Atrogrel wa mankhwala: malangizo ogwiritsira ntchito

Pharmacokinetics. Clopidogrel amaletsa kusankha kwa adenosine diphosphate (ADP) ku masipikisiti ake pamwamba papulatat, amalepheretsa kutsegulidwa kwa mapulateleti ndipo potero amawalepheretsa kuphatikizika. Imalepheretsanso kuphatikiza kwa maselo ambiri chifukwa cha agonists ena. Kuletsa kuphatikizira kwa maselo odyera kumadziwika pakatha maola awiri atayamwa. Pogwiritsa ntchito mobwerezabwereza, zotsatira zake zimakulirakulira, ndipo khola limatha pambuyo pa masiku 3-7 a chithandizo (avareji ya zoletsa kusakanikirana ndi 40-60%). Kuphatikiza kwa mapazi ndi nthawi yotaya magazi kumayambiranso monga masiku 7 mutachotsedwa kwa mankhwalawa, monga kupatsidwa zinthu zam'magazi.
Pharmacokinetics Pambuyo pakukonzekera pakamwa, mankhwalawa amalowetsedwa mofulumira m'matumbo. Kuphatikizika kwa magazi m'magazi sikutanthauza kanthu ndipo pambuyo pa maola 2 atagwiritsidwa ntchito sizinatsimikizidwe (zosakwana 0,025 μg / l). Mwachangu biotransformed mu chiwindi. Metabolite yake yayikulu (85% yazinthu zomwe zimayenda mozungulira m'magazi) sizigwira ntchito. The thiol metabolite yogwira imagwira mwachangu komanso mosasinthika kwa mapulateleti othandizira. Mu madzi a m'magazi simatsimikiza. Clopidogrel ndi metabolite yayikulu yozungulira yozungulira imamangiranso mapuloteni a plasma.
Pambuyo pakamwa, pafupifupi 50% ya mankhwalawa amatengedwa mumkodzo ndi 46% mu ndowe mkati mwa maola 120 mutatha kugwiritsa ntchito. Hafu ya moyo wa metabolite yayikulu ndi maola 8.
Kuchulukitsidwa kwa metabolite yayikulu m'madzi am'magazi odwala okalamba (azaka 75 ndi kupitirira) ndiwokwera kwambiri, komabe, kuchuluka kwa plasma sikumayendetsedwa ndi kusintha kwa kuphatikizana kwa magazi ndi nthawi ya magazi

Kugwiritsa ntchito mankhwala Atrogrel

Mankhwala amatengedwa pakamwa, piritsi 1 (75 mg) nthawi imodzi patsiku, mosasamala za kudya.
Odwala ndi pachimake koronare syndrome popanda gawo kukweza ST (osakhazikika angina kapena myocardial infarction popanda dzino loopsa Q pa ECG) patsiku la 1 la mankhwalawa - mapiritsi 4 (300 mg), pamasiku otsatirawa - piritsi 1 nthawi imodzi patsiku, mosasamala za kudya.
Kutalika kwa mankhwalawa kumatsimikiziridwa ndi dokotala kutengera chithunzi cha matenda.

Contraindous kugwiritsa ntchito mankhwala Atrogrel

Hypersensitivity mankhwala
matenda oopsa a chiwindi
magazi owopsa (intracranial hemorrhage) ndi matenda omwe akukonzekera kukula kwawo (zilonda zam'mimba ndi duodenum mu gawo lovuta, nonspecific ulcerative colitis),
wazaka 18.

Zotsatira zoyipa za mankhwala Atrogrel

Kuchokera ku magazi: leukopenia, kuchepa kwa chiwerengero cha neutrophilic granulocytes ndi eosinophils, kuchuluka kwa nthawi yotuluka magazi komanso kuchepa kwa chiwerengero cha mapaselo. Osowa kwambiri: thrombocytopenic thrombohemolytic purpura, thrombocytopenia, granulocytopenia, agranulocytosis, kuchepa magazi ndi aplastic anemia / pancytopenia. Kuthetsa kwa kutulutsa kosiyanasiyana. Milandu yambiri yotuluka magazi idadziwika m'mwezi woyamba wa chithandizo.
Kuchokera m'mimba thirakiti: kupweteka pamimba, dyspepsia, kutsekula m'mimba, kawirikawiri - kudzimbidwa, kuchuluka kwa zilonda zam'mimba ndi zilonda zam'mimba.
Kuchokera ku minculoskeletal system: kawirikawiri - arthralgia, nyamakazi.
Kuchokera kwamikodzo: kawirikawiri - glomerulonephritis, kuchuluka kwa seramu creatinine.
Kuchokera ku dongosolo lamanjenje lamkati: mutu, chizungulire, parasthesia. Osati kawirikawiri - chisokonezo, kuyerekezera zinthu m'magazi, kuphwanya kwa zomverera.
Thupi lawo siligwirizana: zotupa pakhungu, anaphylactoid zimachitika.
Zina: kawirikawiri - malungo.

Malangizo apadera ogwiritsira ntchito mankhwala Atrogrel

Mosamala, odwala omwe ali ndi chiopsezo chowonjezeka magazi chifukwa chatsoka, njira zopangira opaleshoni, komanso mavuto obisika. Ndi njira yochitira opaleshoni yomwe ikukonzekera (ngati antiplatelet athari ndi osafunika), njira ya mankhwalawa ndi mankhwalawo iyenera kusiyidwa masiku 7 asanayambe opareshoni.
Chenjezo limaperekedwa kwa odwala omwe ali ndi vuto la chiwindi, lomwe ma hemorrhagic diathesis angachitike.
Kusintha kwa Mlingo sikofunikira kwa okalamba, odwala omwe ali ndi vuto laimpso.
Odwala ayenera kuchenjezedwa kuti popeza kusiya kutulutsa magazi komwe kumachitika pogwiritsa ntchito mankhwalawa kumafuna nthawi yochulukirapo, ayenera kudziwitsa dokotala za vuto lililonse lotaya magazi mosazungulira. Odwala ayeneranso kudziwitsa adotolo za kumwa mankhwalawa ngati amuchita opareshoni (opaleshoni, mano, ndi zina) kapena ngati dokotala amupangira wodwala mankhwala atsopano.
Zizindikiro za kutaya magazi kwambiri (m'kamwa, magazi m'matumbo, hematuria), kuwunika kwa hemostasis dongosolo (kutulutsa magazi, kuwerengera, kupatsidwa zinthu za m'magazi).
Kuwunikira pafupipafupi kwa maulalo a ma laboratorous a chiwindi.
PNthawi ya pakati ndi kuyamwa. Kugwiritsa ntchito mankhwala pa nthawi ya pakati kumatsutsana.
Ngati kuli kofunikira kugwiritsa ntchito mankhwalawa panthawi yoyamwa, kuyamwitsa kuyenera kuyimitsidwa.
Ana. Chitetezo ndi kugwiritsa ntchito mankhwalawa kwa anthu ochepera zaka 18 sizinakhazikitsidwe.
Kutha kukopa momwe zinthu zikuyendera mukamayendetsa magalimoto kapena njila zina. Mankhwalawa samakhudza kuyendetsa magalimoto ndipo samachepetsa kuthamanga kwa ma psychomotor.

