Mankhwala Aterocardium: malangizo ntchito

Aterocardium imapezeka mu mawonekedwe a mapiritsi okhala ndi filimu: ozungulira, biconvex, pinki (zidutswa 10 chilichonse pachimake, mu chikatoni cha 1 kapena 4 matuza).

Piritsi 1:

yogwira mankhwala: clopidogrel (munthawi ya clopidogrel hydrosulfate) - 75 mg,
othandizira zigawo zikuluzikulu: magnesium stearate, povidone, lactose monohydrate, pregelatinized starch, polyethylene glycol 6000, microcrystalline cellulose,
Chovala cha kanema: Opadry II Pink (hypromellose, triacetin, titanium dioxide, lactose monohydrate, polyethylene glycol, indigo carmine aluminium varnish, wokongola wofiira aluminium varnish).

Zizindikiro zogwiritsidwa ntchito

Aterocardium imagwiritsidwa ntchito poletsa chiwonetsero cha atherothrombosis m'magulu otsatirawa a odwala akuluakulu:

odwala omwe adwala matenda a ischemic stroke (mankhwalawa amayamba masiku 7 atadwala matenda opha ziwalo, koma osapitirira miyezi 6 zitachitika),
odwala omwe adadwala matenda a myocardial infirction (mankhwalawa amayamba patadutsa masiku angapo pambuyo pa vuto la mtima, koma pasanathe masiku 35 zitachitika),
odwala matenda a zotumphukira mitsempha (mtima atherothrombosis ndi kuwonongeka mitsempha ya m'munsi malekezero),
odwala omwe ali ndi vuto lodana ndi pachimake myocardial infarction ndi gawo lama ST nthawi imodzi ndi ASA (acetylsalicylic acid) (mwa odwala omwe amalandila chithandizo chamankhwala omwe amathandizidwa kuti apatsidwe chithandizo cha thrombolytic),
odwala omwe ali ndi pachimake coronary syndrome popanda kukwezeka kwa gawo (myocardial infarction popanda Q wave kapena osakhazikika angina) munthawi yomweyo ndi acetylsalicylic acid.

Contraindication

kulephera kwambiri kwa chiwindi
intracranial hemorrhage, zilonda zam'mimba ndi zina zomwe zitha kutenga magazi pachiwopsezo,
kuchepa kwa lactase, galactose tsankho, shuga-galactose malabsorption syndrome,
ana ndi achinyamata osakwana zaka 18,
mimba
yoyamwitsa
kuchuluka kwa chidwi cha munthu aliyense ku clopidogrel kapena chilichonse chothandiza cha mankhwalawo.

Wachibale (Aterocardium imagwiritsidwa ntchito mosamala):

zolimbitsa pang'ono mpaka pang'ono zotheka,
kulephera kwa aimpso
mbiri ya hemorrhagic (mbiri),
kuchitapo kanthu kwa opaleshoni, kuvulala ndi zina zokhudzana ndi pathological ndi chiopsezo chowonjezeka cha magazi,
Kugwiritsa ntchito limodzi ndi heparin, ASA, mankhwala osokoneza bongo a anti-yotupa ndi glycoprotein IIb / IIIa zoletsa.

Mlingo ndi makonzedwe

Mapiritsi a Aterocardium amatengedwa pakamwa, mosasamala kanthu za chakudya.

Mlingo woyenera kwa akuluakulu, kuphatikizapo odwala okalamba, ndi piritsi limodzi kamodzi patsiku.

Mu pachimake coronary syndrome popanda kukwezeka kwa gawo, chithandizo chimayambira ndi kuchuluka kwa 300 mg kamodzi, kenako ndikupitilizidwa ndi muyezo wa 75 mg kamodzi pa tsiku limodzi ndi acetylsalicylic acid tsiku lililonse la 75-325 mg. Kutenga Mlingo wambiri wa acetylsalicylic acid kumakulitsa magazi, motero sikulimbikitsidwa kumwa oposa 100 mg a ASA patsiku.

Kutalika kwa nthawi ya maphunzirowa sikunakhazikitsidwe, koma zotsatira za kafukufuku zikuwonetsa kuti Aterocardium iyenera kutengedwa mpaka miyezi 12. Kuchuluka kwa mankhwalawa kunawonedwa pambuyo pa miyezi itatu yogwiritsa ntchito mankhwalawa.

Mu kulowetsedwa pachimake ndi kukwezedwa kwa gawo lama ST, mankhwalawa amayambanso ndi gawo limodzi lokweza (300 mg) osakanikirana ndi acetylsalicylic acid, wokhala ndi kapena wopanda mankhwala a thrombolytic. Odwala opitilira zaka 75 sakhazikitsidwa muyeso wokweza. Kuyang'anira ASA kumayamba koyambirira ndipo kumatenga milungu inayi.

Zotsatira zoyipa

kugaya chakudya dongosolo: Nthawi zambiri - kukanika kwa m'mimba, kupweteka kwam'mimba, kutaya m'mimba, kutsegula m'mimba, kuperewera - kusanza, zilonda zam'mimba, kudzimbidwa, zilonda zam'mimba, kuchepa kwapafupa, kudzimbidwa, kawirikawiri - kubwezeretsa magazi m'mimba, kawirikawiri - stomatitis, colitis (mu kuphatikizapo lymphocytic kapena ulcerative), kapamba, kubwezeretsa m'mimba ndi m'mimba ndikutulutsa kowopsa,
dongosolo la hepatobiliary: kawirikawiri - chiwindi, kusowa kwa chiwindi, mayesero amtundu wa chiwindi,
mtima dongosolo: Nthawi zambiri - hematoma, kawirikawiri - vasculitis, kukha magazi, kuwonda hypotension, magazi kuchokera opaleshoni bala,
hematopoietic dongosolo: pafupipafupi - leukopenia, thrombocytopenia, eosinophilia, kawirikawiri - neutropenia (kuphatikizapo kwambiri), kawirikawiri - kuchepa kwa magazi, agranulocytosis, granulocytopenia, thrombotic thrombocytopenic purpura, pancytopenia, thrombocytopenia
kupuma dongosolo: Nthawi zambiri - nosebleeds, kawirikawiri - bronchospasm, pulmonary hemorrhage, hemoptysis, interstitial pneumonitis,
chapakati mantha dongosolo: pafupipafupi - chizungulire, paresthesia, intracranial magazi (nthawi zina amwalira), mutu, kawirikawiri - kukoma zosokoneza, kuyerekezera zinthu zina, chisokonezo,
ziwalo zamadzimadzi: infrequently - ocular, conjunctival kapena retinal magazi, osowa - chizungulire chifukwa cha matenda amkhutu ndi labyrinth,
minofu: Mafupa a minyewa ya m'mimba: kawirikawiri - nyamakazi, myalgia, hemarthrosis, arthralgia,
kwamikodzo dongosolo: pafupipafupi - hematuria, kawirikawiri - kuwonjezeka kwa plasma creatinine, glomerulonephritis,
khungu ndi subcutaneous minofu: nthawi zambiri - subcutaneous kukha magazi, kosachepera - kuyabwa, zidzolo, phenura, kawirikawiri - urticaria, lichen planus, zotupa za erythematous, eczema, dermatitis wowopsa, angioedema,
thupi lawo siligwirizana: kawirikawiri - anaphylactic zimachitika, seramu matenda,
Zizindikiro zasayansi: pafupipafupi - kukulitsa nthawi ya magazi,
ena: kawirikawiri kwambiri - malungo.

Malangizo apadera

Ngati magazi akukayikiridwa, kuyezetsa koyenera komanso / kapena kuyezetsa magazi mwatsatanetsatane kuyenera kuchitidwa mwachangu.

