Tshuaj Aterocardium: cov lus qhia rau kev siv

Aterocardium yog muaj nyob rau hauv daim ntawv ntawm cov zaj duab xis-ntsiav tshuaj: puag ncig, biconvex, liab dawb (10 daim txhua qhov hauv lub hlwv, hauv pob duab los qhia 1 lossis 4 hlwv).

Composition 1 ntsiav tshuaj:

• cov tshuaj nquag: clopidogrel (hauv daim ntawv ntawm clopidogrel hydrosulfate) - 75 mg,
• Cov khoom xyaw pabcuam: magnesium stearate, povidone, lactose monohydrate, pregelatinized hmoov txhuv nplej siab, polyethylene glycol 6000, microcrystalline cellulose,
• zaj duab xis lub tsho tiv no: Opadry II Paj yeeb (hypromellose, triacetin, titanium dioxide, lactose monohydrate, polyethylene glycol, indigo carmine txhuas cov kua roj vanish, ntxim nyiam liab liab varnish).

Kev ntsuas rau siv

Aterocardium yog siv los tiv thaiv cov tsos mob atherothrombosis hauv cov hauv qab no ntawm cov neeg laus cov neeg mob:

• cov neeg mob uas tau mob ischemic stroke (kev kho mob pib 7 hnub tom qab mob stroke, tab sis tsis pub dhau 6 lub hlis tom qab nws tshwm sim),
• cov neeg mob uas tau myocardial infarction (kev kho mob pib ob peb hnub tom qab lub plawv nres, tab sis tsis pub dhau 35 hnub tom qab nws tshwm sim),
• cov neeg mob uas muaj cov kab mob ntawm cov hlab ntsha peripheral (vascular atherothrombosis thiab kev puas tsuaj rau cov hlab ntsha ntawm qhov qis qis),
• cov neeg mob uas muaj myocardial infarction thiab ST ntu nce siab ib txhij nrog ASA (acetylsalicylic acid) (hauv cov neeg mob uas tau txais kev kho mob raws qauv thiab uas tau qhia rau kev kho thrombolytic),
• cov neeg mob uas muaj mob txha caj qaum tsis hnov ​​cov kabmob ntshav txhaws qhov tsis muaj ST ntu ntawm qhov siab (myocardial infarction tsis muaj Q yoj los sis tsis khov tsis khov) ib txhij nrog acetylsalicylic acid.

Cov Yuav Tsum Muaj

• daim siab ua hauj lwm hnyav
• mob hlab ntsha hauv plab, mob plab thiab lwm yam mob nrog rau qhov mob pheej hmoo, los ntshav,
• lactase deficiency, galactose intolerance, qabzib-galactose malabsorption syndrome,
• cov menyuam yaus thiab cov tub ntxhais hluas hnub nyoog qis dua 18 xyoo,
• cev xeeb tub
• pub niam mis
• nce ib tug neeg rhiab heev rau clopidogrel lossis ib yam ntawm cov tshuaj ntu ntawm cov tshuaj.

Tus txheeb ze (Aterocardium siv nrog ceev faj):

• me me mus rau me me tsis ua haujlwm,
• lub raum tsis ua hauj lwm
• hemorrhagic diathesis (keeb kwm),
• kev phais mob, kev raug mob thiab lwm yam kab mob pathological nrog kev pheej hmoo los ntshav,
• concomitant siv nrog heparin, ASA, tsis siv tshuaj tiv thaiv tsis haum tshuaj thiab glycoprotein IIb / IIIa inhibitors.

Tsuas tshuaj thiab tswj hwm

Aterocardium ntsiav tshuaj yog noj ntawm qhov ncauj, tsis hais txog kev noj zaub mov.

Cov koob tshuaj pom zoo rau cov neeg laus, nrog rau cov neeg mob laus, yog 1 ntsiav tshuaj ib hnub.

Hauv cov mob hlab ntsha hlwb tsis muaj ST ntu kab mob nce siab, kev kho mob yog pib nrog kev thauj khoom ntawm 300 mg ib zaug, thiab tom qab ntawd txuas ntxiv nrog cov koob tshuaj (75 mg) ib hnub ib zaug ua ke nrog acetylsalicylic acid nyob rau hauv ib koob tshuaj txhua hnub ntawm 75-325 mg. Kev noj tshuaj ntau kawg ntawm cov tshuaj acetylsalicylic acid yuav ua rau muaj kev los ntshav ntau, yog li nws tsis pom zoo kom noj ntau tshaj 100 mg ntawm ASA ib hnub.

Cov sijhawm ua haujlwm siab tshaj plaws ntawm cov chav kho mob tsis tau teeb tsa, tab sis cov txiaj ntsig ntawm kev tshawb pom tau pom tias Aterocardium yuav tsum tau coj mus txog 12 lub hlis. Qhov siab tshaj plaws ntawm kev kho mob tau pom tshwm tom qab 3 lub hlis ntawm kev siv tshuaj.

Hauv kev mob myocardial infarction nrog ST ntu nce, kev kho mob kuj pib nrog ib qho kev thauj khoom (300 mg) nrog cov tshuaj acetylsalicylic acid, nrog lossis tsis muaj tshuaj thrombolytic. Cov neeg mob uas muaj hnub nyoog tshaj li 75 xyoos tsis tau sau cia coj los noj. Kev tswj hwm ntawm ASA pib thaum ntxov li sai tau thiab kav tsawg kawg 4 lub lis piam.

Sab sij huam

• plab zom mov: feem ntau - dyspeptic cuam tshuam, mob plab, mob plab, los ntshav, zawv plab, tso tsis tau - xeev siab, ntuav, mob plab, mob plab, mob plab, mob plab, mob plab, mob plab, tsis tshua - retroperitoneal los ntshav, tsis tshua muaj - stomatitis, colitis (hauv suav nrog lymphocytic lossis mob siab), mob pancreatitis, retroperitoneal thiab mob plab zom mov nrog lub txiaj ntsig tuag,
• hepatobiliary system: muaj tsawg kawg - kab mob siab, mob siab tsis ua haujlwm, tshuaj ntsuam lub siab ua tsis taus pa,
• kev mob plawv: feem ntau - hematoma, tsis tshua muaj tshwm sim - vasculitis, mob ntshav siab, mob ntshav khov, los ntshav los ntawm kev ua haujlwm zoo,
• hematopoietic system: ua haujlwm tsis zoo - leukopenia, thrombocytopenia, eosinophilia, tsis tshua muaj - neutropenia (suav nrog rau mob hnyav), tsis tshua muaj tshwm sim - muaj ntshav qab zib, agranulocytosis, granulocytopenia, thrombotic thrombocytopenic purpura, pancytopenia, mob hnyav thrombocytopenia,
• cov kab mob ua pa: feem ntau - txhaws ntswg, tsis tshua muaj - bronchospasm, mob ntsws, mob ntsws, hemoptysis, interstitial pneumonitis,
• cov hlab ntsha hauv nruab nrab: tsis xws luag - kiv taub hau, mob taub hau, mob ntshav hauv ntshav (qee zaum ua rau neeg tuag taus), mob taub hau, tsis tshua pom tseeb - saj tsis txaus, hnov ​​qab, tsis meej,
• cov kabmob hauv lub cev: tso tsis tau dhau-ua pob txha, mob pob txha los ntshav lossis rov tso ntshav tawm, tsis tshua muaj - kiv taub hau vim yog pathology ntawm pob ntseg thiab labyrinth,
• musculoskeletal system: muaj tsawg heev - mob caj dab, mob myalgia, hemarthrosis, arthralgia,
• cov kab mob zis: tso zis - hematuria, tsis tshua muaj heev - kev nce ntshav plasma creatinine, glomerulonephritis,
• cov tawv nqaij thiab cov nqaij mos subcutaneous: feem ntau - subcutaneous hemorrhage, ua tsis xws luag - khaus, tawm pob, purpura, tsis tshua muaj - urticaria, lichen planus, erythematous pob, eczema, dermatitis, mob caj dab,
• kev ua xua: tsis tshua muaj tshwm sim - anaphylactic tshua, ntshiab ntshav mob,
• kev ntsuas ntsuas: tsis tu ncua - txuas ntxiv ntawm lub sijhawm los ntshav,
• lwm tus: tsis tshua muaj - kub taub hau.

Cov lus qhia tshwj xeeb

Yog tias xav tias los ntshav, kev kuaj tsim nyog thiab / lossis kev kuaj ntshav ntxaws ntxaws yuav tsum tau ua sai sai.