Zochita zamankhwala Atrogrel

Clopidogrel imawonjezera mwayi wokhetsa magazi m'mimba ndi NSAIDs.
Kugwiritsa ntchito ndi warfarin sikulimbikitsidwa, chifukwa kuwonjezeka kwa kutulutsa magazi ndizotheka.
Kugwiritsa ntchito ndi acetylsalicylic acid kapena heparin sikukhudza mphamvu ya antiplatelet ya mankhwala, komabe, chitetezo chogwiritsa ntchito mankhwalawa kwa nthawi yayitali sichinakhazikitsidwe, kotero kugwiritsa ntchito mankhwalawa pamafunika kusamala.
Mukamagwiritsidwa ntchito ndi phenytoin ndi tolbutamide, kuwonjezeka kwaminyewa yawo m'magazi a m'magazi ndikotheka. Komabe, kugwiritsa ntchito kwawo kophatikizana ndi clopidogrel ndikotetezeka.
Panalibe zovuta zamankhwala zokhudzana ndi diuretics, β-adrenoreceptor blockers, ACE inhibitors, calcium blockers blocker, antacids, hypoglycemic, hypocholesterolemic ndi mankhwala obwezeretsa mahomoni, antiepileptic mankhwala, phenobarbital, cimetidine, digoxin ndi theofininine ndi digoxin ndi theofin.

Gulu la mankhwala

Othandizira antithrombotic. Khodi ya PBX B01A C04.

Kupewa kuwonetsera kwa atherothrombosis:

  • Odwala omwe adayamba kudwala matendawa (kuyambika kwa mankhwalawa masiku ochepa, koma osadutsa masiku 35 atayamba), matenda a ischemic (kuyamba kwa mankhwala ndi masiku 7, koma osapitilira miyezi 6 atadwala mitsempha yotumphukira
  • odwala ndi pachimake koronare syndrome:
  • ndi pachimake coronary syndrome popanda kukwezeka kwa gawo (osakhazikika angina kapena myocardial infarction yopanda Q wave), kuphatikiza pa odwala omwe anali ndi stent yomwe idayikidwa nthawi ya percutaneous coronary angioplasty, kuphatikizapo acetylsalicylic acid
  • ndi pachimake myocardial infarction ndi gawo gawo ST kuphatikizika ndi acetylsalicylic acid (odwala omwe amalandira chithandizo chokwanira komanso omwe akuwonetsedwa thrombolytic therapy).

Kupewa kwa zochitika za atherothrombotic ndi thromboembolic mu atria fibrillation .

Clopidogrel akuwonetsedwa kuphatikiza acetylsalicylic acid kwa odwala akulu omwe ali ndi fibrillation ya atgency momwe muli chiopsezo chimodzi chodziwika bwino cha zochitika zamitsempha, contraindication pochiza ndi vitamini K antagonists (AVK), chiopsezo chochepa cha magazi, pofuna kupewa zochitika za atherothrombotic ndi thromboembolic, mu kuphatikizapo sitiroko.

Mlingo ndi makonzedwe

Akuluakulu ndi odwala okalamba. Mankhwala amatchulidwa piritsi 1 (75 mg) 1 pa tsiku, mosasamala za kudya.

Odwala ndi pachimake coronary syndrome popanda kukwera kwa gawo la ST (osakhazikika angina pectoris kapena myocardial infarction popanda Q wave pa ECG), mankhwalawa ndi clopidogrel amayamba ndi gawo limodzi lokweza 300 mg, kenako amapitilira mlingo wa 75 mg kamodzi patsiku (ndi acetylsalicylic acid (ASA) pa mlingo wa 75-325 mg patsiku. Popeza kugwiritsa ntchito milingo yapamwamba ya ASA kumawonjezera mwayi wokhetsa magazi, ndikulimbikitsidwa kuti musapitirire mlingo wa ASA 100 mg. Kutalika kokwanira kwa chithandizo sikunakhazikitsidwe mwadongosolo. Zotsatira za kafukufukuyu zikuonetsa kuti mankhwalawa amagwiritsidwa ntchito mpaka miyezi 12, ndipo kuchuluka kwake kunachitika pambuyo pa miyezi itatu ya chithandizo.

Odwala ndi pachimake myocardial infarction ndi ST gawo kukweza clopidogrel ndi mankhwala 75 mg kamodzi patsiku, kuyambira limodzi lokha lomwe limaperekedwa 300 mg molumikizana ndi ASA, mankhwala a thrombolytic kapena opanda thrombolytic. Chithandizo cha odwala azaka zapakati pa 75 ndi kupitirira zimayamba popanda kukweza mlingo wa clopidogrel. Kuphatikiza mankhwalawa kuyenera kuyambikanso atangoyamba kumene zizindikiro ndipo akuyenera kupitiliza kwa milungu inayi. Ubwino wogwiritsa ntchito kuphatikizika kwa clopidogrel ndi ASA kwa masabata opitilira 4 ndi matendawa sizinaphunzire.

Clopidogrel amagwiritsidwa ntchito mu gawo limodzi la 75 mg kwa odwala omwe ali ndi fibrillation ya atria. Pamodzi ndi clopidogrel, kugwiritsidwa ntchito kwa ASA (pa mlingo wa 75-100 mg patsiku) kuyenera kuyambitsidwa ndikupitilizidwa.

Ngati mwasowa mlingo:

  • Ngati kuyambira pomwe anafunika kumwa mlingo wotsatira, osakwana 12:00, wodwalayo atenge kumwa nthawi yomweyo, ndipo mlingo wotsatira uyenera kumwedwa nthawi yomweyo.
  • Ngati zoposa 12:00 zadutsa, wodwalayo azitenga mlingo wotsatira panthawi yovomerezeka koma osachulukitsa kawiri mlingo kuti amalipiritsa mlingo womwe wakuphayo.

