Cov Tshuaj PharmacokineticsCov. Clopidogrel xaiv yam tshuaj tiv thaiv qhov khi ntawm adenosine diphosphate (ADP) rau nws cov receptors nyob rau saum npoo ntawm platelets, thaiv cov kev ua haujlwm ntawm platelets thiab yog li inhibits lawv cov kev sib sau. Nws tseem inhibits platelet aggregation los ntawm lwm cov agonists. Kev txwv tsis pub platelet sib sau ua ke tau sau tseg 2 teev tom qab kev tswj hwm qhov ncauj ntawm kev siv tshuaj ib zaug. Nrog kev rov qab siv dua, cov nyhuv ua rau muaj zog dua, thiab lub xeev ruaj khov yog tiav tom qab 3-7 hnub ntawm kev kho mob (qhov nruab nrab ntawm qhov inhibition ntawm kev sib xyaw yog 40-60%). Platelet sib sau ua ke thiab lub sijhawm los ntshav rov qab los rau hauv qhov chaw nruab nrab 7 hnub tom qab tsis siv tshuaj, vim tias cov plasmaets raug hloov kho.
Cov Tshuaj Pharmacokinetics Tom qab lub qhov ncauj tswj hwm, cov tshuaj sai sai nyob rau hauv cov hnyuv. Nws qhov kev txiav txim siab hauv cov ntshav plasma tsis tseem ceeb thiab tom qab 2 teev tom qab daim ntawv thov nws tsis txiav txim siab (tsawg dua 0.025 μg / l). Nrawm biotransformed hauv lub siab. Nws lub cev metabolite (85% ntawm cov sib hloov ncig hauv cov ntshav ntshav) yog qhov tsis ua haujlwm. Lub nquag ua thiol metabolite khi tau sai thiab nrawm rau platelet receptors. Hauv ntshav ntshav nws tsis tau txiav txim siab. Clopidogrel thiab lub ntsiab nthuav dav metabolite khi reversibly mus rau ntshav protein.
Tom qab cov neeg siv tshuaj noj hauv qhov ncauj, kwv yees li 50% ntawm cov koob tshuaj tau tawm hauv cov zis thiab 46% hauv cov quav hauv 120 teev tom qab thov. Ib nrab-lub neej ntawm cov metabolite tseem ceeb yog 8 teev.
Qhov kev sib txuam ntawm cov tshuaj metabolite tseem ceeb hauv cov ntshav ntshav hauv cov neeg laus (75 xyoo thiab laus dua) yog qhov muaj peev xwm ntau dua, txawm li cas los xij, ntau dua ntshav siab tsis yog nrog cov kev hloov hauv platelet kev sib xyaw thiab lub sijhawm los ntshav

Kev siv ntawm cov tshuaj Atrogrel

Cov tshuaj yog noj ntawm qhov ncauj, 1 ntsiav tshuaj (75 mg) 1 zaug hauv ib hnub, tsis hais txog ntawm cov zaub mov noj.
Cov neeg mob uas muaj mob caj dab mob yam tsis muaj nce qib nce qib ST (tsis khov kho lub pob ntseg lossis myocardial infarction tsis muaj qhov kab mob hniav) Q nyob rau ntawm ECG) nyob rau 1 hnub ntawm kev kho mob - 4 ntsiav tshuaj (300 mg), nyob rau hnub txuas ntxiv - 1 ntsiav tshuaj 1 zaug hauv ib hnub, tsis hais txog kev noj zaub mov.
Lub sijhawm ntawm kev kho yog txiav txim los ntawm tus kws kho mob nyob ntawm saib daim duab ntawm tus kab mob.

Contraindications rau kev siv tshuaj Atrogrel

Hypersensitivity rau cov tshuaj,
mob rau daim siab hnyav
mob ntshav khov (mob ntshav tawm hauv plab) thiab cov kab mob ua rau lawv txoj kev loj hlob (mob rwj ntawm lub plab thiab duodenum nyob rau theem mob huam sai, mob tsis muaj kiav txhab),
hnub nyoog txog 18 xyoo.

