufalikira.
6. Gastritis (matenda omwe amakhala nthawi yayitali omwe amadziwika ndi dystrophic komanso kusintha kwamkati mwa mucosa wam'mimba, amapezeka ndikuphwanya kusinthika.
7. Kulepheretsa kwamkati.
8. Kubwezeranso magazi.
9. Yotupa matenda a colon mucosa.
10. Pancreatitis (matenda omwe kutupa kwa kapamba amawonedwa).
11. Angioedema (mkhalidwe wowopsa wodziwika ndi kufalikira kwakanthawi kwa edema yam'mimba, komanso minyewa yodutsa komanso khungu lokha).
12. Zotupa za nettle.
13. Nyamakazi (matenda a mafupa, limodzi ndi kutupa).
14. Hemarthrosis (hemorrhage mu olowa patsekeke).
15. Arthralgia (kupweteka kolowa).
16. Hematuria (kukhalapo kwa magazi mkodzo).
17. Glomerulonephritis (matenda a impso amadziwika ndi zotupa za glomeruli).

Kodi ndingagwiritse ntchito mankhwalawa panthawi yapakati?

Malinga ndi ndemanga ya Lopirel, amadziwika kuti clopidogrel sanawonetsedwe kuti alibe vuto pakubala komanso pobereka, koma chifukwa chosowa chidziwitso cha chipatala, mankhwalawa amaperekedwa kwa amayi apakati.

Pakuphunzira kumeneku, zidapezeka kuti zinthu zomwe zimagwira ndi ma metabolites zimadutsa mkaka wa m'mawere, ndiye kuti mkaka wa m`mawere uyenera kuyimitsidwa pakumwa mankhwala. Palibe chidziwitso podzipatula kwa clopidogrel mkaka wa amayi. "Lopirel" ndiwoperekedwa kwa ana osakwana zaka khumi ndi zisanu ndi zitatu.

Lopirel ali ndi mankhwala ena othandizira:

1. "Plagril."
2. Muthana.
3. Plavix.
4. "Deplatt 75".
5. Detrombe.
6. Clapitax.
7. "Listab 75".
8. Zeru.
9. Avix.
10. "Orogrel".
11. Brilinta.
12. "Plogil."
13. Reomax.
14. "Medogrel".
15. Cardogrel.
16. Tessiron.
17. "Clorelo."
18. Klopikor.
19. Claridol
20. Gridoklein.

Musanasinthe choyambirira ndi analogue, pitani kuchipatala.

Mankhwalawa amapezeka mu mawonekedwe a mapiritsi, omwe amaphatikizidwa ndi zokutira filimu. Ali ndi mawonekedwe ozungulira, a biconvex, apinki mu utoto. Mapiritsi amaikidwa m'matumba a zidutswa khumi. "Plagril" analogue of "Lopirel".

Maola awiri mutatenga mlingo woyambirira - ma milligram mazana anayi - kuletsa kwa maphatikizidwe am'magazi kumawonedwa. Kuchuluka kwake kumatheka pambuyo masiku asanu ndi awiri, kugwiritsa ntchito mankhwalawa mosamala kuchokera pa makumi asanu mpaka mamiligalamu zana limodzi patsiku.

Malinga ndi malangizo ogwiritsa ntchito ndi analogue ya Lopirel 75 mg, amadziwika kuti zotsatira za mankhwalawa zimatha kwa masiku khumi. Pambuyo pakutha kwa mankhwalawa ndi "Plagril" kwa masiku 5, nthawi yakukha magazi ndi kuphatikiza maplatelet amabwerera pamlingo wawo woyambirira. Mankhwalawa amalepheretsa kuwoneka kwa atherothrombosis mwa anthu omwe ali ndi matenda a atherosulinotic.