Mankhwala. Kukula kwa ma CYP2C19, zomwe zimayambitsa kwapakati komanso kuchepa kwa zochita za CYP2C19, zimasiyana malinga ndi mtundu / fuko. Mlingo woyenera kwambiri wa anthu omwe ali ndi matenda ofooka wa CYP2C19 sanakhazikitsidwebe.

Ana. Chitetezo ndi kugwira ntchito kwa clopidogrel mwa ana sizinakhazikitsidwe, chifukwa chake, mankhwalawa sayenera kugwiritsidwa ntchito mwa ana.

Kulephera kwina. Zowonjezera zothandizira kugwiritsa ntchito mankhwalawa kwa odwala omwe ali ndi vuto laimpso ndizochepa (onani gawo "Zomwe zimagwiritsidwa ntchito").

Kulephera kwa chiwindi. Zowona zochizira kugwiritsa ntchito mankhwalawa kwa odwala omwe ali ndi matenda olimba a chiwindi komanso kuthekera kwa hemorrhagic diathesis kumakhala kochepa (onani gawo "Zomwe zikugwiritsidwa ntchito").

Zotsatira zoyipa

Chovuta chambiri chinali kupopa, komwe nthawi zambiri kumawonedwa m'mwezi woyamba wamankhwala.

Mwazi ndi zamitsempha yamagazi dongosolo

  • thrombocytopenia, leukopenia, eosinophilia,
  • neutropenia, kuphatikizapo kwambiri neutropenia,
  • thrombotic thrombocytopenic purpura (TTP) (onani gawo "Ceculiarities of use"), aplasic anemia, pancytopenia, agranulocytosis, thrombocytopenia, granulocytopenia, kuchepa magazi, kupeza hemophilia A.

chitetezo cha mthupi

  • serum syndrome, anaphylactoid / anaphylactic zochita,
  • mtanda hypersensitivity pakati pa thienopyridines (monga ticlopidine, prasugrel) (onani gawo "Zogwiritsira ntchito").

mavuto amisala

  • kuyerekezera, kusokoneza.

dongosolo lamanjenje

  • magazi amkati (nthawi zina, amafa), mutu, paresthesia, chizungulire
  • Sinthani kaonedwe ka kukoma.

Matenda a ziwalo zamasomphenya

  • magazi m'dera la maso (conjunctiva, chowonera, retinal).

Matenda a khutu ndi labyrinth

kuvulala kwamitsempha

  • hematoma
  • magazi kwambiri, magazi ochokera ku bala, opaleshoni, maseru.

Matenda opatsirana, thoracic komanso mediastinal

  • mphuno
  • magazi ochokera kupuma thirakiti (hemoptysis, pulmonary hemorrhage), bronchospasm, pneumonitis ya m'mimba, pneumonia ya eosinophilic.

Matenda Am'mimba

  • m'mimba kutaya, kutsegula m'mimba, kupweteka kwam'mimba, kukomoka
  • zilonda zam'mimba ndi duodenal, gastritis, kusanza, mseru, kudzimbidwa,
  • retoperitoneal hemorrhage
  • m'mimba komanso kuchepa kwa zotupa m'mimba ndi zotsatira zakupha, kapamba, colitis (makamaka zilonda zam'mimba kapena zam'mimba), stomatitis.

hepatobiliary dongosolo

  • pachimake chiwindi kulephera, chiwindi, zolakwika zotsatira za chiwindi ntchito.

Khungu komanso minyewa yofinya

  • hemorrhage
  • zotupa, kuyabwa, intradermal hemorrhage (purpura),
  • dermatitis yodwala, poyidermerm necrolysis, matenda a Stevens-Johnson, erythema multiforme, angioneurotic edema, erythematous zidzolo, urticaria, Hypersensitivity syndrome, mankhwala osokoneza bongo omwe ali ndi eosinophilia ndi mawonekedwe a systemic (DRESS-lichen, eczema.

Musculoskeletal system, connective ndi mafupa minofu

  • musculoskeletal hemorrhages (hemarthrosis), nyamakazi, arthralgia, myalgia.

Impso ndi kwamikodzo dongosolo

  • hematuria
  • glomerulonephritis, kuchuluka kwa creatinine m'magazi.

zambiri

mayeso a labotale

  • Kutalika kwa nthawi yotuluka magazi, kuchepa kwa chiwerengero cha ma neutrophils ndi mapulateleti.
AnaChildren

Gwiritsani ntchito pa nthawi yoyembekezera kapena mkaka wa m'mawere

Chifukwa chosowa deta yakuchipatala pakugwiritsa ntchito clopidogrel pa nthawi yapakati, sizikulimbikitsidwa kupereka mankhwala kwa amayi apakati.

Sizikudziwika ngati clopidogrel adachotsedwa mkaka wa m'mawere, chifukwa chake, kuyamwitsa kuyenera kusiyidwa pakumwa mankhwala.

Chitetezo ndi kugwira ntchito kwa clopidogrel mwa ana sizinakhazikitsidwe, chifukwa chake, mankhwalawa sayenera kugwiritsidwa ntchito mwa ana.

Zolemba ntchito

Kupuma komanso matenda a hematological.

Chifukwa chakuwuka kwa magazi komanso kusintha kwatsoka kwa hematological, kuyezetsa magazi mwatsatanetsatane ndi / kapena kuyesa kwina koyenera kuyenera kuchitika mwachangu ngati zizindikiro za kutulutsa magazi zimawonedwa pakugwiritsa ntchito mankhwalawa. Monga othandizira ena a antiplatelet, clopidogrel iyenera kugwiritsidwa ntchito mosamala kwa odwala omwe ali ndi chiopsezo chowonjezereka cha magazi chifukwa cha kuvulala, opareshoni kapena zochitika zina zamatenda, komanso pankhani ya odwala omwe amagwiritsa ntchito acetylsalicylic acid (ASA), heparin, IIb / IIa glycoprotein inhibitors, kapena mankhwala osagwiritsa ntchito anti-antiidal. kuphatikizapo COX-2 zoletsa. Ndikofunikira kuyang'anira mosamala mawonetseredwe am'magazi owonekera m'magazi, kuphatikiza magazi obisika, makamaka masabata oyamba a chithandizo komanso / kapena pambuyo panjira yolowerera pamtima ndi kuchitapo kanthu. Kugwiritsa ntchito nthawi yomweyo kwa clopidogrel ndi anticoagulants sikulimbikitsidwa, chifukwa kumatha kuwonjezera kuchuluka kwa magazi (onani Gawo "Kuyanjana ndi mankhwala ena ndi mitundu ina yoyanjana").