Kev phiv tshuaj ntawm Atrogrel

Los ntawm cov ntshav system: leukopenia, txo qis neutrophilic granulocytes thiab eosinophils, nce sijhawm hauv los ntshav thiab txo qis hauv platelet suav. Tsis tshua muaj: mob ntsws thromocytopenic thrombohemolytic purpura, mob hnyav thrombocytopenia, granulocytopenia, agranulocytosis, ntshav txhaws thiab aplastic anemia / pancytopenia. Los ntshav ntawm ntau cov chaw. Feem ntau los ntshav tau sau tseg thaum thawj lub hli ntawm kev kho mob.
Los ntawm cov mob hauv plab zom mov: mob plab, dyspepsia, raws plab, tsis tshua muaj - cem quav, exacerbation ntawm lub plab rwj thiab mob duodenal.
Los ntawm cov leeg musculoskeletal: mob tsawg kawg - arthralgia, mob caj dab.
Los ntawm cov kab mob zis: feem ntau tsis tshua muaj tshwm sim - glomerulonephritis, muaj ntau cov ntshiab si creatinine.
Los ntawm lub hauv nruab nrab poob siab: mob taub hau, kiv taub hau, tuag tes tuag taw. Tsis tshua muaj neeg - tsis meej pem, pom kev xav, ua txhaum ntawm saj cov nqaij.
Kev ua xua tsis haum: tawv nqaij ua pob, anaphylactoid kev tsis haum.
Lwm yam: tsawg kawg - ua npaws.

Cov lus qhia tshwj xeeb rau kev siv tshuaj Atrogrel

Nrog kev ceev faj, cov neeg mob uas muaj kev pheej hmoo los ntshav vim los ntawm kev ua kom raug mob, kev phais mob, thiab kev tiv thaiv kab mob hauv tsev kho mob tau raug kho. Nrog cov kev npaj phais mob (yog tias muaj cov nyhuv antiplatelet tsis tsim nyog), chav kawm ntawm kev kho mob nrog cov tshuaj yuav tsum tsis ua haujlwm 7 hnub ua ntej kev phais mob.
Kev ceeb toom yog teev rau cov neeg mob uas muaj lub siab tsis ua hauj lwm zoo, hauv kev hemorrhagic diathesis yuav tshwm sim.
Cov koob tshuaj hloov pauv tsis tas yuav nyob hauv cov neeg laus, cov neeg mob lub raum tsis ua haujlwm.
Cov neeg mob yuav tsum tau ceeb toom tias txij li txwv tsis pub los ntshav uas tshwm sim nrog kev siv tshuaj yuav tsum tau siv sijhawm ntau dua, lawv yuav tsum qhia tus kws kho mob txog txhua qhov teeb meem los ntshav tsis xwm yeem. Cov neeg mob tseem yuav tsum qhia tus kws kho mob txog kev noj tshuaj yog tias lawv muaj kev phais (phais, phais hniav, thiab lwm yam) lossis yog tias tus kws kho mob tau sau ib cov tshuaj tshiab rau tus neeg mob.
Thaum cov tsos mob ntawm kev los ntshav ntau dhau (cov pos hniav los ntshav, menorrhagia, hematuria) tshwm sim, kev kawm txog qhov mob hemostatic (lub sijhawm los ntshav, platelet suav, platelet ua haujlwm kev ntsuam xyuas) yog qhia.
Pom zoo kom soj ntsuam kev ntsuas lub siab ua haujlwm rau lub siab.
PLub sijhawm ntawm cev xeeb tub thiab lactation. Kev siv cov tshuaj thaum cev xeeb tub yog contraindicated.
Yog tias nws yuav tsum tau siv cov tshuaj thaum lactation, pub mis rau noj yuav tsum tsis ua mus ntxiv.
Cov menyuam. Qhov kev nyab xeeb thiab kev ua haujlwm ntawm cov tshuaj hauv cov neeg muaj hnub nyoog qis dua 18 xyoo tsis tau tsim.
Lub peev xwm los cuam tshuam cov tshuaj tiv thaiv tus nqi thaum tsav tsheb lossis lwm yam txheej txheem. Cov tshuaj tsis cuam tshuam rau lub peev xwm ntawm kev tsav tsheb thiab tsis txo qis kev ceev ntawm cov kev xav psychomotor.