Aterocardium iyenera kutsekedwa masiku 7 asanachitike opaleshoni yomwe ikufunika kuchitidwa, popeza mankhwalawa amawonjezera kutalika kwa magazi.

Odwala ayenera kuchenjezedwa kuti pochiza mankhwalawa clopidogrel, kutuluka kwa magazi kumatha nthawi yayitali ndikuyimanso pambuyo pake. Mlandu uliwonse wokhetsa magazi kwachilendo kapena kutuluka kwachuma kuyenera kuuzidwa kwa dokotala.

Aterocardium siyimakhudza kapena imapangitsa pang'ono pakuthamanga kwa zochitika zama psychomotor komanso kuthekera kwambiri. Ngati chizungulire chitayamba kumwa mankhwala, muyenera kusiya kuyendetsa galimoto ndi zina zomwe zingakhale zoopsa.

Zotsatira za pharmacological

Mapulogalamu ophatikiza mapulatifomu kuphatikizira heparin. Mankhwala. Clopidogrel amasankha moyenera kumanga kwa adenosine diphosphate (ADP) ku receptor pamalo ophatikizika ndi kupangika kwa zovuta kwa GPIIb / IIIa motsogozedwa ndi ADP ndipo, motero, timalepheretsa kuphatikizana kwa mapulateleti. Clopidogrel imalepheretsanso kuphatikiza kwa mapulateleti omwe agonists ena amaletsa kuwonjezeka kwa ntchito ya kupatsidwa zinthu za m'masamba otulutsidwa ndi ADP ndikuwasintha maselo a receptors a ASP. Mapulatifomu omwe adalumikizana ndi kusintha kwa clopidogrel mpaka kumapeto kwa moyo wawo. Ntchito yachilendo yamapulogalamu imabwezeretsedwa pamlingo wogwirizana ndi kukonzanso kwa zinthu zina.
Kuyambira tsiku loyamba logwiritsira ntchito Mlingo wa 75 mg wa mankhwalawa, kusuntha kwakukulu mu ADP-kuphatikizira kupatsidwa zinthu za m'magazi kwapezeka. Kuchita izi kumakulirakulira pang'onopang'ono pakati pa masiku atatu ndi 7. Khola likakhazikika, pafupifupi kuchuluka kwa zoletsa zomwe zimayendetsedwa tsiku lililonse ndi 75 mg kuchokera 40% mpaka 60%. Kuphatikiza kwa masamba ndi kutalika kwa magazi kumayambiranso pakadutsa masiku 5 mutasiya kulandira chithandizo.
Pambuyo pakamwa pakamwa pa 75 mg, imatengedwa mwachangu kuchokera m'mimba. Pafupifupi kuchuluka kwa plasma kwa osasinthika clopidogrel (pafupifupi 250-2.5 ng / ml pambuyo pa gawo limodzi la 75 mg pamlomo) zimatheka pafupifupi mphindi 45 atamwa. Mafuta osachepera 50%, monga momwe amasonyezera ndi kuphipha kwa ma cell a clopidogrel mu mkodzo. Clopidogrel ndi metabolite yayikulu (yosagwira) yomwe ikuyenda m'magazi mu vitro imasinthika kumanga mapuloteni a plasma ya anthu (98% ndi 94%, motsatana). Mgwirizanowu umakhalabe wokhazikika mu vitro pamitundu yambiri.
Mu vitro ndi vivo pali awiri
Clopidogrel ndiyowonjezera njira yayikulu ya kagayidwe kake: imadutsa limodzi ndi kutenga nawo gawo kwa magawo ndipo imayambitsa hydrolysis ndikupanga chogwiritsa ntchito cha carboxylic acid (chomwe chimapangitsa 85% ya metabolites yonse kuzungulira mu plasma), ndi ma enzymes a dongosolo la cytochrome P450 akukhudzidwa ndi zina. Choyamba, clopidogrel imasinthidwa kukhala yapakatikati metabolite ya 2-oxo-clopidogrel. Zotsatira za metabolism yowonjezereka ya 2-oxo-clopidogrel, mphamvu ya thiol, yogwira metabolite, imapangidwa. Mu vitro, njira ya metabolic iyi imayang'aniridwa ndi ma enzymes CYP3A4, CYP2C19, CYP1A2, CYP2B6. The metabolite yogwira ya clopidogrel, yomwe idali yokhayokha mu vitro, mwachangu komanso mosasinthika imamangiriza ku ma cell a receptor, akuletsa kuphatikizana kwa mapulateni.
Maola 120 atatha kumwa, pafupifupi 50% ya mlingo womwe umatengedwa umathiridwa mkodzo 46% ndi ndowe. Pambuyo pakamwa limodzi mlingo, theka moyo wa clopidogrel pafupifupi 6 maola. Hafu yaumoyo wa metabolite yayikulu (yosagwira) yozungulira m'magazi ndi maola 8 pambuyo pa kuperekedwa kamodzi kwa mankhwala.
Ma polymorphic angapo a CYP450 ma enzyme amasintha clopidogrel kukhala metabolite yogwira, ndikuyambitsa. CYP2C19 imathandizira pakupanga kwa metabolite yogwira komanso yapakatikati ya metabolite ya 2-oxo-clopidogrel. Ma pharmacokinetics a metabolite yogwira komanso zotsatira za antiplatelet, malingana ndi muyeso wa kuphatikiza kwa maselo ambiri, zimasiyana kutengera mtundu wa CYP2C19. CYP2C19 * 1 allele ikufanana ndi metabolism yogwira ntchito mokwanira, pomwe ma CYP2C19 * 2 ndi CYP2C19 * 3 malemuwa amafanana ndi metabolism yofooka. Izi zimalimbikitsa 85% yamavuto omwe amachepetsa mphamvu mu azungu ndi 99% ku Asia. Zina zomwe zimagwirizanitsidwa ndi metabolism yofooka ndizophatikiza CYP2C19 * 4, * 5, * 6, * 7 ndi * 8, koma ndizochulukirapo pamtunduwu.

Mlingo ndi makonzedwe

Akuluakulu ndi odwala okalamba. Mkati, piritsi limodzi (75 mg) kamodzi patsiku, mosasamala kanthu za kudya.

Odwala omwe ali ndi pachimake coronary syndrome (ACS) popanda ST gawo kukweza (osakhazikika angina kapena myocardial infarction popanda Q wave pa ECG), chithandizo cha Aterocardium chimayamba ndi mtundu umodzi wa 300 mg, kenaka ndikupitilira mlingo wa 75 mg kamodzi patsiku limodzi ndi acetylsalicylic acid ( ASA) pa mlingo wa 75-325 mg wa patsiku. Popeza kugwiritsa ntchito milingo yapamwamba ya ASA kumawonjezera mwayi wokhetsa magazi, ndikulimbikitsidwa kuti musapitirire mlingo wa acetylsalicylic acid wa 100 mg. Kutalika kokwanira kwa chithandizo sikunakhazikitsidwe. Zotsatira za kafukufukuyu zikuonetsa kuti mankhwalawa amagwiritsidwa ntchito mpaka miyezi 12, ndipo kuchuluka kwake kunachitika pambuyo pa miyezi itatu ya chithandizo.