Mankhwala ayenera kuyimitsidwa masiku asanu ndi awiri asanachitike opaleshoni, momwe antiplatelet kwenikweni ndi osafunika. Potere, munthuyo ayenera kudziwitsa katswiri wa zamankhwala zokhudzana ndi magazi aliwonse omwe angagwiritse ntchito Plagril. Kuphatikiza apo, ngati munthu akufuna kuchitidwa opaleshoni kapena amupatsa mankhwala ena, wodwalayo ayenera kuuzanso dokotalayo za kugwiritsa ntchito Plagril. Munthawi ya chithandizo, ndikofunikira kuwunika momwe chiwindi chikugwirira ntchito.

Mankhwalawa amathandizira kuchepetsa kupendekera, komwe kumakhumudwitsidwa ndi agonists ena, kuletsa kutsegula kwawo ndi adenosine diphosphate.

Malinga ndi malangizowo, analogue ya Lopirel imagwiritsidwa ntchito pochita prophylactic popewa kuchitika kwa atherothrombosis:

1. Anthu omwe adakumana ndi vuto la myocardial infarction, komanso ischemic stroke yomwe yapezeka ndi chotupa cha zotumphukira m'mitsempha.
2. Pa anthu omwe ali ndi pachimake coronary syndrome.
3. Odwala omwe amakhala akusuntha pakati pa coronary angioplasty.

Kuphatikiza apo, Klopikor amalimbikitsidwa chifukwa cha prophylactic cha thromboembolic, zochitika za atherothrombotic zokhala ndi fibrillation ya atria.

Mukamamwa mankhwala muyezo wa ma milligram makumi asanu ndi awiri mphambu asanu patsiku, kuletsa kwakukulu kwa kuphatikizana kwa maplateni kumachitika kuyambira tsiku loyamba la mankhwala. Pamasiku asanu ndi awiri otsatira, izi zikuchulukirachulukira.

Kuponderezedwa kwa mapangidwe amplatri mu equilibrium kumakhala pafupifupi makumi anayi ndi makumi asanu ndi limodzi peresenti (pamene amamwa mankhwalawa poyerekeza ndi milligrams makumi asanu ndi awiri mphambu asanu patsiku). Kuthetsa kwa magazi, kuchuluka kwa mayeso am'mapulogalamu kunabwereranso m'masiku asanu.

Malinga ndi ndemanga, analogi ya Lopirel 75 mg - Zilt imathandizira kupewa kuwonekera kwa mtima kapena sitiroko kwa odwala omwe ali ndi mtima wamatenda a mtima.

Chithandizo chogwira ntchito chimafulumira kulowa pakamwa. Mulingo wokwanira wa Clopidogrel pafupifupi 2.2-2.5 nanograms pa millilita (atatha kumwa kwa milligram makumi asanu ndi awiri mphambu zisanu za mankhwalawo). Nthawi yofika ndende yayitali pafupifupi mphindi makumi anayi ndi zisanu. Mlingo wa mayamwidwe wa wogwira ntchito, malinga ndi chidziwitso cha kupezeka kwa mankhwala a metabolic a impso, ndiwo makumi asanu.

Sikulimbikitsidwa kupereka mankhwalawa kwa anthu omwe ali ndi vuto la kusokonezeka kwa ischemic ndi mankhwala ochepera sabata limodzi. "Zilt" imakulitsa nthawi yakutulutsa magazi, izi ziyenera kukumbukiridwa ngati zimagwiritsidwa ntchito nthawi yomweyo ndi "Aspirin", mankhwala omwe si a antiidal a antiidal, "Heparin" ndi "Warfarin". Odwala otere ayenera kupendedwa kuti awonjezere chidwi cha ticlopidine, prazogrel ndi thienopyridine, popeza kuyambanso kuzolowera kumvetsetsa kwapakati pa mankhwala a gululi ndikotheka.

Pomwe akuwonetsa mu mbiri yachipatala ya wodwala pakukhudza chidwi ndi thienopyridine wina, amayenera kuyang'aniridwa mosamala panthawi ya chithandizo kuti adziwe chizindikiro cha hypersensitivity ku chinthucho. Pokonzekera wodwala ntchito yomwe anakonzekera, kugwiritsa ntchito mankhwalawa kuyenera kuyimitsidwa kwa masiku asanu kapena asanu ndi awiri.