Aterocardium yuav tsum tso tseg 7 hnub ua ntej thov kev phais mob, vim tias cov tshuaj tsub kom ntev li los ntshav.

Cov neeg mob yuav tsum tau ceeb toom tias thaum kho nrog clopidogrel, los ntshav yuav ntev thiab nres tom qab. Txhua kis ntawm qhov txawv los ntshav los ntshav hauv zos yuav tsum qhia rau koj tus kws kho mob.

Aterocardium tsis cuam tshuam lossis muaj kev cuam tshuam tsawg rau kev ceev ntawm psychomotor cov tshuaj tiv thaiv thiab muaj peev xwm mloog zoo. Yog hais tias kiv taub hau loj hlob tuaj thaum noj cov tshuaj, koj yuav tsum tso tseg kev tsav tsheb thiab lwm yam kev ua si phom sij.

Pharmacological kev txiav txim

Platelet aggregation inhibitors uas tsis yog heparin. Cov chaw muag tshuaj. Clopidogrel xaiv yam tshuaj tiv thaiv qhov khi ntawm adenosine diphosphate (ADP) rau lub receptor ntawm platelet nto thiab kev ua haujlwm tom qab ntawm GPIIb / IIIa complex nyob rau hauv tus ntawm ADP thiab, yog li, inhibits platelet aggregation. Clopidogrel tseem ua rau cov platelet sib sau ua ke los ntawm lwm cov agonists los ntawm kev thaiv qhov nce hauv platelet kev ua haujlwm los ntawm kev tso tawm ADP thiab tsis tuaj yeem hloov kho platelet ADP receptors. Platelets uas tau sib cuam tshuam nrog clopidogrel hloov mus txog thaum kawg ntawm lawv lub neej kev ua haujlwm. Lub platelet zoo li qub tau rov qab los ntawm tus nqi sib xws nrog tus nqi platelet txuas ntxiv.
Txij thawj hnub ntawm kev siv hauv kev rov ua dua txhua hnub ntawm 75 mg ntawm cov tshuaj, qhov tseem ceeb qeeb hauv ADP-vim platelet aggregation raug kuaj pom. Qhov kev ua no zuj zus zuj zus thiab ruaj khov ntawm 3 thiab 7 hnub. Thaum ruaj khov, qhov nruab nrab ntawm kev tsis sib xyaw ntawm kev sib xyaw nyob hauv qab ntawm kev noj tshuaj hauv ib hnub ntawm 75 mg yog los ntawm 40% txog 60%. Platelet sib sau ua ke thiab lub sijhawm los ntshav rov qab los rau hauv qhov chaw nruab nrab 5 hnub tom qab tsis kho.
Tom qab qhov ncauj tswj hwm ntawm ib koob tshuaj 75 mg, nws yog sai sai los ntawm cov hnyuv. Qhov nruab nrab ntshav khov ntau ntawm cov tsis hloov pauv clopidogrel (txog 2.2-2.5 ng / ml tom qab ib koob ntawm 75 mg ntawm qhov ncauj) tau kwv yees kwv yees li 45 feeb tom qab noj. Kev nqus yog tsawg kawg yog 50%, raws li qhia los ntawm kev nthuav tawm ntawm clopidogrel metabolites hauv cov zis. Clopidogrel thiab qhov tseem ceeb (tsis voos) metabolite ncig hauv cov ntshav hauv vitro thim rov qab rau tib neeg cov ntshav plasma (98% thiab 94%, feem). Qhov ntawv cog lus no tseem nyob rau hauv vitro dhau ntawm ntau qhov ntau.
Hauv vitro thiab hauv vivo muaj ob
Clopidogrel yog qhov txuas ntxiv ntawm txoj hauv kev tseem ceeb ntawm nws cov metabolism: ib tus dhau los nrog kev koom tes ntawm esterases thiab ua rau hydrolysis nrog kev tsim cov txheej txheem tsis muaj zog ntawm cov carboxylic acid (uas muaj txog 85% ntawm tag nrho cov metabolites hauv lub ntshav), thiab cov enzymes ntawm cytochrome P450 koom nrog lwm qhov. Ua ntej, clopidogrel tau hloov pauv mus rau hauv theem nrab ntawm 2-oxo-clopidogrel. Raws li kev txuas ntxiv ntawm cov metabolism hauv 2-oxo-clopidogrel, thiol derivative, ib qho kev hloov pauv ntawm lub cev, raug tsim. Hauv cov tshuaj vitro, cov kab mob metabolic no tau kho kom haum los ntawm cov enzymes CYP3A4, CYP2C19, CYP1A2, CYP2B6. Cov nquag metabolite ntawm clopidogrel, uas tau muab cais tawm hauv vitro, sai thiab tsis tuaj yeem khi rau platelet receptors, inhibiting platelet aggregation.
120 teev tom qab noj, kwv yees li 50% ntawm cov koob tshuaj tau tso tawm hauv cov zis thiab 46% nrog quav. Tom qab qhov ncauj tswj hwm ntawm ib koob tshuaj, ib nrab lub neej ntawm clopidogrel yog li 6 teev. Ib nrab-lub neej ntawm lub ntsiab (tsis voos) metabolite ncig hauv cov ntshav yog 8 teev tom qab ib zaug thiab rov ua dua ntawm cov tshuaj.
Ob peb cov polymorphic CYP450 cov enzymes hloov clopidogrel rau hauv cov khoom siv ua kom zoo, ua kom nws. CYP2C19 koom nrog kev tsim ntawm ob qho tib si ntawm kev siv hluav taws xob thiab kev sib xyaw ua ke ntawm 2-oxo-clopidogrel. Cov chaw muag tshuaj ntawm cov nquag metabolite thiab cov tshuaj tiv thaiv antiplatelet, raws li kev ntsuas ntawm platelet kev sib xyaw, sib txawv raws CYP2C19 caj ces. CYP2C19 * 1 lub suab sib txuam nrog cov roj ntsha uas ua haujlwm tau zoo, thaum lub CYP2C19 * 2 thiab CYP2C19 * 3 alleles sib raug rau cov metabolism hauv kev ua kom tsis muaj zog. Alleles tau lav rau 85% ntawm alleles uas ua rau cov neeg tawv dawb tsis muaj zog thiab 99% hauv Asians. Lwm cov alleles uas cuam tshuam nrog cov roj ntsha uas tsis muaj zog suav nrog CYP2C19 * 4, * 5, * 6, * 7 thiab * 8, tab sis lawv muaj tsawg dua hauv cov pej xeem.

Tsuas tshuaj thiab tswj hwm

Cov neeg laus thiab cov neeg laus laus. Sab hauv, 1 ntsiav tshuaj (75 mg) ib hnub ib zaug, tsis hais txog ntawm cov khoom noj.

Hauv cov neeg mob uas muaj mob hlab ntsha hlwb (ACS) yam tsis muaj kev tiv thaiv kab mob ST (qib siab tsis txaus ntseeg lub hlwb lossis myocardial infarction tsis muaj Q yoj ntawm ECG), Kev kho mob Aterocardium tau pib nrog ib zaug ntawm 300 mg, thiab tom qab ntawd txuas ntxiv nrog koob tshuaj 75 mg ib hnub ib zaug ua ke nrog acetylsalicylic acid ( ASA) ntawm koob tshuaj 75-325 mg ib hnub twg. Txij li thaum siv cov tshuaj ntau dua ntawm ASA ua rau muaj kev pheej hmoo los ntshav, nws raug nquahu kom tsis txhob tshaj li ib koob tshuaj acetylsalicylic acid ntawm 100 mg. Cov sijhawm zoo ntawm kev kho mob tsis tau tsim. Cov txiaj ntsig ntawm cov kev tshawb fawb pom zoo txog kev siv tshuaj ntau dua li 12 lub hlis, thiab cov txiaj ntsig siab tshaj plaws tau pom tom qab kev kho mob 3 lub hlis.

Rau cov neeg mob uas muaj tus kab mob myocardial infarction nrog ST ntu ntawm qhov nce siab, clopidogrel yog tus kws kho mob 75 mg ib hnub ib zaug, pib siv ib zaug ntawm 300 mg sib xyaw nrog ASA, nrog lossis tsis muaj tshuaj thrombotic. Kev kho mob rau cov neeg mob uas muaj hnub nyoog tshaj li 75 xyoos pib siv tsis tau txhaj tshuaj ntawm clopidogrel. Kev sib xyaw ua ke yuav tsum tau pib sai li sai tau tom qab pib ntawm cov tsos mob thiab yuav tsum txuas mus tsawg kawg yog plaub lub lis piam. Cov txiaj ntsig ntawm kev sib xyaw ntawm clopidogrel nrog ASA rau ntau tshaj plaub lub lis piam tsis tau kawm txog tus kab mob no.