Kwa odwala omwe ali ndi vuto la kupweteka kwamkati wam'mnyewa wamkati ndi kukwezedwa kwa gawo la ST, clopidogrel amalembedwa 75 mg kamodzi patsiku, kuyambira ndi muyeso umodzi wa 300 mg osakanikirana ndi ASA, wokhala ndi mankhwala osokoneza bongo a thrombotic. Chithandizo cha odwala okalamba osaposa zaka 75 chimayamba popanda kukweza mlingo wa clopidogrel. Kuphatikiza mankhwalawa kuyenera kuyambikanso atangoyamba kumene zizindikiro ndipo akuyenera kupitiliza kwa milungu inayi. Ubwino wophatikizidwa wa clopidogrel ndi ASA kwa masabata opitilira anayi sanaphunzitsidwe matendawa.

Mankhwala. Mwa anthu omwe ali ndi mphamvu yofooka ya CYP2C19, kuyankha kochepetsedwa kwa chithandizo cha clopidogrel kunawonedwa. Mlingo woyenera kwambiri mwa anthu omwe ali ndi mphamvu yofooka sunakhazikitsidwebe.

Kulephera kwina. Zomwe timagwiritsa ntchito mankhwalawa kwa odwala omwe ali ndi vuto la impso ndizochepa. Mankhwala ayenera kugwiritsidwa ntchito mosamala (onani gawo "Zomwe zikugwiritsidwa ntchito").

Kulephera kwa chiwindi. Zomwe tikugwiritsa ntchito mankhwalawa odwala omwe ali ndi matenda a chiwindi komanso kuthekera kwa hemorrhagic diathesis ndizochepa. Mankhwala ayenera kugwiritsidwa ntchito mosamala (onani gawo "Zomwe zikugwiritsidwa ntchito").

Zowonetsa ndi Mlingo:

Kupewa kwa atherothrombotic zizindikiro mwa akulu:

Odwala ndi pachimake koronare syndrome

Anthu omwe adadwala matenda a myocardial (ndikofunikira kuyamba mankhwala atatha masiku angapo, koma osapitirira masiku 35 kuchokera pachiwopsezo cha matenda a mtima), ischemic stroke (ndikofunikira kuyamba mankhwala pambuyo masiku 7, koma osapitirira miyezi 6 pambuyo poti adwala), kapena odwala omwe azindikiridwa matenda a zotumphukira mitsempha (atherosulinosis ya ziwiya za m'munsi malekezero ndi kuwonongeka mitsempha)

Odwala osagwa gawo la STG pa ECG (myocardial infarction popanda Q wave kapena osakhazikika), kuphatikiza iwo omwe anali ndi stent yoyikika panthawi ya percutaneous coronary angioplasty, kuphatikizapo acetylsalicylic acid

Odwala omwe ali ndi vuto lodana ndi pachimake myocardial infarction, pamene gawo la ST likwera limodzi ndi acetylsalicylic acid (odwala omwe amalandila chithandizo chamankhwala omwe amafunikira chithandizo cha thrombolytic)

Akuluakulu ndi odwala okalamba ayenera kumwa piritsi limodzi (75 mg) pakamwa kamodzi patsiku, mosasamala kanthu za kudya.

Kwa odwala omwe ali ndi pachimake coronary syndrome popanda kukwezeka kwa ST (myocardial infarction popanda Q wave kapena kusakhazikika kwa angina), mlingo wa 300 mg umakhazikitsidwa kumayambiriro kwa chithandizo.

Kenako piritsi limodzi (75 mg) limayikidwa kamodzi patsiku, limaphatikizidwa ndi acetylsalicylic acid pa mlingo wa 75-325 mg / tsiku.

Kutalika kokwanira kwa chithandizo sikunakhazikitsidwe.

Malinga ndi zotsatira za kafukufuku, kuchuluka kwake kudalembedwa pambuyo pa miyezi itatu kuyambira chiyambi cha chithandizo, ndipo kupindula ndikugwiritsa ntchito mankhwalawa kunali miyezi 12.

Odwala omwe ali ndi vuto lalikulu la kuchepa kwa mtima, omwe gawo la ST limalembedwa pa ECG, mankhwala amapatsidwa mlingo wa 75 mg kamodzi patsiku.

Ndikofunikira kuyamba kumwa Aterocardium ndi muyeso wokweza wa 300 mg kuphatikiza ndi acetylsalicylic acid.

Chithandizo cha odwala omwe ali ndi zaka zopitilira 75 ayenera kuchitika popanda kugulitsa mlingo. Kuphatikiza kwa mankhwalawa kwa Aterocardium ndi acetylsalicylic acid kuyenera kuyambika mutangoyamba kumene kwa zizindikiro ndikupitilira kwa milungu 4. Ubwino wakudya kwakanthawi sizinatsimikizidwe.

Odwala omwe amachepetsa kagayidwe ka CYP 2C19, kuyankhidwa kochepa kwa mankhwalawa ndi Aterocardium kunalembedwa.

Mlingo woyenera kwambiri wa odwala motere sunakhazikitsidwe.

Zomwe zimachitika ndi Aterocardium mwa odwala omwe amalephera kupweteka kwa impso ndizochepa. Fotokozerani mankhwalawa kwa anthu otere mosamala.

Komanso, mosamala, Aterocardium imalembedwa kwa odwala omwe ali ndi matenda a chiwindi ndi anthu omwe ali pachiwopsezo chokhala ndi hemorrhagic diathesis.

Zotsatira zoyipa:

Kuchokera pa hematopoietic dongosolo: leukopenia, thrombocytopenia, eosinophilia, neutropenia (kuphatikizapo kwambiri), thrombotic thrombocytopenic purpura, pancytopenia, kuchepa magazi (kuphatikizanso aplastic), thrombocytopenia, granulocytopenia, agranulocytosis.

Kuchokera pamtima dongosolo: hematomas, zotupa kwambiri, ochepa hypotension, vasculitis, magazi kuchokera mabala a postoperative.

Kuchokera pamatumbo: kupukusa m'mimba, kukanika, kupweteka kwam'mimba, magazi am'mimba, kudzimbidwa, kusanza, zilonda zam'mimba, kusanza, gastritis, kusefukira. Zocheperako zimatha kukhala colitis (kuphatikizapo lymphocytic kapena ulcerative), kapamba, kuchepa kwamatumbo, m'mimba komanso kutuluka kwa magazi ndi chifuwa chomaliza.

Kuchokera ku chiwindi: hepatitis, pachimake chiwindi kulephera, kuyeserera kwa magwiridwe antchito a chiwindi.

Kuchokera kumbali ya chapakati mantha dongosolo: paresthesia, chizungulire, kupweteka kwa mutu, magazi amkati (nthawi zina kumathera muimfa), kuyerekezera zinthu m'maso, kusokoneza chisokonezo, chisokonezo.

Kuchokera pamalingaliro am'mimba: retinal, ocular, conjunctival magazi, chizungulire chomwe chimagwirizanitsidwa ndi matenda a khutu kapena labyrinth.

Kuchokera pakhungu ndi minyewa yodutsa: kukhathamiritsa kwamkati, kuyabwa, purpura, zotupa pakhungu, erythematous zotupa, angioedema, bullous dermatitis (Stevens-Johnson syndrome, erythema multiforme, poyizoni epermermal necrolysis), lichen planus, eczema, urticaria.

Kuchokera kupuma dongosolo: nosebleeds, kupuma magazi (pulmonary hemorrhage, hemoptysis), interstitial pneumonitis, bronchospasm.

Kuchokera ku minculoskeletal system: nyamakazi, hemarthrosis, myalgia, arthralgia.

Kuchokera kwamikodzo dongosolo: hematuria, kuchuluka kwa creatinine m'magazi, glomerulonephritis.

Hypersensitivity zimachitika: anaphylactic zimachitika, seramu matenda.

Zosintha mu magawo a ma labotale: kuchepa kwa magazi ndi ma cell a neutrophil, kuchuluka kwa magazi nthawi.