Ngati mungachite opaleshoni yomwe mwakonzekera, ngati mankhwala a antithrombotic ali osafunikira kwakanthawi, chithandizo chokhala ndi clopidogrel ziyenera kusiyidwa masiku 7 musanachitidwe opareshoni. Odwala ayenera kudziwitsa madokotala ndi madokotala a mano kuti akumwa opaleshoni ya opaleshoni isanachitike kapena mankhwala ena atagwiritsidwa ntchito. 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 pochiza matenda a clopidogrel (okha kapena osakanikirana ndi ASA), kutuluka magazi kumatha kutha kuposa masiku onse, kuti ayenera kudziwitsa dokotala za vuto lililonse lotuluka (nthawi ndi nthawi).

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 ndi njira yakupha yomwe imafunikira chithandizo cham'tsogolo, makamaka plasmapheresis.

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 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 masiku 7 atadwala kwambiri.

Cytochrome P450 2 C19 (CYP2C19 ). Mankhwala.

Odwala omwe ali ndi genetical yafupika ntchito ya CYP2C19 amakhala ndi kuchepa kwakanthawi kogwiritsa ntchito magazi m'magazi am'magazi komanso samatchulidwanso antiplatelet, kuphatikiza apo, amakhala ndi zovuta zambiri zam'mtima pambuyo polimbana ndi myocardial infaration poyerekeza ndi odwala omwe ali ndi magwiridwe antchito a CYP2C19.

Popeza clopidogrel imapangidwa musanapangidwe ndi metabolite yogwira magawo awiri a CYP2C19, kugwiritsa ntchito mankhwala omwe amachepetsa ntchito ya enzymeyi kungayambitse kuchepa kwa kuchuluka kwa metabolite ya clopidogrel mu plasma. Popeza kufunikira kwakukhudzana ndi matendawa sikunafotokozedwe, kugwiritsa ntchito mankhwala komwe kumalepheretsa ntchito ya CYP2C19 kuyenera kupewedwa (onani Gawo "Kuyanjana ndi mankhwala ena ndi mitundu ina yoyanjana").

Kuyambanso pakati pa thienopyridines.

Odwala ayenera kufufuzidwa kuti awone mbiri ya hypersensitivity kwa thienopyridine ena (monga ticlopidine, prasugrel), poti pakhala pali malipoti okhudza kuyanjana pakati pa thienopyridines (onani gawo "Zotsatira zosagwirizana"). Thienopyridines imatha kuyambitsa zovuta pang'ono zomwe sizigwirizana, monga zotupa, edema ya Quincke, kapena kusintha kwa hematologic, monga thrombocytopenia ndi neutropenia. Odwala omwe adakumana ndi zovuta zam'mbuyomu komanso / kapena masanjidwe amtundu wina wa thienopyridine atha kukhala ndi chiopsezo chokhala ndi kufanana kapena kosiyana ndi thienopyridine ena. Analimbikitsa kuwunika kwa zizindikiro za hypersensitivity mwa odwala omwe amagwirizana ndi thienopyridines.

Matenda aimpso.

Zowonjezera zothandizira kugwiritsa ntchito clopidogrel kwa odwala omwe ali ndi vuto la impso ndizochepa, chifukwa chake, odwala oterewa amalembedwa mosamala (onani Gawo "Mlingo ndi Ulamuliro").

Kuwonongeka kwa chiwindi.

Zomwe mungagwiritse ntchito mankhwalawa kwa odwala omwe ali ndi matenda a chiwindi komanso kuchuluka kwa hemorrhagic diathesis ndizochepa. Chifukwa chake, clopidogrel iyenera kutumizidwa kwa odwala mosamala (onani Gawo "Mlingo ndi Ulamuliro").

Mankhwala ali ndi lactose. Odwala osowa cholowa galactose tsankho, Lapp lactase akusowa, mkhutu-galactose malabsorption sayenera kugwiritsa ntchito mankhwalawa.

Mankhwalawa ali ndi mafuta a hydrogenated castor, omwe angayambitse kudzimbidwa ndi m'mimba.

Ngati wodwalayo atayiwala kumwa mankhwalawo ndipo sapitirira 12:00 pambuyo poti wakonzekera, ndiye kuti mankhwalawo amayenera kutengedwa mwachangu, pambuyo pake mlingo wotsatira uyenera kumwedwa panthawi yake. Zopitilira 12:00 zapita, muyenera kudumpha kumwa mankhwala oiwalika ndikumamwa nthawi yotsatira. Sizivomerezeka kumwa mankhwalawa kawiri.

Pa chithandizo, simuyenera kumwa mowa chifukwa choonjezera kutuluka kwa magazi m'matumbo.

Njira zopewera kutaya zotsalira ndi zinyalala. Zina zilizonse zosagwiritsidwa ntchito kapena zinyalala ziyenera kutayidwa malinga ndi zofunikira zakomweko.

Kuyanjana ndi mankhwala ena ndi mitundu ina yoyanjana

Ma anticoagulants amlomo kugwiritsa ntchito nthawi yomweyo clopidogrel ndi anticoagulants amkamwa, kuphatikizapo warfarin, osavomerezeka, popeza kuphatikiza kotereku kumapangitsa kuchuluka kwa magazi.

Glycoprotein IIb / IIIa zoletsa: clopidogrel iyenera kugwiritsidwa ntchito mosamala kwa odwala omwe ali ndi chiopsezo chotaya magazi chifukwa cha kuvulala, maopareshoni, kapena zina zokhudzana ndi matenda omwe glycoprotein IIb / IIIa zoletsa amagwiritsidwa ntchito nthawi imodzi.

Acetylsalicylic acid (ASA): acetylsalicylic acid sasintha choletsa kuchuluka kwa clopidogrel pa ADP-yoyambitsa kupatsidwa zinthu za m'magazi, koma Clopidogrel imawonjezera zotsatira za ASA pa collagen-ikiwayambitsa kuphatikizira kwa mapulaneti. Komabe, kugwiritsa ntchito nthawi imodzimodziyo kwa 500 mg ya ASA kamodzi patsiku limodzi sikunachititse kuti pakhale magazi ambiri, osakhalitsa chifukwa cha clopidogrel. Popeza ngozi yotaya magazi ingatheke, kugwiritsa ntchito mankhwalawa pamafunika kusamala. Komabe, pali chidziwitso chogwiritsa ntchito clopidogrel ndi ASA palimodzi mpaka chaka chimodzi.