Cov Tshuaj Pharmacogenetics. Hauv cov tib neeg uas muaj lub cev tsis muaj zog ntawm CYP2C19, qhov kev txo qis rau kev kho clopidogrel tau pom. Cov tshuaj noj zoo tshaj plaws hauv cov neeg uas muaj cov tshuaj tiv thaiv kab mob uas tsis muaj zog tseem tsis tau tsim.

Tsis hlauv. Cov kev paub ntawm kev siv cov tshuaj nyob rau hauv cov neeg mob uas lub raum tsis ua haujlwm yog txwv. Cov tshuaj yuav tsum tau siv nrog kev ceev faj (saib ntu "Ntu ntawm kev siv").

Daim siab ua haujlwm. Cov kev paub ntawm kev siv cov tshuaj nyob rau hauv cov neeg mob siab mob siab thiab ua tau hemorrhagic diathesis muaj txwv. Cov tshuaj yuav tsum tau siv nrog kev ceev faj (saib ntu "Ntu ntawm kev siv").

Cov lus qhia thiab muab ntau npaum li cas:

Kev tiv thaiv ntawm cov tsos mob atherothrombotic rau cov neeg laus:

Hauv cov neeg mob uas muaj mob ceev txog ntawm txoj hlab ntsha

Cov neeg uas tau myocardial infarction (nws yog ib qho tsim nyog yuav tau pib kho tom qab ob peb hnub, tab sis tsis ntev dua 35 hnub txij li hnub pib mob plawv), ischemic stroke (nws yog qhov yuav tsum tau pib kho tom qab 7 hnub, tab sis tsis ntau tshaj 6 lub hlis tom qab mob hlab ntsha tawg), lossis cov neeg mob uas tau txheeb xyuas cov kab mob ntawm cov hlab ntsha txhaws (atherosclerosis ntawm cov hlab ntsha ntawm qhov qis qis thiab kev puas tsuaj rau cov hlab ntsha)

Hauv cov neeg mob uas tsis muaj ST-ntu nce rau ntawm ECG (myocardial infarction tsis muaj Q yoj los sis tsis khov lub siab), suav nrog cov neeg uas muaj lub stent ntsia thaum lub sijhawm cov ntshav txhaws mob angioplasty, ua ke nrog acetylsalicylic acid

Hauv cov neeg mob uas muaj tus kab mob myocardial infarction, thaum cov kab mob hauv ST tsub ntxiv nrog cov tshuaj acetylsalicylic acid (hauv cov neeg mob tau txais kev kho mob txheem thiab leej twg xav tau kev kho mob thombolytic)

Cov neeg laus thiab cov neeg laus yuav tsum noj 1 ntsiav tshuaj (75 mg) ntawm qhov ncauj ib hnub ib zaug, tsis hais noj zaub mov dab tsi.

Rau cov neeg mob uas muaj tus mob chua leeg mob uas tsis muaj ST ntu nce (myocardial infarction tsis muaj Q yoj los sis tsis khov li lub plawv), qhov chaw thau khoom ntawm 300 mg yog qhov kev kho thaum pib kho.

Tom qab ntawd 1 ntsiav tshuaj (75 mg) yog tshuaj ib hnub ib zaug, ua ke nrog acetylsalicylic acid ntawm kev noj ntau npaum ntawm 75-325 mg / hnub.

Qhov zoo tshaj sijhawm ntawm kev kho mob tsis tau tsim.

Raws li cov txiaj ntsig ntawm kev tshawb fawb, cov txiaj ntsig siab tshaj plaws tau sau tseg tom qab 3 lub hlis los ntawm kev pib kho, thiab cov txiaj ntsig ntawm kev siv tshuaj yeeb yog 12 lub hlis.

Hauv cov neeg mob uas muaj tus kab mob myocardial infarction, uas tus naj npawb ST nce siab tau sau tseg rau hauv ECG, cov tshuaj tau sau tseg ntawm kev noj tshuaj ntawm 75 mg ib hnub ib zaug.

Nws yog ib qho tsim nyog yuav tsum pib noj Aterocardium nrog ib qhov chaw thau khoom ntawm 300 mg hauv kev sib xyaw nrog acetylsalicylic acid.

Kev kho mob ntawm cov neeg mob uas muaj hnub nyoog tshaj li 75 xyoos yuav tsum tau nqa tawm yam uas tsis muaj chaw thau khoom. Kev sib xyaw ua ke ntawm Aterocardium thiab acetylsalicylic acid yuav tsum tau pib tam sim ntawd tom qab pib ntawm cov tsos mob thiab txuas ntxiv rau 4 lub lis piam. Cov txiaj ntsig ntawm kev txais ntev dua tsis tau pov thawj.

Hauv cov neeg mob uas lub cev qeeb ntawm CYP 2C19, qhov lus teb txo qis rau kev kho mob nrog Aterocardium tau sau tseg.

Cov koob tshuaj zoo tshaj plaws rau cov neeg mob zoo li no tseem tsis tau tsim.

Cov kev paub ntawm Aterocardium hauv cov neeg mob raum tsis ua haujlwm yog txwv. Qhia cov tshuaj rau cov neeg no nrog ceev faj.

Tsis tas li ntawd, nrog kev ceev faj, Aterocardium raug kho rau cov neeg mob uas muaj kab mob siab thiab cov neeg muaj kev pheej hmoo ntawm kev mob hemorrhagic diathesis.

Phiv los sis:

Los ntawm cov kab mob ntshav hematopoietic: leukopenia, thrombocytopenia, eosinophilia, neutropenia (suav nrog rau mob hnyav), mob ntsws thrombocytopenic purpura, pancytopenia, ntshav txhaws (suav nrog rau mob aplastic), mob hnyav, mob thrombocytopenia, granulocytopenia, agranulocytosis.

Los ntawm cov hlab plawv system: hematomas, mob ntshav khov, mob ntshav hauv lub plawv, mob vasculitis, los ntshav los ntawm qhov txhab tom qab mob.

Los ntawm lub plab zom mov: raws plab, dyspepsia, mob plab, mob plab zom mov, tso quav, xeev siab, mob plab, ntuav, mob plab, mob plab. Muaj tsawg dua tuaj yeem yog colitis (suav nrog lymphocytic lossis kiav txhab), pancreatitis, stomatitis, plab zom mov thiab retroperitoneal los ntshav nrog lub txiaj ntsig tuag.

Los ntawm daim siab: kab mob siab, mob siab tsis ua haujlwm, tswj tsis tau lub siab ua haujlwm.

Los ntawm sab hauv nruab nrab ntawm lub hauv paus hauv lub paj hlwb: paresthesia, kiv taub hau, mob taub hau, mob ntshav tawm los (qee zaum xaus hauv kev tuag), pom kev, hnov ​​qab kev ntshai, tsis meej pem.

Los ntawm cov khoom hauv lub siab: rov qab, txhaws, mob qhov muag ntshav, kiv taub hau cuam tshuam nrog pathology ntawm pob ntseg lossis labyrinth.

Los ntawm daim tawv nqaij thiab cov nqaij mos subcutaneous: subcutaneous hemorrhage, khaus, purpura, tawv nqaij ua pob, erythematous pob, mob caj dab, mob tawv nqaij daj tawv nqaij mob (Stevens-Johnson syndrome, erythema multiforme, tshuaj lom neeg mob lom hauv lub cev), Lichen planus, eczema, urticaria.

Los ntawm cov kab mob ua pa: txhaws ntswg, ua pa tawm los ntshav (mob ntsws, hemoptysis), mob ntsws interstitial pneumonitis, bronchospasm.

Los ntawm cov leeg musculoskeletal: mob caj dab, hemarthrosis, myalgia, arthralgia.

Los ntawm cov kab mob txeeb zig: hematuria, nce qib ntawm creatinine nyob rau hauv cov ntshav, glomerulonephritis.

Hypersensitivity tshua: anaphylactic kev tsis haum, ntshiab ntshav mob.

Hloov pauv hauv chav ntsuas: qhov txo qis hauv platelet thiab qib neutrophil, nce ntxiv hauv lub sijhawm los ntshav.

Lwm qhov kev phiv: kub taub hau, los ntshav ntawm qhov chaw txhaj tshuaj.