Zotsatira zina zoyipa: kutentha thupi, magazi ku malo a jakisoni.

Mogwirizana ndi mankhwala ena ndi mowa:

Protein Inhibitors IIb / IIIa. Mankhwala ayenera kuikidwa mosamala odwala omwe ali pachiwopsezo chotaya magazi chifukwa cha opaleshoni, zoopsa kapena zina zomwe zimafunikira kugwiritsa ntchito mapuloteni IIb / IIIa zoletsa.

FUNSANI. ASA sichikhudza mphamvu ya clopidogrel ya kuphatikizidwa kwa mapulaneti a ADP, koma clopidogrel imathandizira zotsatira za ASA pamaphatikizidwe ophatikizana am'magazi pansi pa collagen.

Makonzedwe a munthawi yomweyo a 500 mg a ASA kawiri pa tsiku limodzi sizinachititse kuti pakhale magazi ambiri. Kugwiritsa ntchito nthawi yomweyo kwa Aterocardium ndi ASA kumafuna kusamala, popeza pamakhala ngozi yotaya magazi.

Ma anticoagulants amlomo. Chifukwa cha chiwopsezo chachikulu chotaya magazi, kugwiritsa ntchito mankhwala ophatikizira pakamwa ndi atherocardia sikofunikira.

Heparin. Kafukufuku akuwonetsa kuti kugwiritsa ntchito clopidogrel sikukhudza mphamvu ya heparin ndipo sikutanthauza kusintha kwa mlingo kwa chomaliza. Kuvomerezeka kwa heparin sizinakhudze zotsatira za clopidogrel. Koma chifukwa chakuwonjezeka kotulutsa magazi, kugwiritsa ntchito mankhwalawa sikulimbikitsidwa.

Othandizira a thrombolytic. Kutetezedwa kwa mgwirizano wa Aterocardium, fibrin-eni kapena fibrin-enieni a thrombolytic othandizira ndi heparin adaphunziridwa mwa odwala omwe ali ndi infralate ya myocardial infarction. Momwe zimakhalira ndikutuluka kwa magazi zinali zofanana ndi zomwe zimagwiritsidwa ntchito pophatikizira othandizira a thrombolytic othandizira ndi heparin ndi ASA.

NSAIDs. Kugwiritsa ntchito pamodzi kwa Aterocardium ndi naproxen kumawonjezera mwayi wokhetsa magazi kwambiri m'mimba. Palibe deta pakulimbana kwa clopidogrel ndi mankhwala ena omwe si a antiidal.

Kuphatikiza ndi mankhwala ena. Popeza metabolite yogwira ya clopidogrel imapangidwa ndikuchitika kwa CYP 2C19, kugwiritsa ntchito mankhwala omwe amachepetsa ntchito ya enzymeyi kumayambitsa kuchepa kwa ndende ya yogwira metabolite ndipo, motero, kutsika kwa matenda a Aterocardium. Chifukwa chake, ndikofunikira kupewa kuyang'anira munthawi yomweyo Aterocardium ndi mankhwala omwe amakhudza ntchito ya CYP 2C19. Mankhwalawa ndi monga: esomeprazole, omeprazole, fluoxetine, fluvoxamine, moclobemide, voriconazole, ticlopidine, fluconazole, ciprofloxacin, carbamazepine, cimetidine, chloramphenicol ndi oxcarbazepine.

Proton pump zoletsa.

Zimatsimikiziridwa kuti kuchuluka kwa zoletsa za CYP 2C19 pansi pa zochita za mankhwala kuchokera pagulu la proton pump inhibitors sizofanana. Zomwe zilipo zikuwonetsa kuthekera kwa kuyanjana pakati pa Aterocardium ndi mankhwala aliwonse m'gululi. Palibe umboni wotsimikiza kuti mankhwala ena omwe amachepetsa kupanga hydrochloric acid (maantacid, H2 blockers) amakhudza mphamvu ya antiplatelet ya Aterocardium.

Kugwiritsa ntchito kwa Aterocardium kophatikizana ndi atenolol ndi nifedipine sikunasinthe kuthandizira kwamankhwala awa. Kuphatikiza apo, mankhwala aacopodyogic a clopidogrel sanasinthebe akugwiritsidwa ntchito ndi cimetidine, digoxin, theophylline, estrogen, ndi phenobarbital.

Maantacid sichikhudza mayamwidwe a clopidogrel.

Kafukufuku akuwonetsa kuti zochokera ku carbonyl za clopidogrel zitha kulepheretsa ntchito ya cytochrome P450 2C9. Mwanjira, izi zimatha kuyambitsa kuchuluka kwa plasma ya NSAIDs, tolbutamide ndi phenytoin, kagayidwe kamene kamachitika mothandizidwa ndi cytochrome P450 2C9. Koma zotsatira zakufufuza zikuwonetsa kuti tolbutamide ndi phenytoin zitha kutengeka mosamala ndi atherocard.

Palibe kuyanjana kwakukulu mwachipatala komwe kunapezeka pakati pa Aterocardium ndi beta-adrenergic blockers, diuretics, calcium blockers, ACE inhibitors, antacids, antidiabetesic, antiepileptic, antiepileptic, anti-cholesterol-lowering mankhwala, ndi ma hormone obwezeretsa othandizira.

Zopangidwa ndi katundu:

Piritsi limodzi lili:

Clopidogrel 75 mg

Zothandiza: cellcrystalline cellulose, magnesium stearate, lactose monohydrate, pregelatinized starch, polyethylene glycol 6000, povidone K 25, red iron oxide (E 172)

Chosakaniza chachikulu yogwira - clopidogrel - mosamala chimalepheretsa kumangika kwa ADP ku ma receptor pamwamba pa mapulateleti ndi kutseguka kwa GPIIb / IIIa mosakanikirana ndi ADP, zomwe zimapangitsa kulepheretsa kwa kuphatikizana kwa mapulateleti.

Kuletsa kwa kuphatikizira kwa kupatsidwa zinthu za m'magazi kochititsidwa ndi agonists ena kumachitikanso poletsa kuchuluka kwa mapulogalamu am'matulo otulutsidwa ndi ADP komanso kusintha kosasintha kwa mapulani a ADP receptors.

Mapulatifomu omwe adalumikizana ndi clopidogrel amasintha kusintha mpaka kumapeto kwa moyo wawo.

Ntchito yamapulatifomu imabwereranso kwina ikafika nthawi yofunikanso kuti maselo ena amwazi apangidwe.

Kuyambira tsiku loyamba logwiritsa ntchito Mlingo wa 75 mg wa mankhwalawa, kuponderezana kwakukulu kwa ADP-kuphatikizira kupatsidwa zinthu za m'magazi kumajambulidwa.

Izi zimapangidwira pang'onopang'ono, kukhazikika pakukhazikika pakati pa masiku 3 ndi 7 a chithandizo.

Wapakati wolepheretsa kusakanikirana pansi pa gawo la 75 mg pa khola ndi 40-60%.

Kutalika kwa magazi ndi kuchuluka kwa kuphatikizika kwa maselo odyera kubwereranso ku masamba pafupifupi masiku 5 mutatsiriza chithandizo.

Pambuyo m`kamwa makonzedwe a mankhwala mu Mlingo wa 75 mg, mayamwidwe msanga mu kugaya chakudya kumachitika. Chiwonetsero chachikulu cha plasma wozungulira wosasinthika wa clopidogrel (kuchuluka kwa 2.2-2.5 ng / ml pambuyo pakamwa kamodzi pa 75 mg ya mankhwala) adafika mphindi 45 atamwa Aterocardium.