Munthu ayenera kuchenjezedwa za kutaya magazi kwa nthawi yayitali panthawi ya chithandizo komanso kufunika kodziwitsa katswiri wa zamankhwala za vuto lililonse lomwe limatulutsa magazi. Mukakambirana ndi madokotala ena, nthawi zonse muyenera kufotokozera za kugwiritsa ntchito "Zilt", chidziwitso ichi ndichofunikira pokhazikitsa mankhwala atsopano, komanso mukapita kwa dotolo wamano.

Awa ndi mankhwala a antithrombotic omwe amasokoneza mgwirizano wa magazi a m'magazi, akuletsa njira yolumikizira adenosine diphosphate ndi ma receptors omwe ali pa membrane wa mapulateleti, komanso othandizira glycoprotein receptors. "Reomax" imathandizira kuchepetsa kuphatikiza kwa ma platelet, omwe amakwiya ndi agonists ena, kuletsa kuyambitsa kwawo ndi adenosine diphosphate.

Ntchito yogwira (clopidogrel) imasankha adenosine diphosphate ndi mapuloteni othandizira, ndikulepheretsa mayanjano awo. Kulumikizana kosasinthika ndi mitsempha yotereyi, kumapangitsa kuti ma cell a magazi azigwira ntchito mozungulira nthawi yawo yonse ya moyo. Egithromb ndi analogue ya mapiritsi a Lopirel.

Kupsinjika kwa mayanjano kumadziwika pambuyo pa maola awiri, ndipo phindu lalikulu limawonedwa patatha masiku asanu kapena asanu ndi awiri. Sizikhudza zochita za gulu la ma enzymes omwe amachepetsa mphamvu ya phosphodiester.

Pamaso pa matenda aubongo osatha, momwe cholesterol ndi mafuta ena amayikidwa kukhoma lamkati la mitsempha mu mawonekedwe amipawo ndi zipere, ndipo makomawo enieni amakhala osawoneka bwino ndikulephera kwawo, mankhwalawo amathandizira kupewa thrombosis.

Mankhwala akuimira gulu la mankhwala - antiplatelet agents. Amagwiritsidwa ntchito popewa zovuta za atherothrombotic m'njira zosiyanasiyana zamatenda amtima.

Chosakaniza chogwiritsidwa ntchito pamapiritsi a Plavix ndi clopidogrel. Imalepheretsa ntchito yamapulatini a gluing. Zotsatira zake zachilengedwe zimachitika chifukwa cha kusankha kwa kuphatikiza kwa adenosine diphosphoric acid ku malekezero amitsempha am'mitsempha komanso kuyambitsa kwakanthawi kwamakonzedwe awo. Izi zimachitika mu moyo wonse wa mapulateleti (masiku asanu ndi awiri mpaka khumi), kotero kuthekera kuyambiranso kuphatikizika kumawonekera pokhapokha maselo ataberekanso.

Phemvix zotsatira za Plavix zimachitika pambuyo pa kusinthana kwa clopidogrel m'chiwindi, ndipo yogwira metabolic product imapangidwa, yomwe imalepheretsa kuphatikizika kwa mapulosi. Pambuyo poyambira kugwiritsa ntchito Plavix, kukhazikitsa ntchito zotsutsana ndikuchitika kumachitika kwa masiku awiri kapena atatu kenako ndikufikira nthawi zonse.

Pambuyo pakutha kwa chithandizo cha mankhwala a Plavix, zolimbitsa thupi zimayambiranso kwa masiku asanu mpaka asanu ndi awiri. Kugwiritsa ntchito mankhwala kumachepetsa mwayi wokhala ndi vuto la chithokomiro, komanso kulowetsedwa kwa magazi m'mitsempha yosiyanasiyana ya mtima ndi mitsempha yamagazi, kuphatikizapo kuwonjezeka kwa mapangidwe a atgency, omwe amachititsa kuti magazi azigundika.