Kev cuam tshuam nrog lwm yam tshuaj thiab dej caw:

Protein Tus Txwv Tshuaj IIb / IIIa. Cov tshuaj yuav tsum tau sau ntawv nrog ceev faj rau cov neeg mob uas muaj kev pheej hmoo los ntshav vim yog kev phais, mob lossis lwm yam mob uas yuav tsum siv protein IIb / IIIa inhibitors.

Nug. ASA tsis cuam tshuam rau inhibitory nyhuv ntawm clopidogrel ntawm ADP-vim platelet aggregation, tab sis clopidogrel ua rau muaj kev cuam tshuam ntawm ASA ntawm platelet aggregation nyob rau hauv kev txiav txim ntawm collagen.

Kev tswj hwm ib txhij ntawm 500 mg ntawm ASA ob zaug hauv ib hnub rau ib hnub tsis ua rau muaj qhov hloov pauv tseem ceeb ntawm lub sijhawm los ntshav. Kev siv tib txhij ntawm Aterocardium thiab ASA yuav tsum ceev faj, vim tias muaj kev pheej hmoo los ntshav.

Qhov ncauj anticoagulants. Vim tias qhov kev pheej hmoo siab los ntshav, qhov sib xyaw ua ke ntawm cov tshuaj tiv thaiv qhov ncauj thiab atherocardia tsis pom zoo.

Heparin. Cov kev tshawb fawb qhia tias kev siv clopidogrel tsis cuam tshuam rau cov nyhuv ntawm heparin thiab tsis xav tau kev hloov kho koob ntawm tus tom kawg. Kev nkag ntawm heparin tsis cuam tshuam rau cov nyhuv ntawm clopidogrel. Tab sis vim tias qhov kev pheej hmoo ntawm los ntshav, kev siv cov tshuaj no ib txhij tsis zoo.

Thrombolytic tus neeg sawv cev. Kev nyab xeeb ntawm kev sib koom tes ntawm Aterocardium, fibrin-specific lossis fibrin-specific thrombolytic cov neeg sawv cev thiab heparin tau kawm hauv cov neeg mob uas muaj myocardial infarction. Qhov ntxim nyiam ntawm kev tsim los ntshav yog tib yam li kev siv cov tshuaj thrombolytic thiab heparin nrog ASA.

NSAIDs. Siv tib lub sij hawm ntawm Aterocardium thiab naproxen nce qhov kev pheej hmoo ntawm txoj hnyuv ntshav tau los ntshav. Tsis muaj ntaub ntawv hais txog kev cuam tshuam ntawm clopidogrel nrog lwm cov tshuaj tsis-steroidal los tiv thaiv.

Ua ke nrog lwm cov tshuaj. Txij li cov nquag metabolite ntawm clopidogrel yog tsim nyob rau hauv qhov kev nqis tes ntawm CYP 2C19, kev siv cov tshuaj uas txo cov kev ua haujlwm ntawm cov enzyme no ua rau txo qis qhov kev cia siab ntawm cov nquag metabolite thiab, yog li ntawd, kom txo qis hauv kev kho mob ntawm Aterocardium. Yog li, nws yog ib qho tsim nyog kom tsis txhob muaj kev tswj hwm ntawm Aterocardium thiab tshuaj siv uas cuam tshuam rau kev ua haujlwm ntawm CYP 2C19. Cov tshuaj no suav nrog: esomeprazole, omeprazole, fluoxetine, fluvoxamine, moclobemide, voriconazole, ticlopidine, fluconazole, ciprofloxacin, carbamazepine, cimetidine, chloramphenicol thiab oxcarbazepine.

Proton twj tso kua mis inhibitors.

Nws yog qhov tseeb tias qhov degree ntawm inhibition ntawm CYP 2C19 enzyme nyob rau hauv kev nqis tes ua los ntawm cov tshuaj los ntawm cov pab pawg ntawm cov twj tso kua mis tshuaj tiv thaiv tsis yog tib yam. Cov ntaub ntawv niaj hnub no qhia tau tias tseem muaj peev xwm cuam tshuam ntawm Aterocardium thiab ib qho ntawm cov tshuaj hauv pab pawg no. Tsis muaj pov thawj txaus ntseeg tau hais tias lwm cov tshuaj uas txo cov khoom tsim cov kua qaub (antacids, H2 blockers) cuam tshuam rau cov nyhuv antiplatelet ntawm Aterocardium.

Kev siv tshuaj sib txuas ntawm Aterocardium nrog atenolol thiab nifedipine tsis hloov pauv kev ua haujlwm zoo ntawm cov tshuaj no. Ntxiv rau, cov chaw muag tshuaj ntawm clopidogrel tseem tsis hloov thaum siv nrog cimetidine, digoxin, theophylline, estrogen, thiab phenobarbital.

Antacids tsis cuam tshuam rau kev nqus ntawm clopidogrel.

Cov kev tshawb fawb qhia tias carbonyl derivatives ntawm clopidogrel tuaj yeem tiv thaiv kev ua haujlwm ntawm cytochrome P450 2C9. Muaj peev xwm, qhov no yuav ua rau muaj kev nce plasma ntau ntawm NSAIDs, tolbutamide thiab phenytoin, cov metabolism hauv uas tshwm sim nyob rau hauv kev cuam tshuam ntawm cytochrome P450 2C9. Tab sis kev tshawb fawb tshawb pom qhia tau tias tolbutamide thiab phenytoin tuaj yeem tiv thaiv nrog atherocard yam xyuam xim.

Tsis muaj kev sib cuam tshuam hauv chaw kho mob tau pom nyob nruab nrab ntawm Aterocardium thiab beta-adrenergic blockers, diuretics, calcium channel blockers, ACE inhibitors, antacids, antidiabetic, antiepileptic, antiepileptic, anti-cholesterol-txo tshuaj, thiab kev hloov tshuaj hormone kho qis III antagonists.

Muaj pes tsawg leeg thiab lub zog:

1 ntsiav tshuaj muaj:

Clopidogrel 75 mg

Ntu cov khoom siv: microcrystalline cellulose, magnesium stearate, lactose monohydrate, pregelatinized hmoov txhuv nplej siab, polyethylene glycol 6000, povidone K 25, liab hlau oxide (E 172)

Cov khoom siv tseem ceeb - clopidogrel - xaiv kev tiv thaiv qhov khi ntawm ADP rau cov chaw txais ntawm platelets thiab kev ua haujlwm tom qab ntawm GPIIb / IIIa complexes nyob rau hauv kev cuam tshuam ntawm ADP, uas ua rau inhibition of platelet aggregation.

Kev txwv tsis pub platelet aggregation ntxias los ntawm lwm cov agonists kuj tshwm sim los ntawm kev thaiv qhov nce hauv platelet kev ua haujlwm los ntawm kev tso tawm ADP thiab kev hloov pauv tsis yooj yim platelet ADP receptors.

Platelets uas tau sib cuam tshuam nrog clopidogrel hloov txoj kev hloov kho kom txog rau thaum kawg ntawm lawv lub neej.

Platelet muaj nuj nqi rov qab zoo li qub tom qab lub sijhawm xav tau rov ua dua tshiab ntawm cov ntshav.

Txij thawj hnub ntawm kev siv rau hauv cov rov qab noj ntau dua ntawm 75 mg ntawm cov tshuaj, qhov tseem ceeb ntawm ADP-ntxias cov platelet aggregation tau sau cia.

Cov nyhuv no hloov zuj zus, txhim kho lub sij hawm nyob rau hnub 3 thiab 7 hnub ntawm kev kho mob.

Qib nruab nrab ntawm kev txwv tsis pub suav nrog nyob rau hauv qhov kev txiav txim ntawm qhov ntau npaum ntawm 75 mg ntawm lub xeev ruaj khov yog 40-60%.

Lub sijhawm ua los ntshav thiab tus lej ntawm cov ntshav platelet rov qab los rau hauv qhov chaw nruab nrab 5 hnub tom qab kev kho tiav.

Tom qab qhov ncauj tswj hwm ntawm cov tshuaj hauv qhov ntau npaum ntawm 75 mg, kev nqus sai hauv cov hnyuv tshwm sim. Tsom ntswm cov ntshav plasma ntau ntawm tsis hloov pauv clopidogrel (hauv qhov siab ntawm 2.2-2.5 ng / ml tom qab ib qho ncauj ntawm 75 mg ntawm cov tshuaj) tau mus txog 45 feeb tom qab noj Aterocardium.