Kuchulukitsa kwa clopidogrel ndi mkodzo kumawonetsa kuti kuyamwa kwa chinthu chogwira ntchito kuli pafupifupi 50%.

Mu kuyesa kwa vitro, clopidogrel ndi metabolite yake yogwira m'madzi amadzi am'magazi omwe amamangiratu mapuloteni, kulumikizana uku kumapitilira kuchuluka kwake kwakukulu.

Metabolism yachilengedwe ya clopidogrel imachitika m'chiwindi. Mu vivo ndi vitro pali njira ziwiri za kagayidwe.

Yoyamba imadutsa komanso kutenga nawo mbali kwa magawo, zomwe zimapangitsa kuti hydrolysis ipangidwe mochokera mu carboxylic acid yochokera (gawo ili limapanga 85% ya metabolites yonse m'magazi).

Njira yachiwiri ya metabolic imachitika ndikugwira nawo ntchito ya cytochrome P450 enzyme.

Choyamba, yapakatikati metabolite 2-oxo-clopidogrel imapangidwa kuchokera ku clopidogrel, yomwe pambuyo pake imasanduka yogwira metabolite (thiol yotengera). Metabolite yogwira yogonera mu vitro mwachangu komanso mosasinthika imagwirizana ndi zida zamagetsi zam'magazi, zomwe zimasokoneza kuphatikizana kwa maselo ambiri.

Pafupifupi 50% ya mlingo womwe umayamwa umatulutsidwa mkodzo ndipo pafupifupi 46% ndi ndowe atatha maola 120. Hafu ya moyo wa limodzi mlingo ndi 6 maola.

Hafu yaumoyo wa metabolite wosagwira ndi maola 8 (onse atatha kumwa kamodzi komanso pambuyo pobwereza).

Mapiritsi Ovomerezeka 75 mg No. 10, 40.

Kutentha kopitilira 25 digiri Celsius pakunyamula koyambirira.

Mankhwala

Clopidogrel amaletsa kusankha kwa adenosine diphosphate (ADP) ku receptor pamalo ophatikizika ndi mapuloteni omwe amatsatira a GPIIb / IIIa ovuta a ADP ndipo motero amalepheretsa kuphatikizana kwa mapulateleti. Clopidogrel imathandizanso kuphatikizana kwa maselo othandiza anzawo kugwirizanitsa ndikulepheretsa kuchuluka kwa mapulogalamu am'matulo otulutsidwa ndi ADP ndikusintha masinthidwe a mapulaneti a ADP. Mapulatifomu omwe adalumikizana ndi kusintha kwa clopidogrel mpaka kumapeto kwa moyo wawo. Ntchito yachilendo yamapulogalamu imabwezeretsedwa pamlingo wofanana ndi kukonzanso kwa chakudya cha zinthu zina.

Kuyambira tsiku loyamba la makonzedwe obwereza tsiku ndi tsiku a 75 mg, kuchepa kwakukulu kwa mphamvu ya kuphatikizira kwa mapulani a ADP kumawonekera. Kuchita izi kumakulirakulira pang'onopang'ono pakati pa masiku atatu ndi 7. Khola likakhazikika, pafupifupi kuchuluka kwa zoletsa zomwe zimayendetsedwa tsiku lililonse ndi 75 mg kuchokera 40% mpaka 60%. Kuphatikizana kwa magazi ndi kupukusika kwa magazi kwa nthawi yayitali kubwerera ku chiyambi pafupifupi masiku 5 mutachotsa chithandizo.

Pambuyo pakamwa pakamwa pa 75 mg, imatengedwa mwachangu kuchokera m'mimba.

Kuchuluka kwa plasma ndende yosasinthika ya clopidogrel (pafupifupi 2,2,5,5 ng / ml pambuyo pa mlingo umodzi wa 75 mg pakamwa) zimatheka pafupifupi mphindi 45 mutatha kugwiritsa ntchito. Mafuta osachepera 50%, monga momwe amasonyezera ndi kuphipha kwa ma cell a clopidogrel mu mkodzo. Clopidogrel ndi metabolite yayikulu (yosagwira) yogwiritsa ntchito m'magazi mu vitro imasinthika kumanga mapuloteni a plasma (98% ndi 94%, motsatana).

Mgwirizanowu umakhalabe wolimba mu vitro pamitundu yambiri.

Clopidogrel imapangidwa kwambiri mu chiwindi. In vitro ndi vivo, pali njira ziwiri zazikulu za kagayidwe kake: chimodzi chimachitika ndi gawo la magawidwe amtundu ndipo amatsogolera ku hydrolysis ndikupanga mawonekedwe osakhazikika a carboxylic acid (omwe amachititsa 85% ya metabolites yonse kuzungulira mu plasma yamagazi), ndi ma enzymes a dongosolo la cytochrome P450 akukhudzidwa ndi zina. .

Choyamba, clopidogrel imasinthidwa kukhala yapakatikati metabolite ya 2-oxo-clopidogrel. Zotsatira za metabolism yowonjezereka ya 2-oxo-clopidogrel, mphamvu ya thiol, yogwira metabolite, imapangidwa. Mu vitro, njira ya metabolic iyi imayang'aniridwa ndi ma enzymes CYP3A4, CYP2C19, CYP1A2, ndi CYP2B6. Metabolite yogwira ya clopidogrel, yomwe idali yokhayokha mu vitro, mwachangu komanso mosasinthika imamangiriza ku ma cell a receptor, mwakutero ikulepheretsa kuphatikizika kwa mapulateleti.

Pakadutsa maola 120 mutamwa, pafupifupi 50% ya mankhwalawa amamuchotsa mkodzo 46% ndi ndowe. Pambuyo pakamwa limodzi mlingo, theka moyo wa clopidogrel pafupifupi 6:00. Hafu ya moyo wa metabolite yayikulu (yosagwira) yozungulira m'magazi ndi 8:00 pambuyo pa kugwiritsa ntchito mankhwalawa mobwerezabwereza.

Mankhwala. Ma polymorphic angapo a CYP450 ma enzyme amasintha clopidogrel kukhala metabolite yogwira, ndikuyambitsa. CYP2C19 imathandizira pakupanga kwa metabolite yogwira komanso yapakatikati ya metabolite ya 2-oxo-clopidogrel. Ma pharmacokinetics a metabolite yogwira komanso zotsatira za antiplatelet, malingana ndi muyeso wa kuphatikiza kwa maselo ambiri, zimasiyana kutengera mtundu wa CYP2C19. CYP2C19 * 1 imakhala yolingana ndi metabolism yogwira ntchito mokwanira, pomwe ma CYP2C19 * 2 ndi CYP2C19 * 3 malemuwa amafanana ndi metabolism yofooka. Izi zimayambitsa 85% ya malesenti, zimafooketsa ntchito yoyera ndi 99% ku Asia. Zina zomwe zimagwirizanitsidwa ndi metabolism yofooka ndizophatikiza CYP2C19 * 4, * 5, * 6, * 7 ndi * 8, koma ndizochulukirapo pamtunduwu.

Kupewa kwa atherothrombosis mwa akulu

Odwala pambuyo myocardial infarction (chiyambi cha mankhwala - masiku angapo, koma pasanathe masiku 35 kuchokera pamene isanayambike), ischemic stroke (chiyambi cha chithandizo - masiku 7, koma osapitirira miyezi 6 kuchokera kumayambiriro kwake) kapena omwe adapezeka ndi matendawa mitsempha yodutsa (kuwonongeka kwa mitsempha ndi ma atherothrombosis a ziwiya zapansi),
odwala ndi pachimake koronare syndrome:

̶ ndi acute coronary syndrome popanda kukwezeka kwa ST (kusakhazikika kwa angina kapena kupindika kwa myocardial yopanda Q wave), kuphatikiza pa odwala omwe anali ndi stent yomwe idayikidwa nthawi ya percutaneous coronary angioplasty, limodzi ndi acetylsalicylic acid (ASA)

̶ ndi infalction yacute myocardial ndi kuwonjezeka kwa gawo la ST kuphatikiza acetylsalicylic acid (odwala omwe amalandila chithandizo chamankhwala omwe akuwonetsedwa ndi thrombolytic therapy).