Kev sib cuam tshuam txog yeeb tshuaj Atrogrel

Clopidogrel ua rau muaj kev pheej hmoo mob plab hnyuv ntshav nrog NSAIDs.
Kev siv nrog warfarin tsis pom zoo, vim tias qhov nce ntxiv hauv ntshav yuav ua tau.
Kev siv nrog acetylsalicylic acid lossis heparin tsis cuam tshuam rau cov nyhuv antiplatelet ntawm cov tshuaj, txawm li cas los xij, kev nyab xeeb ntawm kev siv lub sijhawm ntev ntawm cov kev sib txuas ua ke tseem tsis tau tsim, yog li kev siv ua ke ntawm cov tshuaj no yuav tsum ceev faj.
Thaum siv nrog phenytoin thiab tolbutamide, ib qho kev nce ntxiv ntawm lawv cov theem hauv cov ntshav ntshav yog ua tau. Txawm li cas los xij, lawv qhov kev siv sib xyaw nrog clopidogrel muaj kev nyab xeeb.
Muaj tsis muaj kev sib cuam tshuam hauv chaw kho mob nrog diuretics, β-adrenoreceptor blockers, ACE inhibitors, calcium channel blockers, antacids, hypoglycemic, hypocholesterolemic thiab hormone hloov tshuaj, tshuaj antiepileptic, phenobarbital, cimetidine, digoxin thiab theofinomine thiab digoxin thiab theofinomine.

Pharmacological pawg

Antithrombotic cov neeg sawv cev. PBX code B01A C04.

Kev tiv thaiv ntawm kev tiv thaiv atherothrombosis:

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), mob ischemic stroke (qhov pib kho yog 7 hnub, tab sis tsis pub dhau 6 lub hlis tom qab pib) lossis tus neeg tau kuaj pom tus kab mob peripheral leeg
nyob rau hauv cov neeg mob uas muaj mob rau cov hlab ntshav siab:
nrog rau mob huam sai sai tsis muaj ST ntu kab mob siab (tsis khov kho lub hlwb lossis myocardial infarction yam tsis muaj yoj), suav nrog rau cov neeg mob uas tau ntsia lub cev tsis nco qab thaum mob caj dab mob plawv, nrog rau cov tshuaj acetylsalicylic acid
nrog rau mob myocardial infarction nrog rau qib ntu ntawm ST kom muaj 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 qhia nyob rau hauv kev sib xyaw nrog acetylsalicylic acid rau cov neeg laus cov neeg mob atrial fibrillation nyob rau hauv uas muaj tsawg kawg yog ib qho kev pheej hmoo rau qhov tshwm sim ntawm vascular cov xwm txheej, contraindications rau kev kho mob nrog vitamin K antagonists (AVK), muaj kev pheej hmoo tsawg los ntshav, rau kev tiv thaiv atherothrombotic thiab thromboembolic cov xwm txheej, hauv suav nrog mob stroke.

Tsuas tshuaj thiab tswj hwm

Cov neeg laus thiab cov neeg laus laus. Cov tshuaj raug xaj 1 ntsiav tshuaj (75 mg) 1 zaug hauv ib hnub, tsis hais txog ntawm cov zaub mov noj.