Heparin: mu kafukufuku wopangidwa ndi odzipereka athanzi, kugwiritsa ntchito clopidogrel sikunafunike kusintha kwa heparin ndipo sikunasinthe momwe heparin imapangidwira. Kugwiritsa ntchito nthawi imodzi kwa heparin sikunasinthe kufooka kwa mphamvu ya Clopidogrel pa kuphatikizidwa kwa maselo ambiri. Popeza kulumikizana kwa pharmacodynamic pakati pa clopidogrel ndi heparin ndikotheka ndikuwonjezereka kwa magazi, munthawi yomweyo kugwiritsa ntchito mankhwalawa kumafunikira kusamala.

Mankhwala a thrombolytic: chitetezo cha munthawi yomweyo kugwiritsa ntchito clopidogrel, fibrin-eni kapena fibrin-enieni a thrombolytic othandizira ndi heparin adayesedwa ndi kutengapo gawo kwa odwala omwe ali ndi infral myocardial infarction. Zomwe zimachitika kuti magazi amatuluka magazi kwambiri zinali zofanana ndi zomwe zimawonedwa pakutenga mankhwala othandizira ndi heparin ndi ASA.

Mankhwala othana ndi zotupa a nonsteroidal (NSAIDs): mu kafukufuku wochitidwa pa odzipereka athanzi, kugwiritsa ntchito nthawi yomweyo Clopidogrel ndi naproxen kumawonjezera kuchuluka kwa magazi am'mimba obwera. Komabe, chifukwa cha kuchepa kwa maphunziro pakukhudzana ndi mankhwalawa ndi ena a NSAID, sizikudziwikiratu, chiopsezo cha kutuluka kwa m'mimba chimawonjezeka mukamagwiritsa ntchito clopidogrel ndi NSAID ena. Chifukwa chake, kusamala ndikofunikira pakugwiritsa ntchito nthawi imodzi ya NSAIDs, kuphatikiza COX-2 zoletsa, ndi clopidogrel.

Kugwiritsa ntchito pamodzi mankhwala ena: popeza clopidogrel imapangidwa metabolite isanapangidwe ndi CYP2C19, kugwiritsa ntchito mankhwala omwe amachepetsa ntchito ya enzymeyi kungathandize kuchepetsa kuchuluka kwa metabolite ya clopidogrel m'magazi a m'magazi. Kukula kwakukhudzana kwa mankhwalawa sikumveka bwino, motero, kugwiritsa ntchito mankhwala omwe amalepheretsa ntchito ya CYP2C19 kuyenera kupewedwa.

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

Proton Pump Inhibitors (PPIs): mphamvu ya antithrombotic zochita za clopidogrel imatha kuchepetsedwa pafupifupi theka ikaphatikizidwa ndi PPI. Ngakhale kuchuluka kwa zoletsa za CYP2C19 mothandizidwa ndi mankhwala osiyanasiyana omwe ali mgululi la PPI sizofanana, Kafukufuku akuwonetsa kukhalapo kwa kulumikizana ndi pafupifupi onse oimira gululi. Pankhaniyi, kusiyana kwa kayendetsedwe ka nthawi sikukhudza kuchepa kwa kugwira ntchito kwa clopidogrel. Chifukwa chake, kugwiritsa ntchito ma PPI munthawi yomweyo kuyenera kupewedwa pokhapokha pakufunika.

Umboni kuti mankhwala ena omwe amachepetsa kupanga asidi m'mimba, monga

H 2 blockers (kupatula cimetidine zomwe zimalepheretsa ntchito ya CYP2C19) kapena maantacid , zimakhudza ntchito ya antiplatelet ya clopidogrel, ayi.

Kuphatikiza ndi mankhwala ena: Kafukufuku wambiri pa clopidogrel ndi mankhwala ena adachitidwa kuti aphunzire kuyanjana kwa pharmacodynamic ndi pharmacokinetic, zomwe zidawonetsa kuti pogwiritsa ntchito clopidogrel ndi:

  • atenolol, nifedipine kapena ndi mankhwala onse awiriwo, palibe njira yofunika kwambiri yamankhwala yomwe yapezeka,
  • phenobarbital ndi estrogen zopanda phindu pa pharmacodynamics of clopidogrel,
  • digoxin kapena theofylline: magawo a pharmacokinetic sanasinthe,
  • Maantacid: palibe vuto pa mulingo wa mayamwidwe a clopidogrel
  • phenytoin ndi tobutamide: carboxyl metabolites ya clopidogrel imatha kulepheretsa ntchito ya cytochrome P450 2C9, yomwe imatha kukulitsa kuchuluka kwamankhwala a plasma monga phenytoin , tolbutamide ndi NSAIDs zomwe zimapukusidwa 450 2C9. Koma ngakhale izi, phenytoin ndi tolbutamide zitha kugwiritsidwa ntchito mosamala nthawi yomweyo ndi clopidogrel,
  • okodzetsa, β-blockers, zoletsa za ACE, othandizira calcium, othandizira a cholesterol, othandizira a hypoglycemic (kuphatikiza insulin), antiepileptic mankhwala, mankhwala obwezeretsa ma cell ndi Otsutsa a GPIIb / IIIa: mu maphunziro azachipatala, palibe zotsatira zoyipa zazachipatala zomwe zidapezeka.
AnaChildren

Malangizo ogwiritsira ntchito Atrogrel

yogwira: clopidogrel,

Piritsi 1 ili ndi clopidogrel mu mawonekedwe aopopidogrel bisulfate, malinga ndi 100% Clopidogrel - 75 mg.

Omwe amathandizira: croscarmellose sodium, cellcrystalline cellulose, lactose, mafuta a hydrogenated castor,

membrane wa kanema: hypromellose, lactose, titanium dioxide (E171), triacetin, carmine (E120).

Kupewera kwa mawonetseredwe a atherothrombosis: odwala omwe adadwala matenda opatsirana poyambira (kuyamba kwa mankhwala ndi masiku angapo, koma osapitirira masiku 35 zitachitika), ischemic stroke (kuyamba kwa chithandizo ndi masiku 7, koma osapitirira miyezi 6 zitachitika) omwe adapezeka kuti ali ndi matenda amtundu wamatumbo, odwala omwe ali ndi vuto la coralary coronary syndrome: ndi pachimake coronary syndrome yopanda ST segment electionable (angina osakhazikika kapena myocardial infarction yopanda Q wave), kuphatikiza pa odwala omwe apezeka ndi matenda NT pa percutaneous transluminal inatsekeratu angioplasty, osakaniza ndi asidi acetylsalicylic, ndi pachimake infarction m'mnyewa wamtima ndi cha ku Switzerland gawo okwera osakaniza ndi asidi acetylsalicylic (odwala kulandira mankhwala muyezo ndi zomwe thrombolytic mankhwala).

Kupewa kwa zochitika za atherothrombotic ndi thromboembolic mu atria fibrillation.