Kupewa kwa zochitika za atherothrombotic ndi thromboembolic mu atria fibrillation. Clopidogrel wophatikizana ndi ASA imawonetsedwa mwa odwala akuluakulu omwe ali ndi fibrillation ya atgency, omwe ali ndi vuto limodzi pangozi ya zomwe zimachitika mu mtima, momwe mumakhala zotsutsana ndi chithandizo cha vitamini K antagonists (AVK) komanso omwe ali ndi chiopsezo chochepa cha magazi, pofuna kupewa atherothrombotic ndi thromboembolic zochitika kuphatikizapo sitiroko. Wonaninso gawo la "Pharmacological katundu".

Kuyanjana kwa mankhwala osokoneza bongo

Sitikulimbikitsidwa kuphatikiza mankhwala a Aterocardium ndi anticoagulants pamlomo chifukwa chowopseza kuchuluka kwa magazi.

Kuchita zotheka ndi munthawi yomweyo kugwiritsa ntchito clopidogrel ndi mankhwala ena: / kukonzekera:

mankhwala osapweteka a antiidal (monga COX-2 inhibitors), ASA, protein IIb / IIIa zoletsa, mankhwala a thrombolytic, heparin: ndikotheka kutulutsa magazi (ndikofunikira kugwiritsa ntchito clopidogrel mosamala ndi kuphatikiza uku),
fluconazole, fluoxetine, omeprazole, moclobemide, esomeprazole, voriconazole, carbamazepine, ticlopidine, chloramphenicol, ciprofloxacin, fluvoxamine, oxcarbazepine, cimetidine (mankhwala omwe amalepheretsa zochitika za CYP2C19):
proton pump zoletsa: kulumikizana kumatha kuchitika, chifukwa chake, izi siziphatikizidwa, pokhapokha ngati ndizofunikira,
Mankhwala omwe amapangidwa pogwiritsa ntchito cytochrome P450 2C9: ndizotheka kuwonjezera kuchuluka kwa mankhwalawa mu plasma (kupatula tolbutamide ndi phenytoin, yomwe ndiotetezeka kugwiritsa ntchito ndi Aterocardium)
atenolol, nifedipine, estrogen, cimetidine, phenobarbital, theophylline, antacids, digoxin, okodzetsa, ACE inhibitors (angiotensin-akatembenuka enzyme), beta-blockers, calcium blockers, antiepileptic, hypocholesterolemic ndi mankhwala ena. kukulitsa ziwiya zama coronary, GPIIb / IIIa antagonists, mahomoni othandizira olowa m'magazi: palibe kuyanjana kwakukulu kwakadadziwika.

Mndandanda wa Aterocardium ndi: Clopidogrel, Plavix, Aspirin Cardio, Dipyridamole.

Zotsatira zoyipa

hematoma, chosowa kwambiri

wamba - kukha magazi, magazi ochokera ku bala, opaleshoni,

Kuchokera pamimba: kupweteka kwam'mimba, kutsegula m'mimba, kukanika kwa m'mimba, kutaya magazi - mseru, kudzimbidwa, zilonda zam'mimba ndi duodenal, gastritis, kusanza, kusefukira kwam'mimba, kawirikawiri - kubwezeretsa magazi m'mimba, kawirikawiri - pancreatitis, colitis (kuphatikizapo ulcerative kapena lymphocytic), kupha m'mimba komanso kutuluka kwa magazi kwa m'mimba, stomatitis,

Kuchokera ku hepatobiliary system: chosowa kwambiri - kulephera kwa chiwindi, chiwindi, kuyesa kwa chiwindi,

Kuchokera kwamanjenje yayikulu: zosadziwika - kupweteka mutu, kupweteka kwa m'mimba, chizungulire, magazi amkati (nthawi zina, amafa), osadziwika kwambiri - chisokonezo, kuyerekezera zinthu m'magazi, kusokonezeka kwa malingaliro,

kuchokera ku ziwalo zam'maganizo: sizachilendo - magazi akutulutsa magazi

(conjunctival, ocular, retinal), chosadziwika kawirikawiri - chizungulire (matenda a khutu ndi labyrinth),

pa khungu ndi subcutaneous minofu: wamba - subcutaneous kukha mwazi, osadziwika - zotupa pakhungu, kuyabwa, purpura, osadziwika kwambiri - angioedema, erythematous zidzolo, oxous dermatitis (poizoni epermermosis, Stevens-Johnson syndrome, erythema multiforme, kraemia), lichen planus

Kuchokera kupuma dongosolo: wamba - nosebleeds, osadziwika kwambiri - kupuma magazi (hemoptysis, pulmonary hemorrhage), bronchospasm, interstitial pneumonitis,

Kuchokera kwamankhwala am'mimba: Matenda owopsa kwambiri - hemarthrosis, nyamakazi, arthralgia, myalgia,

Kuchokera kwamikodzo dongosolo: zosadziwika - hematuria, osadziwika kwambiri - glomerulonephritis, kuchuluka kwa creatinine m'magazi,

Hypersensitivity zimachitika anati, osadziwika kwambiri - seramu matenda, anaphylactic zimachitikira,

zizindikiro za labotale: sizachilendo - kutalika kwa nthawi yotuluka magazi, kuchepa kwa ma neutrophils ndi mapulateleti,

ena: wamba - magazi m'malo a jakisoni, osadziwika kwambiri - malungo.

Kuyanjana ndi mankhwala ena ndi mitundu ina yoyanjana

Ma anticoagulants amlomo. Kugwiritsidwa ntchito mosavomerezeka ndi clopidogrel sikulimbikitsidwa, chifukwa pamakhala chiopsezo cha kuchuluka kwa magazi.

Zoletsa za glycoprotein IIb, / IIIA. Aterocardium iyenera kugwiritsidwa ntchito mosamala kwa odwala omwe ali pachiwopsezo chotaya magazi chifukwa cha kuvulala, maopaleshoni kapena zina zodwala zomwe glycoprotein IIb, IIAa inhibitors amagwiritsidwa ntchito munthawi yomweyo.

Acetylsalicylic acid (ASA). ASA sikusintha zoletsa zomwe zimapangitsa kuti magazi aziwoneka kuti ndi ophatikizika papulogogog ya ADP, koma clopidogrel imathandizira zotsatira za ASA pa collagen-ikiwayambitsa kuphatikizira kwa mapulaneti. Komabe, kugwiritsa ntchito nthawi imodzimodziyo kwa 500 mg ya ASA 2 kawiri pa tsiku limodzi 1 sikunayambitse kuwonjezeka kwakukulu kwa nthawi ya magazi, owonjezereka chifukwa chogwiritsa ntchito clopidogrel. Popeza kuyanjana pakati pa clopidogrel ndi acetylsalicylic acid ndikotheka ndikuwonjezereka kwa magazi, kugwiritsa ntchito mankhwalawa munthawi yomweyo kumafunika kusamala. Ngakhale izi, clopidogrel ndi ASA adagwiritsidwa ntchito limodzi mpaka chaka chimodzi.