Hauv cov neeg mob nrog cov mob leeg mob vwm yam uas tsis muaj kev tiv thaiv ST theem (tsis khov kho angina pectoris lossis myocardial infarction tsis muaj Q yoj ntawm ECG), kev kho mob nrog clopidogrel pib nrog ib zaug ntawm 300 mg, thiab tom qab ntawd txuas ntxiv ntawm koob tshuaj 75 mg ib hnub ib zaug (nrog rau acetylsalicylic acid (ASA) ntawm koob tshuaj 75-325 mg ib hnub). Txij li siv cov koob tshuaj ntau dua ntawm ASA ua rau muaj kev pheej hmoo los ntshav, nws raug nquahu kom tsis txhob tshaj li koob tshuaj ASA 100 mg. Qhov zoo tshaj plaws sijhawm ntawm kev kho mob tsis tau pom tseeb lub cev. 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.

Hauv cov neeg mob nrog mob myocardial infarction nrog ST ntu ntu kom siab ntxiv clopidogrel yog tus kws kho mob 75 mg ib hnub ib zaug, pib siv ib zaug ntawm 300 mg rau hauv kev sib xyaw nrog ASA, nrog lossis tsis muaj tshuaj thrombolytic. Kev kho mob rau cov neeg mob hnub nyoog 75 thiab tshaj pib pib yam tsis muaj chaw thau khoom 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 4 lub lis piam. Qhov txiaj ntsig ntawm kev siv ua ke ntawm clopidogrel nrog ASA rau ntau dua 4 lub lis piam nrog tus kab mob no tsis tau kawm.

Clopidogrel siv nyob rau hauv ib qho tshuaj ntawm 75 mg rau cov neeg mob atrial fibrillation. Ua ke nrog clopidogrel, kev siv tshuaj ASA (ntawm ib koob ntawm 75-100 mg ib hnub twg) yuav tsum tau pib thiab txuas ntxiv.

Yog tias tsis nco qab:

yog los ntawm lub sijhawm thaum nws yuav tsum tau noj dua tom ntej, tsawg dua 12:00 dhau los, tus neeg mob yuav tsum tau noj tam sim ntawd, thiab cov koob tshuaj txuas ntxiv yuav tsum tau noj nyob rau lub sijhawm ib txwm,
yog tias ntau dua 12:00 tau dhau mus lawm, tus neeg mob yuav tsum tau txhaj koob tshuaj ntxiv rau hauv lub sijhawm ib txwm tab sis tsis txhob txhaj ob npaug txhawm rau txhawm rau them rov qab.

Tshuaj Kho Mob. Kev nthuav dav ntawm CYP2C19 alleles, uas ua rau muaj kev cuam tshuam thiab txo qis kev ua haujlwm ntawm CYP2C19, sib txawv raws li haiv neeg / haiv neeg. Cov tshuaj noj zoo tshaj plaws hauv cov neeg uas muaj cov roj ntsha tsis muaj zog ntawm CYP2C19 tseem tsis tau tsim los.

Cov menyuam. Kev nyab xeeb thiab ua haujlwm ntawm clopidogrel hauv cov menyuam yaus tseem tsis tau tsim, yog li, cov tshuaj yuav tsum tsis txhob siv rau menyuam yaus.

Tsis hlauv. Txoj kev kho kom zoo ntawm kev siv cov tshuaj rau cov neeg mob uas lub raum tsis txaus muaj qhov txwv (saib ntu "Cov yam ntxwv ntawm kev siv").

Daim siab ua haujlwm. Txoj kev kho kom zoo ntawm kev siv tshuaj rau hauv cov neeg mob uas muaj mob rau daim siab thiab ua tau hemorrhagic diathesis yog txwv (saib ntu "Cov yam ntxwv ntawm kev siv").

Kev phiv tshuaj

Feem ntau cov nyom tshwm sim yog los ntshav, uas feem ntau pom nyob hauv thawj lub hlis ntawm kev kho mob.