Mankhwala ndi a gulu la achire mankhwala - antiplatelet agents ndi anticoagulants. Brilinta amagwiritsidwa ntchito pakuwongolera matenda a mtima, momwe mumakhala chiwopsezo cha kuundana kwa magazi mkati mwa ma capillaries, omwe angayambitse matenda a sitiroko kapena kuphwanya m'mitsempha.

Mukatha kugwiritsa ntchito mankhwalawa, gawo lomwe limagwira pakamwa limatengedwa m'magazi kuchokera m'matumbo aang'ono. Zomwe zimapangidwira m'magazi zimakwaniritsidwa mphindi makumi awiri ndi zitatu atatha kugwiritsa ntchito mankhwalawa, kuchuluka kwakukulu kumachitika pambuyo pa ola limodzi ndi theka.

Yogawana ikufalikira mthupi lonse lathunthu, kudutsa chotchinga muubongo ndipo kudzera mu chotchinga cha mwana wosabadwa ndi mkaka munthawi yoyamwa. Pulogalamu yogwira (ticagrelor) imasinthidwa m'maselo a chiwindi, zinthu zake zowola zimapukusidwa mu ndulu. Kuchotsa theka-moyo pafupifupi maola asanu ndi awiri.

Gwiritsani ntchito odwala omwe ali ndi genetic yotsika ya CYP2C19 isoenzyme

Ndi zochitika zochepa za CYP2C19 isoenzyme, mphamvu ya antiplatelet ya clopidogrel imatsika. Mukamagwiritsa ntchito waukulu Mlingo wa 600 mg, kenako 150 mg patsiku tsiku lililonse, mphamvu ya antiplatelet ya Clopidogrel imachulukanso. Poganizira zotsatila zamaphunziro a kafukufukuyu, sizotheka kukhazikitsa njira yabwino kwambiri ya odwala omwe ali ndi metabolism yochepetsedwa chifukwa chogwira ntchito yochepa ya CYP2C19 isoenzyme.

Gwiritsani ntchito odwala a mafuko osiyanasiyana

Kwa oimira mafuko osiyanasiyana, kuchuluka kwa ma genes a CYP2C19 isoenzyme, omwe amachititsa kuchepetsedwa komanso kwapakatikati kagayidwe ka clopidogrel ku metabolite yogwira, imasiyanasiyana. Pali zambiri zochepa pa oimira mtundu wa Mongoloid okhudza kuwunika kwa ubale wa CYP2C19 isoenzyme genotype ndi zotsatira zamankhwala.

Gwiritsani ntchito mwa amuna ndi akazi

Kafukufuku wochepa akufanizira kuchuluka kwa pharmacodynamic a Lopirel m'magulu onse awiri adawonetsa kutsika kwa zoletsa za ADP-zomwe zimapangitsa kuti azimayi azikhala, koma panalibe kusiyana pakukhetsa magazi. Phunziro lalikulu lolamulidwa ndi CAPRIE (kuphatikiza kwa clopidogrel ndi acetylsalicylic acid mwa odwala omwe ali ndi mwayi wopeza zovuta za ischemic) mwa azimayi ndi abambo, pafupipafupi pazotsatira zamankhwala, kupatuka kwachipatala ndi kwa Laborator kuchokera kwazomwe zikuchitika, komanso zotsatirapo zina zinali zofanana.

Zotsatira zoyipa

Kafukufuku wachitetezo adachitika wokhudza odwala opitilira 44,000, kuphatikiza odwala opitilira 12,000 omwe adachitiridwa chithandizo osachepera chaka chimodzi. Kulekerera kwapakati pa Clopidogrel kuli kofanana ndi kulekerera kwa acetylsalicylic acid, mosasamala mtundu, jenda komanso zaka za odwala. Maphunziro angapo azachipatala (CURE, CAPRIE, COMMIT, CLARITY, ACTIVE A) adawonetsa zovuta zoyipa zomwe zidanenedwa pansipa.