Heparin. Malinga ndi kafukufukuyu, clopidogrel sanafune kusintha kwa heparin ndipo sanasinthe momwe heparin imapangidwira. Kugwiritsa ntchito nthawi imodzi kwa heparin sikunasinthe kufooka kwa mphamvu ya Clopidogrel pa kuphatikizidwa kwa maselo ambiri. Popeza kuyanjana pakati pa clopidogrel ndi heparin ndikotheka ndikuwonjezereka kwa magazi, munthawi yomweyo pamafunika kusamala.

Othandizira a thrombolytic. Chitetezo pakugwiritsa ntchito nthawi yomweyo clopidogrel, fibrin-eni kapena fibrin-enieni a thrombolytic othandizira ndi heparin amafufuzidwa mwa odwala omwe ali ndi infral myocardial infarction. Pafupipafupi magazi omwe anali ndi magazi kwambiri anali ofanana ndi omwe amapezeka munthawi yomweyo ngati mankhwala osokoneza bongo a thrombolytic ndi heparin ndi ASA.

Mankhwala osokoneza bongo a nonsteroidal anti-kutupa (NSAIDs). Kugwiritsa ntchito nthawi yomweyo Clopidogrel ndi naproxen kungakulitse kuchuluka kwa magazi am'mimba omwe amatuluka. Komabe, pakadalibe chidziwitso pakukhudzana kwa mankhwalawa ndi ena a NSAID, sizikudziwikiratu kapena chiopsezo chotaya magazi mukagwiritsidwa ntchito ndi onse a NSAID. Chifukwa chake, kusamala ndikofunikira mukamagwiritsa ntchito NSAIDs, makamaka COX-2 inhibitors, yokhala ndi clopidogrel.

Kuphatikiza ndi mankhwala ena.

Popeza clopidogrel imatembenuzidwa kukhala yogwira metabolite pang'ono ndi CYP2C19, kugwiritsa ntchito mankhwala omwe amachepetsa ntchito ya enzyme imeneyi kungapangitse kuchepa kwa chidwi cha metabolite yogwira ya clopidogrel m'magazi am'magazi, komanso kuchepa kwa mphamvu ya chipatala. Kugwiritsa ntchito pamodzi mankhwala omwe amalepheretsa ntchito za CYP2C19 kuyenera kupewedwa.

Mankhwala omwe amalepheretsa ntchito ya CYP2C19 akuphatikizapo omeprazole, esomeprazole, fluvoxamine, fluoxetine, moclobemide, voriconazole, fluconazole, ticlopidine, ciprofloxacin, cimetidine, carbamazepine, oxcarbazepine ndi chloramphenicol.

Proton pump zoletsa. Ngakhale umboniwo ukuonetsa kuti kuchuluka kwa zoletsa za CYP2C19 mothandizidwa ndi mankhwala osiyanasiyana omwe ali mgululi la proton pump inhibitors sikofanana, pali umboni womwe ukuonetsa kuti akhoza kuyenderana ndi pafupifupi mankhwala onse a kalasi iyi. Chifukwa chake, kugwiritsa ntchito nthawi yomweyo ma proton pump zoletsa kuyenera kupewedwa, pokhapokha ngati pakufunika kutero. Palibe umboni kuti mankhwala ena omwe amachepetsa kupanga asidi m'mimba, monga, mwachitsanzo, ma H 2 blockers (kupatula cimetidine, yemwe ndi CYP2C9 inhibitor) kapena ma antacid, amakhudza ntchito ya antiplatelet ya clopidogrel.

Zotsatira zamaphunzirowa, palibe kuyanjana kwakukulu kwachipatala komwe kunawululidwa ndikugwiritsa ntchito clopidogrel nthawi yomweyo ndi atenolol, nifedipine, kapena ndi mankhwala onse awiri. Kuphatikiza apo, pharmacodynamic ntchito ya clopidogrel idasinthiratu osagwiritsidwa ntchito ndi phenobarbital ndi estrogen.

Mankhwala a digoxin kapena theophylline sanasinthe ngakhale atagwiritsidwa ntchito ndi clopidogrel. Maantacid sichikhudza mayamwidwe a clopidogrel.

Kafukufuku wofufuza akuwonetsa kuti carboxyl metabolites ya clopidogrel ikhoza kulepheretsa ntchito ya cytochrome P450 2C9. Izi zitha kuwonjezera kuchuluka kwa plasma a phenytoin, tolbutamide ndi NSAIDs, omwe amakonzedwa ndi cytochrome P450 2C9. Ngakhale izi, zotsatira za kafukufuku zikuwonetsa kuti phenytoin ndi tolbutamide zitha kugwiritsidwa ntchito mosamala nthawi yomweyo ndi clopidogrel.

Panalibe zofunika zachipatala zomwe zimakhudzana ndi okodzetsa, ma beta-blockers, ma ACE inhibitors, calcium blockers, othandizira omwe amachepetsa ziwiya zam'mimba, ma antacid, hypoglycemic (kuphatikizapo insulin), hypocholesterolemic, antiepileptic, GPIIb / IIIa antagonists, and antagonists of GPIIb / IIIa.

Zolemba ntchito

Kupuma komanso matenda a hematological. Chifukwa cha kuopsa kwa magazi ndi mavuto obwera chifukwa cha mankhwalawa, kuyezetsa magazi mwatsatanetsatane komanso / kapena kuyesedwa kwina koyenera kuyenera kuchitika mwachangu ngati zizindikiro za kutulutsa magazi zimawonedwa pakugwiritsa ntchito mankhwalawa

Pofuna kuchitidwa opaleshoni yomwe yakonzedwa, pakanthawi kochepa pamafunika kugwiritsa ntchito ma antiplatelet othandizira, mankhwalawa ndi clopidogrel ayenera kusiyidwa masiku 7 asanachitike opaleshoni. Odwala ayenera kudziwitsa dokotala (kuphatikizapo dotolo wamano) kuti akugwiritsa ntchito clopidogrel, opaleshoni iliyonse isanafike, kapena musanayambe kugwiritsa ntchito mankhwala atsopano. Clopidogrel imachulukitsa kutalika kwa magazi, choncho iyenera kugwiritsidwa ntchito mosamala odwala omwe ali ndi chiopsezo chotaya magazi (makamaka m'mimba ndi intraocular).

Odwala ayenera kuchenjezedwa kuti pakumwa mankhwalawa ndi clopidogrel (yekha kapena osakanikirana ndi ASA), kutuluka magazi kumatha kutha kuposa masiku onse, ndikuti adziwitse dokotalayo za vuto lililonse lomwe lingachitike (m'malo mwake kapena nthawi yayitali).

Thrombotic thrombocytopenic purpura (TTP). Milandu ya thrombotic thrombocytopenic purpura (TTP) siinawoneke kwambiri kawirikawiri pambuyo pa kayendetsedwe ka clopidogrel, nthawi zina ngakhale atagwiritsidwa ntchito kwakanthawi kochepa. TTP imawonetsedwa ndi thrombocytopenia ndi microangiopathic hemolytic anemia yodziwonetsa minyewa, kukanika kwa aimpso, kapena kutentha thupi. TTP ndichikhalidwe chowopsa chomwe chimatha kupha, chifukwa chake chimafuna chithandizo chamanthawi yomweyo, kuphatikizapo plasmapheresis.

Anapeza hemophilia. Milandu yokhudzana ndi kupezeka kwa hemophilia atagwiritsidwa ntchito clopidogrel. Milandu yakuwonjezereka kwakutali kwa APTT (nthawi yodziwika ya thromboplastin nthawi), yomwe imayendera limodzi kapena siyikuperekezedwa ndi magazi, funso lofunsa kuti ali ndi hemophilia liyenera kuganiziridwa. Odwala omwe ali ndi vuto lowonetsa kuti ali ndi hemophilia ayenera kuyang'aniridwa ndi dokotala ndikulandila chithandizo, kugwiritsa ntchito clopidogrel kuyenera kusiyidwa.