Clopidogrel akuwonetsedwa kuphatikiza acetylsalicylic acid kwa odwala akulu omwe ali ndi fibrillation ya atgency momwe muli chiopsezo chimodzi chodziwika bwino cha zochitika zamitsempha, contraindication pochiza ndi vitamini K antagonists (AVK), chiopsezo chochepa cha magazi, pofuna kupewa zochitika za atherothrombotic ndi thromboembolic, mu kuphatikizapo sitiroko.

Atrogrel wa mankhwala: malangizo ogwiritsira ntchito

Atrogrel ndi mankhwala omwe ali ndi antiplatelet. Amagwiritsidwa ntchito pochiza komanso kupewa matenda oyamba, obwera pafupipafupi, kugunda kwa mtima pamaso pa odwala. Mankhwalawa amathandizira kuthetsa mtima wamatenda a mtima chifukwa cha mphamvu ya clopidogrel poletsa kuphatikizira kwa maselo ambiri. Ndikofunikira kudziwa kuti mukamalandira chithandizo, nthawi yoletsa magazi imawonjezeka.

Pharmacokinetics

Pambuyo pa makonzedwe, mankhwalawa amatengedwa mwachangu kuchokera m'mimba. Zomwe zimapangitsa kuti magazi azikhala m'magazi ndi osagwirizana ndipo pambuyo pa 2:00 ntchito sinafotokozedwe (zosakwana 0,025 μg / l). Mwachangu biotransformed mu chiwindi. Metabolite yake yayikulu (85% ya plasma yomwe imazungulira) imagwira ntchito. The thiol metabolite yogwira imagwira mwachangu komanso mosasinthika kwa mapulateleti othandizira. M'magazi am'magazi, sapezeka. Clopidogrel ndi metabolite yayikulu yozungulira yozungulira imabweza mapuloteni a plasma.
Mukatha kumwa, pafupifupi 50% ya mankhwalawo amatengedwa mumkodzo ndipo 46% ndi ndowe mkati mwa maola 120 mutatha kugwiritsa ntchito. Hafu ya moyo wa metabolite yayikulu ndi 8:00.
Kuchulukitsidwa kwa metabolite yayikulu mu plasma mwa okalamba odwala (azaka 75 ndi akulu) ndikwambiri kwambiri, komabe, kuchuluka kwa plasma sikumayendera limodzi ndi kusintha kwa kuphatikizika kwa maselo a magazi ndi nthawi ya magazi.

Kutulutsa mafomu ndi kapangidwe kake

Mankhwala amapangidwa piritsi. Chigawo cha mankhwalawa ndi utoto-wamafuta, wokhala ndi utoto. Piritsi 1 ili ndi 75 mg yogwira - clopidogrel bisulfate. Zina zomwe zikuphatikiza:

  • cellcrystalline mapadi,
  • hydrogenated castor mafuta,
  • shuga mkaka
  • croscarmellose sodium.

Chipolopolo chakunja chimakhala ndi carmine, hypromellose, shuga ya lactose, titanium dioxide, triacetin.

Mankhwala amapangidwa piritsi. Piritsi 1 ili ndi 75 mg yogwira - clopidogrel bisulfate.

Zotsatira za pharmacological

Mankhwalawa amalepheretsa kumangiriza kwa adenosine diphosphate ku zolumikizira zolingana padziko lapansi. Zotsatira zamachitidwe a clopidogrel, kuphatikiza kwa maselo ambiri ndi zomatira zimatsitsidwa, zimayambika mwachilengedwe kapena zimayambitsa chidwi cha mankhwala ena. The achire zotsatira olembedwa labotale 2 mawola pambuyo pakamwa mankhwala.

Ndi wachiwiri kudya, mphamvu ya mankhwalawa imapangidwira komanso imakhazikika pokhapokha masiku 3-7 a mankhwala. Nthawi yomweyo, pafupifupi zoletsa za kuphatikizana kwa mapulateleti ukufika 45-60%.The achire zotsatira zimapitirira kwa sabata, pambuyo pake kuphatikiza kwa maselo amwazi ndi seramu kubwerera pazomwe amayambira. Izi zimachitika chifukwa cha kukonzanso kwa maselo amwazi (moyo wa m'mapulogalamu ndi masiku 7).

Kodi chimathandiza ndi chiyani?

Mankhwala amagwiritsidwa ntchito ngati njira yochizira matenda a atherothrombosis mwa odwala akuluakulu ndikuchotsa zotsatirazi:

  • matenda a zotumphukira mitsempha pa chitukuko cha matenda a mtima chifukwa atherothrombosis m'munsi malekezero,
  • pachimake coronary syndrome motsutsana ndi vuto la mtima chifukwa chosagwa ndi mafunde a Q pa electrocardiogram (ECG) kapena pamaso pa angina osakhazikika,
  • kupewa yachiwiri myocardial infarction ndi kufulumizitsa kukonzanso kwa mtima minofu (mankhwalawa ntchito palibe patadutsa masiku 35 kuchokera patachitika matenda)
  • kupewa imfa mwadzidzidzi,
  • pachimake myocardial infarction mukakweza gawo ST pa ECG yokhala ndiwofatsa mankhwala ndi acetylsalicylic acid,
  • ischemic stroke pa chiyambi cha mankhwala pambuyo masiku 7 (pasanathe miyezi 6) kuchokera pakupanga matenda.


Mankhwala amagwiritsidwa ntchito ngati njira yochizira matenda a atherothrombosis mwa odwala akuluakulu.
Komanso, mankhwalawa amagwiritsidwa ntchito poletsa kuchepa kwachiwiri kwa myocardial.
Atrogrel imalembedwa kwa odwala kuti apewe kufa kwadzidzidzi kwa coronary.
Chizindikiro chogwiritsa ntchito mankhwalawa ndi ischemic stroke pakuyamba kwa mankhwala pambuyo pa masiku 7 (pasanathe miyezi 6) kuchokera pakupanga kwa matenda.


Mankhwalawa amagwiritsidwa ntchito popewa kupezeka kwa chikhalidwe cha atherothrombotic ndi blockage (embolism) ya lumen ya chotengera ndi thrombus panthawi ya atria fibrillation. Pankhaniyi, tikulimbikitsidwa kugwiritsa ntchito kuphatikiza kwa acetylsalicylic acid ndi clopidogrel.