Kev nqhis ntawm clopidogrel nrog zis qhia tau hais tias kev nqus ntawm cov khoom nquag yog tsawg kawg 50%.

Hauv kev sim tshuaj hauv vitro, clopidogrel thiab nws lub cev tsis muaj zog ntawm cov ntshav plasma reversibly khi rau cov protein, qhov kev sib txuas no tau ceev nws qhov kev tsis txaus siab ntawm ntau qhov ntau.

Lub cev metabolism ntawm clopidogrel yog nqa tawm hauv lub siab. Hauv vivo thiab hauv vitro muaj ob txoj hauv kev cov metabolism.

Thawj kis nrog kev koom tes ntawm esterases, ua rau hydrolysis nrog kev tsim ntawm ib puag ncig carboxylic acid derivative (qhov sib xyaw no ua kom 85% ntawm tag nrho cov metabolites hauv cov ntshav).

Qhov thib ob ntawm txoj kev zom zaubmov yog ua nrog kev koom tes ntawm cytochrome P450 enzyme system.

Ua ntej, qhov nruab nrab metabolite 2-oxo-clopidogrel yog tsim los ntawm clopidogrel, uas tom qab ntawd hloov mus ua ib qho nquag metabolite (thiol derivative). Kev nquag metabolite cais nyob rau hauv vitro sai sai thiab cuam tshuam nrog lub platelet receptor apparatus, uas cuam tshuam rau platelet aggregation.

Li ntawm 50% ntawm cov koob tshuaj muab rau hauv cov zis thiab li 46% nrog quav thaum tom qab 120 teev. Ib nrab-lub neej ntawm ib koob tshuaj yog 6 teev.

Ib nrab-lub neej ntawm lub cev tsis muaj zog metabolite yog 8 teev (ob qho tib si tom qab ib zaug thiab tom qab rov ua dua).

Coated ntsiav tshuaj 75 mg No. 10, 40.

Nyob rau qhov kub thiab txias tsis tshaj 25 degrees Celsius hauv cov ntawv ntim thawj.

Cov chaw muag tshuaj

Clopidogrel xaiv yam tshuaj tiv thaiv qhov khi ntawm adenosine diphosphate (ADP) mus rau qhov chaw txais tshuaj ntawm platelet nto thiab kev ua haujlwm tom qab ntawm GPIIb / IIIa complex los ntawm ADP thiab yog li inhibits platelet aggregation. Clopidogrel tseem ua rau platelet sib sau ua ke los ntawm lwm tus agonists los ntawm kev thaiv qhov nce hauv platelet kev ua haujlwm los ntawm kev tso tawm ADP thiab tsis tuaj yeem hloov kho platelet ADP receptors. Platelets uas tau sib cuam tshuam nrog clopidogrel hloov mus txog thaum kawg ntawm lawv lub neej kev ua haujlwm. Lub platelet muaj nuj nqi li qub tau rov qab los ntawm tus nqi sib haum rau tus nqi ntshav txuas txuas ntxiv.

Txij thawj hnub ntawm kev tswj hwm hauv kev rov ua dua txhua hnub ntawm 75 mg, qhov tseem ceeb qeeb ntawm ADP-vim platelet aggregation tshwm sim. Qhov kev ua no zuj zus zuj zus thiab ruaj khov ntawm 3 thiab 7 hnub. Thaum ruaj khov, qhov nruab nrab ntawm kev tsis sib xyaw ntawm kev sib xyaw nyob hauv qab ntawm kev noj tshuaj hauv ib hnub ntawm 75 mg yog los ntawm 40% txog 60%. Platelet sib sau thiab lub caij los ntshav rov qab los rau hauv qhov chaw nruab nrab 5 hnub tom qab tsis kho.

Tom qab qhov ncauj tswj hwm ntawm ib koob tshuaj 75 mg, nws yog sai sai los ntawm cov hnyuv.

Qhov siab tshaj plaws ntshav plasma concentration ntawm tsis hloov pauv clopidogrel (txog 2.2-2.5 ng / ml tom qab ib koob ntawm 75 mg ntawm qhov ncauj) tau kwv yees kwv yees li 45 feeb tom qab thov. Kev nqus yog tsawg kawg yog 50%, raws li qhia los ntawm kev nthuav tawm ntawm clopidogrel metabolites hauv cov zis. Clopidogrel thiab qhov tseem ceeb (tsis voos) metabolite ncig hauv cov ntshav hauv vitro thim rov qab rau tib neeg cov ntshav plasma (98% thiab 94%, feem).

Qhov ntawv cog lus no tseem nyob ntev hauv vitro dhau ntawm ntau qhov ntau.

Clopidogrel muaj ntau heev nyob rau hauv lub siab. Nyob rau hauv vitro thiab hauv vivo, muaj ob txoj hauv kev ntawm nws cov metabolism: ib qho tshwm sim nrog kev koom tes ntawm esterases thiab ua rau hydrolysis nrog kev tsim cov tsis muaj zog ntawm cov carboxylic acid (uas suav txog 85% ntawm tag nrho cov metabolites hauv cov ntshav ntshav), thiab cov enzymes ntawm cytochrome P450 koom nrog lwm qhov Cov.

Ua ntej, clopidogrel tau hloov pauv mus rau hauv theem nrab ntawm 2-oxo-clopidogrel. Raws li kev txuas ntxiv ntawm cov metabolism hauv 2-oxo-clopidogrel, thiol derivative, ib qho kev hloov pauv ntawm lub cev, raug tsim. Hauv cov vitro, cov kab mob metabolic no tau kho kom haum los ntawm cov enzymes CYP3A4, CYP2C19, CYP1A2, thiab CYP2B6. Cov nquag metabolite ntawm clopidogrel, uas tau muab cais tawm hauv vitro, sai thiab tsis tuaj yeem khi rau platelet receptors, yog li inhibiting platelet aggregation.

120 teev tom qab noj, kwv yees li 50% ntawm cov koob tau tso tawm hauv cov zis thiab 46% nrog quav. Tom qab qhov ncauj tswj hwm ntawm ib koob tshuaj, ib nrab lub neej ntawm clopidogrel yog kwv yees li 6:00. Ib nrab-lub neej ntawm qhov tseem ceeb (tsis voos) metabolite ncig hauv cov ntshav yog 8:00 tom qab ib zaug thiab rov qab siv cov tshuaj.

Cov Tshuaj Pharmacogenetics. Ob peb cov polymorphic CYP450 cov enzymes hloov clopidogrel rau hauv kev siv cov khoom ua rau lub cev, ua kom lub cev muaj zog. CYP2C19 koom nrog kev tsim ntawm ob qho tib si ntawm kev siv hluav taws xob thiab kev sib xyaw ua ke ntawm 2-oxo-clopidogrel. Cov chaw muag tshuaj ntawm cov nquag metabolite thiab cov tshuaj tiv thaiv antiplatelet, raws li kev ntsuas ntawm platelet kev sib xyaw, sib txawv raws CYP2C19 caj ces. CYP2C19 * 1 lub suab sib txuam nrog cov roj ntsha uas ua haujlwm tau zoo, thaum lub CYP2C19 * 2 thiab CYP2C19 * 3 alleles sib raug rau cov metabolism hauv kev ua kom tsis muaj zog. Tag nrho cov alleles tau lav rau 85% ntawm alleles, ua kom txoj haujlwm tsis muaj tawv dawb thiab 99% hauv Asians. Lwm cov alleles uas cuam tshuam nrog cov roj ntsha uas tsis muaj zog suav nrog CYP2C19 * 4, * 5, * 6, * 7 thiab * 8, tab sis lawv muaj tsawg dua hauv cov pej xeem.

Kev tiv thaiv kab mob atherothrombosis rau cov neeg laus

• hauv cov neeg mob uas tau mob myocardial infarction (kev pib kho yog ob peb hnub, tab sis tsis pub dhau 35 hnub tom qab pib), ischemic stroke (pib kho yog 7 hnub, tab sis tsis pub dhau 6 lub hlis tom qab pib) lossis tus neeg tau kuaj nrog peripheral arteries (puas rau cov hlab ntsha thiab atherothrombosis ntawm cov hlab ntsha ntawm qhov qis qis dua),
• nyob rau hauv cov neeg mob uas muaj mob rau cov hlab ntshav siab:

̶ nrog mob txha caj qaum mob plawv yam tsis muaj ST ntu kab mob siab (tsis ruaj khov angina lossis myocardial infarction tsis muaj Q yoj), suav nrog rau cov neeg mob uas muaj lub cev tsis chwv thaum mob caj dab mob txha caj qaum, nrog rau acetylsalicylic acid (ASA)

̶ mob siab myocardial infarction nrog rau kev nce qib hauv ntu hauv ST nrog kev sib xyaw nrog acetylsalicylic acid (hauv cov neeg mob tau txais cov qauv tshuaj thiab cov uas pom muaj kev kho thrombolytic).