Posachedwa wavutika ischemic stroke. Chifukwa chosakwanira, sizikulimbikitsidwa kuti mupereke mankhwala a clopidogrel m'masiku 7 oyamba atatha kupweteka kwa ischemic.

Cytochrome P450 2 C19 (CYP2C19). Pharmacogenetics Odwala omwe ali ndi genetical yafupika ntchito ya CYP2C19, pamakhala kuchuluka kochepa kwa yogwira metabolop ya clopidogrel m'magazi am'magazi komanso osagwiritsa ntchito antiplatelet. Tsopano pali mayeso kuti adziwe mtundu wa CYP2C19 genotype wodwala.

Popeza clopidogrel imatembenuka kukhala yogwira metabolite pang'ono mothandizidwa ndi CYP2C19, kugwiritsa ntchito mankhwala omwe amachepetsa ntchito ya enzymeyi kungayambitse kuchepa kwa kuchuluka kwa metabolite ya clopidogrel m'magazi a m'magazi. Komabe, kufunikira kwakukhudzaku mukulumikizanaku sikunafotokozeredwe. Chifukwa chake, muyikawu ndi kupatula kugwiritsa ntchito nthawi imodzi yama CYP2C19 zoletsa zolimba komanso zolimbitsa (onani

Kuyambanso pakati pa thienopyridines. Mbiri ya wodwala ya hypersensitivity to thienopyridine ena (monga tinlopidine, prasugrel) iyenera kuyang'aniridwa chifukwa pakhala pali malipoti okhudza kuyanjana pakati pa thienopyridines (onani gawo "Zotsatira zosiyana"). Kugwiritsidwa ntchito kwa thienopyridines kumatha kubweretsa zovuta zomwe zimakhudzana kwambiri ndi kuzunzika koopsa, monga zotupa, edema ya Quincke, kapena masinthidwe a 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. Kuyang'anira kuyambiranso kumalimbikitsidwa.

Matenda aimpso. Zowonjezera zothandizira kugwiritsa ntchito clopidogrel mwa odwala omwe amalephera kupweteka kwa impso ndizochepa, chifukwa chake, odwala oterewa ayenera kuyamwa mankhwalawa mosamala (onani Gawo "Mlingo ndi Ulamuliro").

Kuwonongeka kwa chiwindi. Zomwe mungagwiritse ntchito mankhwalawa odwala omwe ali ndi matenda olimba a chiwindi komanso kuchepa kwa hemorrhagic diathesis ndizochepa, motero, odwala oterewa ayenera kuikidwa Clopidogrel mosamala (onani Gawo "Mlingo ndi Administration").

Othandizira. Aterocardium ili ndi lactose. Odwala omwe ali ndi matenda osowa monga chibadwa cha galactose, kuperewera kwa lappase kapena kufupika kwa glucose-galactose malabsorption sayenera kugwiritsa ntchito mankhwalawa.

Gwiritsani ntchito pa nthawi yoyembekezera kapena mkaka wa m'mawere

Chifukwa chosowa deta yakuchipatala pakugwiritsa ntchito clopidogrel pa nthawi yomwe ali ndi pakati, mankhwalawa sayenera kuperekedwa kwa amayi apakati (monga kusamala). Kuyesa kwanyama sikunawonetse zotsatira zoyipa za clopidogrel pa mimba, mwana wosabadwayo / chitukuko cha mwana, kubala kwa mwana ndi kukulira kwa pambuyo pake.

Sizikudziwika ngati clopidogrel adachotsedwa mkaka wa m'mawere. Kafukufuku wazinyama adawonetsa kuti amachotseredwa mkaka wa m'mawere, kotero kuyamwitsa kuyenera kusiyidwa pakumwa mankhwalawa.

Chonde. Mu maphunziro a nyama yothandizira, palibe zovuta zoyipa za clopidogrel pazachuma zomwe zapezeka.

Bongo

Zizindikiro: Kutalika kwa magazi nthawi yayitali ndi zovuta zotsatirazi.

Mankhwalawa ndi chizindikiro. Ngati ndi kotheka, kukonza mwachangu kwa nthawi yayitali magazi, mphamvu ya mankhwalawa imatha kuchotsedwa mwa kuthiridwa kwa magazi. Mankhwala a Clopidogrel a pharmacological sakudziwika.

Zotsatira zoyipa

Kumbali yamagazi ndi dongosolo la lymphatic: thrombocytopenia, leukopenia, eosinophilia, neutropenia, kuphatikiza kwambiri neutropenia, thrombotic thrombocytopenic Purpura (TTP) (onani gawo "Peculiarities of use"), aplasic anemia, pancytopenia, agranulocphia hemogulopopia, agranulocphia, agranulocphia, agranulocphia, agranulocphia granulocytopenia, magazi m'thupi.

Kuchokera kumbali ya chitetezo chamthupi: matenda a seramu, zochita za anaphylactoid, mawonekedwe a hypenensitivity pakati pa thienopyridine (monga ticlopidine, prasugrel) (onani.

Kuchokera kumitsempha yamitsempha: magazi amkati (nthawi zina - akumwalira), kupweteka mutu, paresthesia, chizungulire, kusintha kwa kuzindikira.

Kuchokera kumbali ya gawo la masomphenyawo: magazi m'dera lamaso (conjunctiva, chowoneka, retinal).

Pa mbali ya ziwalo kumva ndi bwino: chizungulire.

Kuchokera kwamitsempha yama mtima: hematoma, kukha magazi kwambiri, magazi ochokera ku bala la opaleshoni, vasculitis, ochepa hypotension.

Kuchokera m'mimba thirakiti: Kutaya magazi m'mimba, kutsekula m'mimba, kupweteka kwam'mimba, kupweteka kwa m'mimba, zilonda zam'mimba, gastritis, kusanza, kusanza, kutupa, kupweteka kwa m'mimba, kuchepa kwa m'mimba, kuchepa kwamatumbo (makamaka, ulcerative kapena lymphocytic), stomatitis.

Kuchokera mmimba: kukanika kwa chiwindi, chiwindi, zotsatira zoyipa zamayendedwe a chiwindi.

Pa khungu ndi subcutaneous minofu: zotupa kukhathamiritsa, zotupa, pruritus, intradermal hemorrhage (phenura), oxous dermatitis (poizoni epermermal necrolysis, Stevens-Johnson syndrome, erythema multiforme), angioneurotic edema, erythematous rash, rash, ndi eosinophilia ndi chiwonetsero cha dongosolo (DRESS syndrome), eczema, lichen planus.

Pa gawo la mafupa minofu dongosolo, wolumikizika ndi mafupa minofu: musculoskeletal hemorrhage (hemarthrosis), nyamakazi, arthralgia, myalgia.

Kuchokera impso ndi kwamikodzo dongosolo: hematuria glomerulonephritis, kuchuluka kwa creatinine m'magazi.

Matenda amisala yamaganizidwe: kuyerekezera zinthu zina, kusokoneza.

Matenda opatsirana, thoracic ndi mediastinal: nosebleeds, kupuma thirakiti (hemoptysis, pulmonary hemorrhage), bronchospasm, pneumonitis wa pakati, pneumonitis wa pakati.

Matenda ofala: kutentha thupi.

Maphunziro a Laborator: Kutalika kwa magazi nthawi yayitali, kuchepa kwa chiwerengero cha ma neutrophils ndi mapulateleti.