Ndi chisamaliro

Chenjezo limaperekedwa kwa odwala omwe ali pachiwopsezo chachikulu cha kukhetsa magazi chifukwa cha kuvulala kwamakina, njira zopangira opaleshoni, komanso kusakhazikika bwino kosakwanira kwa asidi m'thupi. Kuvomerezedwa kwa Atrogrel ndikosayenera kwa odwala omwe ali ndi vuto lolakwika la chiwindi, chifukwa pali chiopsezo chokhala ndi hemorrhagic diathesis.


Mankhwala sinafotokozeredwe zovuta matenda a chiwindi.
Atrogrel sagwiritsidwa ntchito zotupa zotupa zam'mimba ndi duodenum mu siteji yovuta.
Mankhwala osavomerezeka kuti azimwedwa pakamwa poyamwitsa ndi amayi apakati.
Kusamala kumalangizidwa kwa odwala omwe ali pachiwopsezo chachikulu chokhetsa magazi.


Kodi kutenga Atrogrel?

Mankhwalawa adapangira pakumwa pakamwa, ngakhale kudya zakudya. Muyezo tsiku lililonse ndi 75 mg kamodzi. Odwala omwe ali ndi matenda oopsa a mtsempha wamagazi, osakhazikika angina ndi kulowerera m'mitsempha amalimbikitsidwa kuti amwe mankhwala 300 mg tsiku loyamba - mapiritsi 4. Mlingo wotsatira ndi muyezo.

Kutalika kwa maphunzirowa kumatsimikiziridwa ndi dokotala aliyense payekhapayekha, kutengera chithunzi cha matenda. Kuphatikiza mankhwala ndi mankhwala ena kumayikidwa posachedwa. Nthawi yayitali yodwala ndi milungu 4.

Zotsatira zoyipa za Atrogrel

Zotsatira zoyipa kuchokera ku ziwalo ndi machitidwe zimakhazikika nthawi zambiri ngati wodwalayo ali ndi vuto loti ziwalo zina zigwirira ntchito kapena mapiritsi atengedwa molakwika.


Mankhwalawa adapangira pakumwa pakamwa, ngakhale kudya zakudya.
Odwala omwe ali ndi matenda oopsa a mtsempha wamagazi, osakhazikika angina ndi kulowerera m'mitsempha amalimbikitsidwa kuti amwe mankhwala 300 mg tsiku loyamba - mapiritsi 4.
Anthu odwala matenda ashuga sayenera kusintha njira yochiritsira ndi mankhwalawa.

Hematopoietic ziwalo

Kuchuluka kwa zinthu zopangidwa m'magazi kumachepa, kupanga ma leukocytes ndi eosinophilic granulocytes kusokonezeka. Nthawi yosiya magazi ikutuluka. Supombocytopenic purpura, kuchepa magazi, thrombocytopenia ndi agranulocytosis angayambe ndi kuwonongeka kwa hematopoietic dongosolo.

Odwala amati kukula kwa magazi pambuyo pa mwezi umodzi wamankhwala.

Pakati mantha dongosolo

Ndi poizoni wamavuto a mankhwalawa pamanjenje, kupweteka mutu, chizungulire komanso kuwonongeka kwa chidwi. Nthawi zina, kuwonongeka kwa malingaliro, kuyerekezera zinthu, kusokonezeka ndi kusazindikira, kukomoka kwa zipatso zotheka ndikotheka.


Zotsatira zoyipa za Atrogrel mu minculoskeletal system zimawonekera mu mawonekedwe a ululu mu minofu ndi mafupa.
Zotsatira zoyipa za mankhwalawa, dyspepsia imatha kuchitika.
Ndi kugwiritsa ntchito mankhwalawa kwa nthawi yayitali, kupuma movutikira komanso zilonda zapakhosi kumatha.

Zizindikiro zogwiritsidwa ntchito

Mankhwala Atrogrel Amagwiritsidwa ntchito popewa kuwonetsa kwa atherothrombosis mwa odwala pambuyo poyambitsa matenda (chiyambi cha chithandizo - masiku angapo, koma osapitirira masiku 35 zitachitika), ischemic stroke (kuyamba kwa chithandizo - masiku 7, koma osapitirira miyezi 6 zitachitika) kapena omwe apezeka ndi matenda osokoneza bongo
Odwala ndi pachimake koronare matenda:
- ndi pachimake coronary syndrome popanda kukwera kwa ST (kusakhazikika kwa angina kapena kupindika kwa myocardial yopanda Q wave), kuphatikiza pa odwala omwe ali ndi stent yoyikika panthawi yopanda coronary angioplasty, osakanikirana ndi acetylsalicylic acid
- ndi kulowetsedwa pachimake kwa myocardial ndi kukwezedwa kwa gawo la ST limodzi ndi acetylsalicylic acid (odwala omwe amalandila chithandizo chamankhwala omwe akuwonetsedwa ngati thrombolytic therapy).
Kupewa kwa zochitika za atherothrombotic ndi thromboembolic mu atria fibrillation.
Clopidogrel akuwonetsedwa kuphatikiza acetylsalicylic acid kwa odwala akulu omwe ali ndi fibrillation ya atgency momwe muli chiopsezo chimodzi chodziwika bwino cha zochitika zamitsempha, contraindication pochiza ndi vitamini K antagonists (AVK), chiopsezo chochepa cha magazi, pofuna kupewa zochitika za atherothrombotic ndi thromboembolic, mu kuphatikizapo sitiroko.

Kuchokera pamtima

Ndi poizoni wa mankhwalawa pamagazi, tachycardia imawoneka, kusokoneza kwamitsempha yama coronary komanso kupweteka pachifuwa.


Ndi poizoni wa mankhwalawa pamagazi a magazi, tachycardia imawonekera.
Ndi kukula kwa zoyipa m'mimba thirakiti, kuchepa kwa njala kumatheka.
Odwala ambiri ali ndi uritisaria, totupa.

Kuchokera kumbali ya kagayidwe

Mankhwalawa alibe mphamvu pa kagayidwe kachakudya, koma ndikupanga zotsatira zoyipa m'matumbo am'mimba, kuchepa kwa chilakolako chokwanira kumatha.

Odwala omwe akuyembekezeka kukhazikika kwa anaphylactoid zimachitika, nthawi zina pamakhala chiopsezo cha anaphylactic, edema ya Quincke, mankhwala osokoneza bongo. Odwala ambiri amakhala ndi ming'oma, totupa, ndi khungu loyenda.

Kuyenderana ndi mowa

Munthawi yamankhwala osokoneza bongo, sikulimbikitsidwa kumwa zakumwa zoledzeretsa. Mowa wa Ethyl umakulitsa mkhalidwe wamkati wamanjenje ndi mtima, kuwonjezereka kwa zovuta m'magawo am'mimba ndikuwonjezera nthawi yotuluka magazi. Ethanol angayambitse zilonda zam'mimba.