Mu mayeso a CAPRIE, kulekerera kwa Clopidogrel (tsiku lililonse 75 mg) kumafanana ndi kwa acetylsalicylic acid (tsiku ndi tsiku 325 mg). Mauthenga ongodzipereka amakhala ndi chidziwitso chokhudza zomwe zimachitika.

M'mayesero azachipatala ndi kugwiritsidwa ntchito kwa malonda a Clopidogrel, nthawi zambiri amatulutsa magazi (makamaka mwezi woyamba wa chithandizo) adalemba.

M'mayeso azachipatala a CAPRIE, kuchuluka kwa magazi omwe amagwiritsidwa ntchito mosiyana ndi clopidogrel kapena acetylsalicylic acid anali 9,3%. Kutulutsa magazi kwambiri ndi Clopidogrel kunalembedwa pafupipafupi komanso acetylsalicylic acid.

Mu chipatala cha CURE chochita pogwiritsa ntchito acetylsalicylic acid ndi clopidogrel kwa masiku 7 pambuyo poti ma coronary artery adutsa polumikizana mwa odwala omwe anasiya kulandira chithandizo masiku opitilira 5 asanachitike opaleshoni, kuwonjezeka kwa magazi kwambiri sikunachitike. Odwala omwe amapitiliza kumwa mankhwalawa kwa masiku 5 isanayambike kukomoka kwa chotupa cham'mimba, kutaya magazi kwambiri kumawonedwa pafupipafupi ndi 9.6% (kuphatikiza acetylsalicylic acid + clopidogrel) ndi 6.3% (kuphatikiza acetylsalicylic acid + placebo).

Mayeso azachipatala a CLARITY adawonetsa kuwonjezeka kwa chiwongola dzanja cha gulu la acetylsalicylic acid + Clopidogrel poyerekeza ndi gulu la acetylsalicylic acid + placebo. M'magulu onse awiri, pafupipafupi magazi amatuluka kwambiri ndipo anali ofanana pafupifupi ndi mtundu wa heparin kapena fibrinolytic therapy komanso mawonekedwe oyamba a odwala.

Poyesedwa pachipatala cha COMMIT, kuchuluka kwa zotupa za m'matumbo kapena hemorrhage yayikulu kwambiri siyinali yotsika ndipo sikunasiyana magulu onse awiriwa.

M'mayesero azachipatala a ACTIVE-A, chiwopsezo cha kutulutsa magazi kwambiri chinali chachikulu kwa gulu la acetylsalicylic acid + Clopidogrel kuposa gulu la acetylsalicylic acid + placebo (6.7% ndi 4.3%, motsatana). Kwenikweni, magazi akulu m'magulu onsewa anali a extracranial (5.3% ndi 3.5%, motero), magazi am'mimba ambiri amapangidwa (3.5% ndi 1.8%, motero). Mu gulu la acetylsalicylic acid + clopidogrel, zotupa za intracranial zinali zofala kwambiri poyerekeza ndi gulu la acetylsalicylic acid + placebo (1.4% ndi 0.8%, motsatana). Panalibe kusiyana kwakukulu pamanambala awa m'maguluwa chifukwa cha matenda a hemorrhagic stroke (0.8% ndi 0.6%, motsatana) komanso magazi owopsa (1.1% ndi 0.7%, motsatana).

M'maphunziro azachipatala komanso malipoti ochitika zokha, zosintha zotsatirazi zidalembedwa:

• dongosolo la lymphatic ndi circulatory system: infrequently - eosinophilia, leukopenia, thrombocytopenia, kawirikawiri neutropenia (kuphatikizapo kwambiri neutropenia), kawirikawiri aplasic anemia, thrombotic thrombocytopenic purpura, agranulocytosis, pancytopenia, strombocytopenia, kali thrombocytopenia, strombocytopenia, kali thrombocytopenia, kali thrombocytopenia
• chitetezo chamthupi: kawirikawiri - anaphylactoid zimachitika, seramu matenda, pafupipafupi sizikudziwika - kukula kwa zochita zamkati mwa hypersensitivity ndi thienopyridines (mwachitsanzo, ndi ticlopidine ndi prasugrel),
• psyche: kawirikawiri - chisokonezo, kuyerekezera zinthu m'maganizo,
• dongosolo lamanjenje: pafupipafupi - kupweteka mutu, intracranial hemorrhage (zina zakupha), chizungulire, paresthesia, kawirikawiri - kukoma kosokoneza,
• masomphenya: pafupipafupi - zotupa za m'maso (m'matumbo amaso, conjunctiva, retina),
• kumva: kawirikawiri - vertigo,
• Mitsempha yamagazi: Nthawi zambiri - hematomas, osowa kwambiri - magazi ochokera ku bala, opaleshoni yayikulu, magazi ochepa, vasculitis,
• kupuma dongosolo: Nthawi zambiri - nosebleeds, kawirikawiri - bronchospasm, magazi ochokera kupuma dongosolo (pulmonary hemorrhage, hemoptysis), chibayo eosinophilic, chibayo cham'mimba,
• m'mimba thirakiti: Nthawi zambiri kutsekula m'mimba, kutaya kwa m'mimba, kupweteka kwa m'mimba, kupweteka kwam'mimba, zilonda zam'mimba komanso duodenal, nseru, kusanza, kugonja, kusowa kwa magazi pafupipafupi, kusowa kwambiri kwa m'mbuyomu komanso m'mimba. magazi am'matumbo owopsa, colitis (kuphatikizapo zamitsempha kapena zilonda zam'mimba), kapamba, stomatitis,
• chiwindi ndi kwamikodzo thirakiti: kawirikawiri - chiwindi, kuperewera kwa chiwindi, zosabereka mu maphunziro a labotale a chiwindi,
• khungu ndi subcutaneous minofu: zambiri - kuvulaza, pafupipafupi - kuyabwa, zidzolo, purpura, kawirikawiri - angioedema, oxous dermatitis (erythema multiforme, Stevens-Johnson syndrome, poyizoni epermermal necrolysis), mankhwala hypersensitivity syndrome, erythematic kapena exfoliative syrup zidzolo ndi zizindikiro za eicinophilia, urticaria, lichen planus, chikanga,
• minofu: mafupa a minofu ndi mafupa: kawirikawiri - nyamakazi, hemarthrosis (hemorrhage mu musculoskeletal system), myalgia, arthralgia,
• impso ndi kwamikodzo thirakiti: pafupipafupi - hematuria, osowa - kuwonjezeka kwa kuchuluka kwa creatinine m'magazi, glomerulonephritis,
• maphunziro othandizira ndi a labotale: pafupipafupi - kuchepa kwa chiwerengero cha neutrophils, kuchuluka kwa nthawi yotulutsa magazi, kuchepa kwa kuchuluka kwa mapulateleti,
• zovuta pamalowa jakisoni ndi zovuta zina: kawirikawiri - magazi ochokera kumalo opumira, kawirikawiri - malungo.

Kupuma, matenda a hematological

Zizindikiro zamankhwala zikawoneka zomwe zikuwonetsa kuti magazi akutuluka komanso chiopsezo chokhala ndi zotsatira zosafunikira, ndikofunikira kuyeseza magazi mwachangu, kudziwa komwe kungayambitse gawo la thromboplastin nthawi, kuwerengetsa kupatsidwa zinthu za m'magazi, zochitika zina zamagulu ena.

Lopirel iyenera kugwiritsidwa ntchito mosamala kwa odwala omwe ali ndi chiopsezo chowonjezereka cha magazi omwe amayamba chifukwa cha njira zopangira opaleshoni, kuvulala, zovuta zina zam'magazi, ndipo mwa odwala omwe amalandila mankhwala osapatsa-anti-cellidal (makamaka, acetylsalicylic acid, heparin, COX-2 inhibitors, glycoprotein IIb / IIb / inhibitors IIIa kapena kusankha ma serotonin reuptake inhibitors).

Pakati pa milungu yoyamba ya Lopirel chithandizo ndi / kapena pambuyo pothandizidwa ndi mtima kapena kuchitapo opaleshoni, kuyang'anira mosamala za magazi, kuphatikiza latent, ziyenera kuchitika.