Kev tiv thaiv ntawm atherothrombotic thiab thromboembolic cov xwm txheej hauv atrial fibrillation. Clopidogrel nyob rau hauv kev sib xyaw nrog ASA yog qhia hauv cov neeg laus uas muaj atrial fibrillation, uas muaj tsawg kawg yog ib qho kev pheej hmoo rau kev tshwm sim ntawm vascular cov xwm txheej, uas muaj contraindications rau kev kho mob nrog vitamin K antagonists (AVK) thiab uas muaj kev pheej hmoo tsawg los ntshav, rau kev tiv thaiv atherothrombotic thiab thromboembolic cov xwm txheej. suav nrog mob stroke. Saib hauv ntu "Cov yam ntxwv ntawm lub tsev muag tshuaj".

Yeeb tshuaj sib cuam tshuam

Nws tsis pom zoo kom los ua ke nrog Aterocardium txoj kev kho nrog lub qhov ncauj tiv thaiv kev tiv thaiv vim tias qhov kev hem thawj ntawm kev nce ntshav ntxiv.

Kev sib cuam tshuam muaj peev xwm nrog kev siv thooj txhij ntawm clopidogrel nrog lwm yam tshuaj muaj txiaj ntsig / kev npaj:

• cov tshuaj tsis haum tshuaj (nrog rau COX-2 inhibitors), ASA, protein IIb / IIIa inhibitors, cov tshuaj thrombolytic, heparin: tseem muaj peev xwm los ntshav (siv clopidogrel nrog ceev faj nrog txoj kev sib xyaw no),
• fluconazole, fluoxetine, omeprazole, moclobemide, esomeprazole, voriconazole, carbamazepine, ticlopidine, chloramphenicol, ciprofloxacin, fluvoxamine, oxcarbazepine, cimetidine (cov tshuaj uas txwv cov kev ua haujlwm ntawm CYP2C19 txo, nws plam cov plasma metabolism, ua kom cov plua plav metabolism tsawg, ua kom cov plasma metabolism tsawg, ua rau nws txo qis, ua kom cov plasma metabolism tsawg.
• proton twj tso kua mis inhibitors: kev sib cuam tshuam muaj peev xwm ua tau, yog li ntawd, cov kev sib txuas no tsis pom zoo, tsuas yog thaum nws tseem ceeb,
• cov tshuaj uas metabolized siv cytochrome P450 2C9: nws muaj peev xwm nce qib ntawm cov tshuaj no hauv ntshav (nrog rau tolbutamide thiab phenytoin, uas muaj kev nyab xeeb siv nrog Aterocardium),
• atenolol, nifedipine, estrogen, cimetidine, phenobarbital, theophylline, antacids, digoxin, diuretics, ACE inhibitors (angiotensin-hloov enzyme), beta-blockers, calcium channel blockers, antiepileptic, hypocholesterolemic thiab lwm yam tshuaj. nthuav dav cov hlab ntsha, GPIIb / IIIa cov thaiv kev ua haujlwm, kev hloov tshuaj kho cov tshuaj hormones: tsis muaj kev cuam tshuam tseem ceeb hauv thaj chaw tau sau tseg.

Cov tshuaj ntawm Aterocardium yog: Clopidogrel, Plavix, Aspirin Cardio, Dipyridamole.

Sab sij huam

hematoma, muaj tsawg heev

nquag - mob ntshav siab los ntshav, los ntshav los ntawm kev ua haujlwm zoo, vasculitis, ntshav hlab ntaws,

los ntawm lub plab zom mov: muaj ntau - mob plab, raws plab, dyspepsia, mob plab zom mov, tsis tshua muaj tshwm sim - xeev siab, cem quav, mob plab thiab duodenal mob rwj, mob plab, ntuav, plab, tsis tshua muaj tshwm sim - los ntshav retroperitoneal, tsis tshua muaj tshwm sim - pancreatitis, colitis (suav nrog rau ulcerative los yog lymphocytic), ua kom lub plab zom mov thiab retroperitoneal los ntshav, stomatitis,

los ntawm cov kab mob hepatobiliary: muaj tsawg kawg - mob siab ua haujlwm siab, kab mob siab, ua kom lub siab ua kom tsis zoo ntawm kev kuaj ntshav,

los ntawm lub hauv nruab nrab hauv cov hlab ntsha hauv lub cev: tsis muaj tshwm sim - mob taub hau, mob taub hau, dias taub hau, mob ntshav hauv ntshav (qee qhov, ua rau neeg tuag taus), tsis tshua muaj tshwm sim - tsis meej pem, pom kev tsis hnov ​​tsw, hnov ​​qab kev cuam tshuam,

los ntawm cov kev paub ntawm cov kabmob: tsis muaj tshwm sim - qhov muag ntshav

(kev sib txuam, tawv nqaij, rov qab), tsis tshua muaj tshwm sim - kiv taub hau (pathology ntawm pob ntseg thiab labyrinth),

nyob rau ntawm daim tawv nqaij thiab cov nqaij mos subcutaneous: hom - subcutaneous hemorrhage, tsis-nquag - tawv nqaij ua pob khaus, khaus, purpura, tsis tshua muaj tshwm sim - mob hlwb, mob pob khaus, ua pob ua paug, mob ua paug (mob ua paug rau cov leeg ntshav, Stevens-Johnson mob, erythema multiforme, kraemia), lichen planus

los ntawm cov kab mob ua pa: feem ntau - ntswg, tsis tshua muaj tshwm sim - ua pa los ntshav (hemoptysis, mob ntsws), mob ntsws, mob ntsws, ua mob rau daim tawv nqaij,

los ntawm cov musculoskeletal system: tsis tshua muaj tshwm sim - hemarthrosis, mob caj dab, mob pob txaws, mob myalgia,

los ntawm cov kab mob txeeb zis: tsis-siv tau - hematuria, tsis tshua muaj neeg pom - glomerulonephritis, muaj ntau ntxiv creatinine hauv cov ntshav,

Kev tshuaj tiv thaiv kev tsis haum lub cev tau tshwm sim, feem ntau tsis tshua pom tshwm sim - muaj mob hnyav, anaphylactic kev hloov,

kev ntsuas ntsuas: tsis muaj ntau - ncua ntev ntawm lub sijhawm los ntshav, txo qis hauv qib neutrophils thiab platelets,

lwm tus: nquag - los ntshav ntawm thaj chaw txhaj tshuaj, feem ntau tsis tshua muaj tshwm sim - ua npaws.

Kev sib cuam tshuam nrog lwm yam tshuaj thiab lwm yam kev sib cuam tshuam

Qhov ncauj anticoagulants. Kev siv yooj yim nrog clopidogrel tsis pom zoo, vim tias muaj kev pheej hmoo ntawm ntshav nce ntxiv.

Inhibitors ntawm glycoprotein IIb, / IIIA. Aterocardium yuav tsum siv nrog ceev faj hauv cov neeg mob uas muaj kev pheej hmoo los ntshav ntau vim los ntawm kev raug mob, phais lossis lwm yam kab mob pathological uas glycoprotein IIb, IIAa inhibitors siv ib txhij.

Acetylsalicylic acid (ASA). ASA tsis hloov pauv qhov tshwm sim ntawm clopidogrel ntawm ADP-vim platelet aggregation, tab sis clopidogrel ua rau kom muaj kev cuam tshuam ntawm ASA rau ntawm collagen-induced platelet aggregation. Txawm li cas los xij, kev siv ib txhij ntawm 500 mg ntawm ASA 2 zaug hauv ib hnub rau 1 hnub tsis ua rau muaj kev cuam tshuam ntau ntxiv rau lub sijhawm los ntshav, txuas ntxiv vim kev siv clopidogrel. Txij li kev cuam tshuam ntawm clopidogrel thiab acetylsalicylic acid yog ua tau nrog kev pheej hmoo los ntshav ntau ntxiv, kev siv cov tshuaj no ib txhij yuav tsum ceev faj. Dua li ntawm qhov no, clopidogrel thiab ASA tau siv ua ke ntev txog 1 xyoos.