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Mankhwalawa amalembedwa kuti agwiritsidwe ntchito ndi amayi apakati, chifukwa clopidogrel imatha kusokoneza kuyika kwa ziwalo ndi machitidwe pakukonzekera kwa embryonic kapena kukulitsa mwayi wokhetsa magazi nthawi yakubala, zomwe zimapangitsa mkhalidwe wovuta m'miyoyo ya mayi.

Mankhwalawa amawakunga mu tiziwalo ta mammary ndipo amachotseredwa mkaka wa m'mawere, chifukwa cha mankhwalawa ndi Atrogrel, tikulimbikitsidwa kuti muchepetse kuyamwa.

Kusintha kwa mlingo wowonjezera pakuwonongeka kwa impso sikofunikira.

Zosokoneza bongo za Atrogrel

Ndi kugwiritsa ntchito mankhwala osokoneza bongo, kukula kwa zosakhudza zam'mimba (zotupa zam'mimba, zotupa zam'mimba, kupweteka kwa m'mimba, kusanza ndi kusanza, kukha mwazi m'mitsempha yam'mimba mwa thirakiti la m'mimba) ndikutuluka kwa nthawi yayitali. Ndi gawo limodzi la mlingo waukulu, wolakwiridwayo ayenera kuyimba ambulansi. M'malo osasunthika, kuikidwa magazi kumathandizira kubwezeretsa mwachangu ziwopsezo zamagazi.

Ngati wodwala walowetsa mapiritsi ambiri pakadutsa maola 4, ndiye kuti wodwalayo ayenera kusanza, kutsuka m'mimba ndikupereka chinthu chofunikira kuti muchepetse kuyamwa kwa clopidogrel.


Ngati mankhwalawa agwiritsidwa ntchito molakwika, zimapangitsa kuti pakhale zovuta m'matumbo, mwachitsanzo, kusanza.
Ndi gawo limodzi la mlingo waukulu, wolakwiridwayo ayenera kuyimba ambulansi.
M'malo osasunthika, kuikidwa magazi kumathandizira kubwezeretsa mwachangu ziwopsezo zamagazi.
Kulimba kwa zotupa m'matumbo mwake kumatheka chifukwa cha ntchito ya Warfarin.


Kuchita ndi mankhwala ena

Pogwiritsa ntchito nthawi yomweyo Arthrogrel ndi mankhwala ena, izi ndizogwirizana ndi mankhwalawa:

  1. Ngakhale mukumwa mankhwala osagwiritsa ntchito mankhwala a anti-yotupa, pali kuwonjezeka kwa kutuluka kwa magazi m'mimba. Kulimba kwa zotupa m'matumbo mwake kumatheka chifukwa cha ntchito ya Warfarin.
  2. Kuchuluka kwa plasma ya phenytoin ndi tolbutamide kumawonjezeka. Pankhaniyi, zosintha zoyipa za thupi sizimawonedwa.
  3. Heparin ndi acetylsalicylates sizikhudza kuchiritsa kwa Atrogrel.

Palibe kutengera kwa mankhwala kophatikizana ndi beta-adrenoreceptor blockers, diuretics, antiepileptic ndi hypoglycemic.

Zokhudza mphamvu pakuwongolera njira

Mankhwalawa saphwanya kuyenda ndi magwiridwe antchito a minofu ya mafupa. Chifukwa chake, munthawi yoperekera chithandizo, kuyendetsa, kuwongolera njira zovuta ndi zochitika zina zomwe zimafuna kuthamanga kwa wodwala pama psychomotor reaction ndi ndende amaloledwa.

M'malo mwa Atrogrel mulinso mankhwala otsatirawa, omwe ali ndi yogwira pophika monga mankhwala ndi ma pharmacological:

  • Sylt,
  • Clopacin,
  • Clopidogrel,
  • Acecor Cardio,
  • Agrelide,
  • Cormagnyl
  • Ecorin
  • Cardiomagnyl.

Cardiomagnyl ndi mapiritsi a adyo Clopidogrel Cardiomagnyl Malangizo Opezeka

Popeza mankhwalawa palibe pamene mukumwa Atrogrel, ndikofunikira kuti mufunsane ndi dokotala za kusintha kwa mankhwalawa. Kusinthira ku mankhwala ena okha sikofunikira.

Tsiku lotha ntchito


Analogue yotchuka ya mankhwala ndi Cardiomagnyl.
Ngati ndi kotheka, mankhwalawa amatha kusintha ndi Zilt.
Mapangidwe ofanana ndi Clopidogrel.

Wopanga

JSC Sayansi ndi Zachipatala Center "Borshchagovsky Chemical and Pharmaceutical Plant", Ukraine.

Oleg Hvorostnikov, wa zaka 52, Ivanovo.

Potsatira malangizo a dokotala, adayamba kumwa piritsi limodzi la 75 mg usiku wokhudzana ndi matenda a atherosulinosis a m'munsi. Mankhwalawa adathandizira, zovuta zake adayamba kumva kuperewera. Koma patsiku la 5 la chithandizo ndimayenera kuyimba ambulansi. Kutupa kwamkati mwa m'mimba kunayamba. Sindikulimbikitsa kuti anthu azolowere kukhala ndi gastritis ndi zilonda zam'mimba. Kwa ine, izi zinali zolakwika.

Victor Drozdov, wazaka 45, Lipetsk.

Mnzake yemwe, atadwala matenda opha ziwalo, atadwala, adamulembera piritsi limodzi la Atrogrel kwa masabata awiri. Pambuyo pa sitiroko, ischemia idayamba, choncho mkono wamanja sunamveke. Pamapeto pa sabata loyamba la chithandizo, kulumala kunayamba m'miyendo. Mankhwalawa adapereka chotsatira. Madotolo adati mankhwalawa amachepetsa mitsempha yamagazi ndikuwonjezera magazi m'dera la ischemic. Ndikusiyirani ndemanga yabwino.

Kutulutsa Fomu

Atrogrel - mapiritsi.
Mapiritsi 10 mu chithuza, 1 chithuza m'mpaketi, mapiritsi 10 mu chithuza, matuza atatu mu paketi.

Piritsi 1Atrogrel muli clopidogrel mu mawonekedwe aopopidogrel bisulfate, malinga ndi 100% Clopidogrel - 75 mg.
Omwe amathandizira: croscarmellose sodium, microcrystalline cellulose, lactose, castor hydrogenated film membrane film: hypromellose, lactose, titanium dioxide (E171), triacetin, carmine (E120).

Kusiya Ndemanga Yanu