Chifukwa chowonjezereka pakuchulukitsa kwa magazi, kuphatikiza kwa Lopirel ndi warfarin sikulimbikitsidwa. Kupatulako sikumakhala kovuta muchipatala: kupezeka kwamanzere kwamitsempha yoyandama, kulimbikitsa odwala omwe ali ndi fibrillation ya atria, ndi zina zambiri.

Pakachitika opaleshoni yomwe ikukonzekera yomwe ikubwera komanso ngati pakufunika kuonetsetsa kuti antiplatelet ikuchitika, makonzedwe a Lopirel amayenera kuyimitsidwa masiku 7 masiku asanachitike.

Asanayambe mankhwala aliwonse komanso asanachitike opaleshoni yomwe ikubwera, wodwalayo ayenera kudziwitsa dokotala (kuphatikizapo dotolo wamano) za kumwa Lopirel.

Mankhwalawa amakulitsa nthawi ya kukhetsa magazi, motero, iyenera kugwiritsidwa ntchito mosamala odwala omwe ali ndi vuto lotaya magazi (makamaka intraocular ndi m'mimba).

Wodwalayo ayenera kuchenjezedwa kuti ngati mutenga Lopirel (mu monotherapy kapena kuphatikiza ndi acetylsalicylic acid), kusiya magazi kumafuna nthawi yambiri. Ngati magazi abwinobwino atheka (mwa kutalika kapena kutulutsa), muyenera kufunsa dokotala.

Thrombotic Thrombocytopenic Purpura (TTP)

Ngakhale patadutsa kanthawi kochepa clopidogrel, panali zochitika zochepa kwambiri za thrombotic thrombocytopenic purpura, zomwe zimadziwika ndi thrombocytopenia, microangiopathic hemolytic anemia, limodzi ndi vuto laimpso, kutentha thupi, kuchepa kwa mitsempha. TTP imawonedwa ngati chinthu chowopsa m'moyo chomwe chimafuna chithandizo chamanthawi, kuphatikizira plasmapheresis.

Anapeza hemophilia

Mankhwala a clopidogrel, milandu ya hemophilia idalembedwa. Pomwe mukutsimikizira kuchuluka kwa nthawi yodziyimira ya thromboplastin osayamba kutuluka magazi kapena ndi magazi, muyenera kuganizira za mwayi wokhala ndi hemophilia, ndipo ngati kupezeka koyenera kwawoneka, siyani kumwa Lopirel ndikuyamba chithandizo chokwanira.

Posachedwa ischemic stroke

Lopirel simalimbikitsidwa popereka mankhwala osokoneza bongo a ischemic mpaka masiku 7 apitawa chifukwa chosowa deta pakugwiritsa ntchito kwake.Kuphatikiza mankhwala omwe ali ndi acetylsalicylic acid ndi clopidogrel mwa odwala omwe ali ndi vuto losachedwa kwambiri la ischemic kapena ischemic stroke komanso kuthekera kwakukulu kobwerezabwereza zochitika za atherothrombotic sikuthandiza kwambiri kuposa monotherapy yokhala ndi clopidogrel, koma ali ndi chiwopsezo chachikulu cha magazi.

Mimba komanso kuyamwa

Kafukufuku wanyama sanawonetse vuto losasintha la clopidogrel pakukula kwa mimbayo, kutenga pakati, kubereka, chitukuko cha pambuyo pake, koma chifukwa cha kusowa kwa zidziwitso zakuchipatala, kugwiritsa ntchito Lopirel kumatsutsana ndi odwala oyembekezera.

Popita kafukufuku pa makoswe, zidapezeka kuti clopidogrel ndi ma metabolites amadutsa mkaka wa m'mawere, chifukwa chake, pakachitika chithandizo ndi Lopirel, kuyamwitsa kuyenera kusiyidwa. Palibe deta pakudzipatula kwa clopidogrel ndi mkaka wa m'mawere wa anthu.