Heparin. Raws li kev tshawb nrhiav, clopidogrel tsis xav tau kev hloov kho koob tshuaj rau tus mob heparin thiab tsis hloov pauv qhov tshwm sim ntawm heparin ntawm kev coagulation. Kev siv txhij ib txhij ntawm heparin tsis hloov pauv qhov cuam tshuam ntawm clopidogrel ntawm platelet aggregation. Txij li kev cuam tshuam ntawm clopidogrel thiab heparin muaj peev xwm ua tau nrog kev pheej hmoo ntawm los ntshav ntau, siv ib txhij ceev faj.

Thrombolytic tus neeg sawv cev. Kev nyab xeeb ntawm kev siv tib txhij ntawm clopidogrel, fibrin-specific lossis fibrin-specific thrombolytic cov neeg sawv cev thiab heparin tau tshawb xyuas hauv cov neeg mob uas muaj myocardial infarction. Qhov ntau zaus los ntshav tseem ceeb ntawm kev kuaj ntshav tau zoo ib yam li tau pom nrog kev siv cov tshuaj thrombolytic thiab heparin nrog ASA.

Nonsteroidal anti-inflammatory tshuaj (NSAIDs). Kev siv tib txhij ntawm clopidogrel thiab naproxen tuaj yeem ua rau kom ntau ntxiv latent gastrointestinal los ntshav. Txawm li cas los xij, thaum tsis muaj ntaub ntawv hais txog kev cuam tshuam ntawm kev siv yeeb tshuaj nrog lwm cov NSAIDs, nws tseem tsis tau meej meej lossis tsis muaj kev pheej hmoo los ntshav thaum siv nrog txhua NSAIDs. Yog li, kev ceev faj yog qhov tsim nyog thaum siv NSAIDs, tshwj xeeb COX-2 inhibitors, nrog clopidogrel.

Ua ke nrog lwm cov tshuaj.

Txij li thaum clopidogrel hloov mus rau hauv nws cov nquag metabolite ib feem nyob rau hauv kev cuam tshuam ntawm CYP2C19, kev siv cov tshuaj uas txo cov kev ua haujlwm ntawm cov enzyme no tuaj yeem ua rau txo qis ntawm cov tshuaj lom neeg ntawm cov metabolite ntawm clopidogrel hauv ntshav plasma, nrog rau kev txo qis hauv kev kho mob. Kev siv ib txhij rau cov tshuaj uas thaiv qhov kev ua si ntawm CYP2C19 yuav tsum zam.

Cov tshuaj uas tiv thaiv kev ua si ntawm CYP2C19 suav nrog omeprazole, esomeprazole, fluvoxamine, fluoxetine, moclobemide, voriconazole, fluconazole, ticlopidine, ciprofloxacin, cimetidine, carbamazepine, oxcarbazepine thiab chloramphenicol.

Proton twj tso kua mis inhibitors. Txawm hais tias cov ntaub ntawv pov thawj pom tau hais tias qhov kev txwv ntawm kev cuam tshuam ntawm CYP2C19 kev ua raws li kev txiav txim siab ntawm ntau yam tshuaj muaj feem rau cov chav kawm ntawm cov tshuaj tiv thaiv proton twj tso kua mis tsis zoo li qub, muaj pov thawj qhia txog qhov muaj peev xwm cuam tshuam nrog yuav luag txhua cov tshuaj ntawm chav kawm no. Yog li ntawd, kev siv tib txhij ntawm cov twj tso kua mis proton twj tso kua mis yuav tsum zam, tshwj tsis yog tsim nyog siv kiag li. Tsis muaj pov thawj ntxiv tias lwm cov tshuaj uas txo cov kua qaub hauv lub plab, xws li, piv txwv li, H 2 blockers (tshwj tsis yog cimetidine, uas yog CYP2C9 inhibitor) lossis antacids, cuam tshuam rau cov haujlwm antiplatelet ntawm clopidogrel.

Raws li cov txiaj ntsig ntawm cov kev tshawb fawb, tsis muaj kev cuam tshuam loj hauv kev kho mob tau qhia nrog kev siv clopidogrel ib txhij nrog atenolol, nifedipine, lossis nrog ob qho tshuaj. Tsis tas li ntawd, pharmacodynamic kev ua haujlwm ntawm clopidogrel tseem tsis hloov pauv thaum siv nrog phenobarbital thiab estrogen.

Cov chaw muag tshuaj ntawm digoxin lossis theophylline tsis hloov pauv thaum siv clopidogrel. Antacids tsis cuam tshuam rau kev nqus ntawm clopidogrel.

Cov ntaub ntawv tshawb fawb qhia tau tias cov carboxyl metabolites ntawm clopidogrel tuaj yeem tiv thaiv kev ua si ntawm cytochrome P450 2C9. Qhov no tuaj yeem ua rau plasma theem ntawm phenytoin, tolbutamide thiab NSAIDs, uas yog cov metabolized los ntawm cytochrome P450 2C9. Dua li ntawm qhov no, qhov tshwm sim ntawm cov kev tshawb fawb pom tias phenytoin thiab tolbutamide tuaj yeem siv tau nyab xeeb ib txhij nrog clopidogrel.

Muaj tsis muaj kev sib cuam tshuam hauv cov chaw kho mob nrog diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, cov tshuaj tiv thaiv uas ua rau cov hlab ntsha hlab ntsha, antacids, hypoglycemic (suav nrog insulin), hypocholesterolemic, antiepileptic tshuaj, GPIIb / IIIa antagonists, thiab antagonists ntawm GPIIb / IIIa.

Daim ntawv thov nta

Los ntshav thiab mob ntshav tsis xis nyob. Vim tias txoj kev pheej hmoo ntawm los ntshav thiab hematological tshwm sim, ib qho kev kuaj ntshav ntxiv thiab / lossis lwm yam kev kuaj mob tsim nyog yuav tsum tau nqa tawm tam sim ntawd yog tias pom cov tsos mob los ntshav pom thaum lub sijhawm siv cov tshuaj (saib

Yog tias tau npaj los ntawm kev phais mob, ib ntus yuav tsum siv cov tshuaj antiplatelet, kev kho mob nrog clopidogrel yuav tsum tau tsum txiav 7 hnub ua ntej kev phais mob. Cov neeg mob yuav tsum qhia rau tus kws kho mob (suav nrog tus kws kho hniav) tias lawv siv clopidogrel, ua ntej ib qho kev phais twg tau siv, lossis ua ntej siv cov tshuaj tshiab. Clopidogrel ncua sijhawm ntev los ntshav, yog li nws yuav tsum tau siv nrog ceev faj hauv cov neeg mob uas muaj kev pheej hmoo los ntshav ntau (tshwj xeeb yog plab hnyuv tws thiab ntshav ntawm nplooj siab).

Cov neeg mob yuav tsum tau ceeb toom tias thaum kho tus mob clopidogrel (ib leeg lossis ua ke nrog ASA), kev los ntshav yuav tso tseg lig dua li ib txwm, thiab hais tias lawv yuav tsum qhia tus kws kho mob txog txhua kis tsis txawv (ntawm chaw lossis sijhawm) los ntshav.

Ua kom pom cov kab mob thrombocytopenic purpura (TTP). Cov xwm txheej ntawm thrombotic thrombocytopenic purpura (TTP) tsis tshua pom muaj tom qab clopidogrel tswj hwm, qee zaum txawm tias tom qab nws siv sijhawm luv. TT tshwm sim los ntawm kev mob ntsws thrombocytopenia thiab microangiopathic hemolytic anemia nrog cov leeg hlwb, lub raum tsis ua haujlwm, lossis ua npaws. TTP yog ib qho muaj mob txaus ntshai uas tuaj yeem ua rau neeg tuag taus, thiab yog li ntawd xav tau kev kho mob sai, suav nrog plasmapheresis.

Nrhiav Hemophilia. Cov kab mob ntawm kev txhim kho cov kev ua mob hemophilia tom qab siv cov tshuaj clopidogrel tau tshaj tawm. Nyob rau hauv cov xwm txheej ntawm paub tseeb cais nce nyob rau hauv APTT (ua kom lub sij hawm thromboplastin lub sijhawm), uas yog nrog los yog tsis nrog los ntshav, cov lus nug ntawm kev kuaj mob nrhiav hemophilia yuav tsum tau txiav txim siab. Cov neeg mob uas kuaj pom tias tus mob hemophilia yuav tsum yog kev saib xyuas ntawm tus kws kho mob thiab tau txais kev kho mob, kev siv clopidogrel yuav tsum tsis ua mus ntxiv.

Nyuam qhuav raug mob ischemic mob stroke. Vim tias cov ntaub ntawv tsis txaus, nws tsis pom zoo kom sau ntawv rau clopidogrel hauv thawj 7 hnub tom qab muaj mob stroke ischemic mob.

Cytochrome P450 2 C19 (CYP2C19). Pharmacogenetics Hauv cov neeg mob uas txo cov kev ua haujlwm ntawm CYP2C19, muaj qis qis ntawm lub cev sib xyaw ntawm clopidogrel hauv cov ntshav ntshav thiab tsis tshua muaj cov nyhuv antiplatelet. Tam sim no muaj kev tshuaj ntsuam kom paub tus cim CYP2C19 noob qes nyob rau hauv tus neeg mob.

Txij li thaum clopidogrel hloov mus rau hauv nws cov nquag metabolite ib feem nyob rau hauv kev cuam tshuam ntawm CYP2C19, kev siv cov tshuaj uas txo cov kev ua haujlwm ntawm cov enzyme no yuav ua rau txo qis hauv kev ua kom muaj zog ntawm cov nquag metabolite ntawm clopidogrel hauv ntshav ntshav. Txawm li cas los xij, kev kho mob tseem ceeb ntawm qhov kev sib txuam no tsis tau elucidated. Yog li ntawd, kev ntsuas yog cais tawm ntawm kev siv tib lub sijhawm muaj zog thiab tsis sib xws CYP2C19 inhibitors (saib

Cross-reactivity ntawm thienopyridines. Tus neeg mob cov keeb kwm txog kev tiv thaiv tsis haum rau lwm cov thienopyridines (xws li ticlopidine, prasugrel) yuav tsum tau kuaj xyuas vim tias muaj cov lus qhia hais txog kev tsis haum khaub thuas ntawm cov thienopyridines (saib ntu “Cov kev tsis haum”). Kev siv ntawm thienopyridines tuaj yeem ua rau ua rau muaj kev tsis haum ntawm cov mob sib khuav ntawm mob sib khuav xwb xws li pob xoo, Quincke's edema, lossis hematological tshua xws li thrombocytopenia thiab neutropenia. Cov neeg mob uas muaj keeb kwm ua xua thiab / lossis hematological tsis haum rau ib qho thienopyridine yuav muaj kev pheej hmoo ntawm kev tsim kom zoo ib yam lossis txawv dua lwm tus thienopyridine. Kev tshuaj xyuas kev tiv thaiv kab mob tau pom zoo.

Lub raum khiav tsis zoo. Txoj kev kho kom zoo ntawm kev siv clopidogrel hauv cov neeg mob uas lub raum tsis ua haujlwm yog tsawg, yog li, cov neeg mob zoo li no yuav tsum tau muab cov tshuaj nrog ceev faj (saib Ntu "Kev Noj Tshuaj thiab Txoj Cai Tswj Xyuas").

Lub siab ua haujlwm tsis zoo. Cov kev paub ntawm kev siv cov tshuaj hauv cov neeg mob uas muaj kab mob hauv lub siab thiab kev txaus siab hemorrhagic diathesis tsuas yog muaj tsawg, yog li, cov neeg mob zoo li no yuav tsum raug kho clopidogrel nrog kev ceev faj (saib Ntu "Kev Noj Tshuaj thiab Kev Tswj Xyuas").

Tshwjxeeb. Aterocardium muaj lactose. Cov neeg mob uas tsis tshua muaj cov mob muaj keeb xws li galactose intolerance, Lapp lactase deficiency los yog cuam tshuam cov piam thaj-galactose malabsorption yuav tsum tsis txhob siv cov tshuaj no.

Siv thaum cev xeeb tub lossis lactation

Vim tias tsis muaj cov ntaub ntawv tshawb fawb txog kev siv clopidogrel thaum cev xeeb tub, cov tshuaj yuav tsum tsis txhob raug rau cov poj niam cev xeeb tub (raws li kev ceev faj). Cov kev sim tsiaj tsis tau qhia txog qhov tsis zoo ntawm clopidogrel ntawm kev xeeb tub, kev yug menyuam / tus menyuam hauv plab, kev yug menyuam thiab kev loj hlob tom qab.

Kuj tsis paub meej tias clopidogrel ua rau niam mis tso. Cov kev tshawb fawb tsiaj pom tias nws tau tawm hauv niam mis, yog li kev pub mis rau menyuam yuav tsum tsis pub mus ntxiv thaum kho cov tshuaj.

Cuam Tshuam. Thaum lub sij hawm kev tshawb fawb hauv chav kuaj tsiaj, tsis muaj qhov tshwm sim tsis zoo ntawm clopidogrel ntawm kev muaj menyuam hauv plab tau kuaj pom.

Noj ntau dhau

Cov tsos mob: lub sijhawm ntev los ntshav nrog cov mob hauv qab no.

Txoj kev kho yog mob. Yog tias tsim nyog, kev kho sai ntawm lub sijhawm los ntshav ntev ntev, cov nyhuv ntawm cov tshuaj tuaj yeem tshem tawm los ntawm kev hloov ntshav ntawm platelet pawg. Qhov tshuaj tiv thaiv kab mob ntawm kev ua haujlwm ntawm clopidogrel tsis paub txog.

Kev phiv tshuaj

Ntawm ib feem ntawm cov ntshav thiab cov kab mob lymphatic: thrombocytopenia, leukopenia, eosinophilia, neutropenia, suav nrog neutropenia, mob thrombotic thrombocytopenic purpura (TTP) (saib ntu "Peculiarities ntawm kev siv"), aplastic anemia, pancytopenia, agranulocytia, agranulocytia granulocytopenia, anemia.

Los ntawm ib sab hauv lub cev tiv thaiv kab mob: mob ntshav hauv ntshav, anaphylactoid tshua, hla kev tiv thaiv kab mob ntawm thienopyridines (xws li ticlopidine, prasugrel) (saib

Los ntawm sab hauv ntawm cov hlab ntsha hauv plab: txhaws ntshav hauv ntshav (qee qhov - tuag taus), mob taub hau, mob caj dab, kiv taub hau, hloov pauv hauv kev saj.

Los ntawm sab ntawm cov khoom hauv nruab nrog ntawm lub zeem muag: los ntshav hauv thaj chaw qhov muag (pom pob, tsom iav, pob txha).

Ntawm ib feem ntawm cov plab hnyuv siab raum ntawm kev hnov ​​thiab sib npaug: kiv taub hau.

Los ntawm cov kab mob vascular: hematoma, mob ntshav siab, los ntshav los ntawm kev phais mob, vasculitis, hlab ntsha hypotension.

Los ntawm kev mob plab hnyuv: ua rau lub plab zom mov, mob plab, mob plab, mob plab, mob plab, mob plab, mob plab, ntuav, xeev siab, cem quav, mob plab, retroperitoneal hemorrhage, gastrointestinal thiab retroperitoneal hemorrhage, mob plab, mob plab. (hauv kev tshwj xeeb, mob rwj lossis mob lymphocytic), mob plab.

Los ntawm lub plab zom mov: mob lub siab ua haujlwm, kab mob siab, ua haujlwm tsis txaus siab ntawm daim siab kev ua haujlwm.

Nyob rau ntawm daim tawv nqaij thiab cov nqaij mos subcutaneous: subcutaneous hemorrhage, tawm pob, pruritus, intradermal hemorrhage (purpura), tawv nqaij dermatitis (mob ua paug epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme), angioneurotic edema, mob pob khaus, mob pob, mob pob, mob pob nrog eosinophilia thiab cov kab ke ua haujlwm (DRESS syndrome), eczema, lichen planus.

Ntawm ib feem ntawm cov leeg pob txha-mob, kev sib txuas thiab pob txha nqaij: nqaij mus rau hauv lub cev (mob leeg), mob caj dab, mob pob txha, mob myalgia.

Los ntawm ob lub raum thiab lub chaw tso zis: hematuria glomerulonephritis, nce creatinine hauv cov ntshav.

Kev puas siab ntsws: kev xav, tsis meej pem.

Mob ntsws, thoracic thiab mediastinal ntshawv siab: txhaws ntswg, ua pa tawm ntawm cov hlab ntshav (hemoptysis, mob ntsws), bronchospasm, interstitial pneumonitis, eosinophilic mob ntsws.

Cov kev tsis sib xws: ua npaws.

Kev tshawb fawb hauv chav sim: lub sijhawm ntev los ntshav, txo qis ntawm cov hlwb neutrophils thiab platelets.