Ntshav thiab lymphatic system

thrombocytopenia, leukopenia, eosinophilia,
neutropenia, suav nrog neutropenia,
thrombotic thrombocytopenic purpura (TTP) (saib ntu "Peculiarities ntawm kev siv"), mob ntshav tsis txaus, pancytopenia, agranulocytosis, mob hnyav thrombocytopenia, granulocytopenia, ua kom ntshav txhav, kis tau hemophilia A.

lub cev tiv thaiv kab mob

Ntshav siab mob, anaphylactoid / anaphylactic tshua,
hla kev tiv thaiv qhov tsis haum ntawm thienopyridines (xws li ticlopidine, prasugrel) (saib ntu "Cov yam ntxwv ntawm kev siv").

kev nyuaj siab mob hlwb

kev tso siab, tsis meej pem.

cov leeg hlab hlwb

mob intracranial los ntshav (qee qhov, tuag taus), mob taub hau, mob caj dab, kiv taub hau
hloov pauv hauv kev xaav.

Pathology ntawm plab hnyuv siab raum ntawm lub zeem muag

los ntshav hauv cheeb tsam lub qhov muag (pom pob txha, tsom iav, pob txha).

Kev kawm ntawm pob ntseg thiab labyrinth

leeg noj ntshav tsis nqis

hematoma
los ntshav ntau, los ntshav los ntawm kev ua haujlwm zoo, vasculitis, hlab ntshav tawm ntshav.

Kev ua pa, thoracic thiab mediastinal ntshawv siab

taub ntswg
los ntshav los ntawm kev mob khaub thuas (hemoptysis, pulmonary hemorrhage), bronchospasm, interstitial pneumonitis, eosinophilic mob ntsws.

Lub plab zom mov tsis zoo

lub plab zom mov tuaj ntshav, zawv plab, mob plab, dyspepsia
mob plab thiab duodenal mob rwj, mob plab, ntuav, xeev siab, cem quav, plab zom mov,
retroperitoneal hemorrhage
lub plab zom mov thiab retroperitoneal hemorrhages nrog cov txiaj ntsig tuag, pancreatitis, colitis (tshwj xeeb yog ulcerative lossis lymphocytic), stomatitis.

hepatobiliary qhov system

mob siab tsis ua haujlwm, kab mob siab, ua haujlwm tshwm sim ntawm lub siab ua haujlwm qhov ntsuas.

Daim tawv nqaij thiab cov nqaij mos

subcutaneous hemorrhage,
xoo pob, khaus, intradermal hemorrhage (purpura),
cov kab mob ua rau mob ntshav liab, mob ua paug rau cov mob, Stevens-Johnson syndrome, erythema multiforme, angioneurotic edema, erythematous pob, urticaria, tshuaj tiv thaiv kab mob siab, tshuaj pob mob nrog eosinophilia thiab cov kev ua haujlwm rau lub cev (DRESS-lichen, eczema).

Musculoskeletal system, sib txuas thiab pob txha nqaij

musculoskeletal hemorrhages (hemarthrosis), mob caj dab, mob pob txha, mob myalgia.

Raum thiab zis

hematuria
glomerulonephritis, muaj ntau dua creatinine nyob rau hauv cov ntshav.

cov xwm txheej dav dav

kev kuaj sim

lengthening ntawm lub sijhawm los ntshav, txo qis ntawm cov hlwb neutrophils thiab platelets.

Cov Menyuam Yaus

Siv thaum cev xeeb tub lossis lactation

Vim tias tsis muaj cov ntaub ntawv tshawb fawb txog kev siv clopidogrel thaum cev xeeb tub, nws tsis pom zoo kom sau cov tshuaj rau cov poj niam cev xeeb tub.

Nws tsis paub meej tias clopidogrel ua haujlwm tawm hauv niam cov kua mis, yog li ntawd, kev pub niam mis rau menyuam yuav tsum tsis pub ntxiv thaum kho cov tshuaj.

Kev nyab xeeb thiab ua haujlwm ntawm clopidogrel hauv cov menyuam yaus tseem tsis tau tsim, yog li, cov tshuaj yuav tsum tsis txhob siv rau menyuam yaus.

Daim ntawv thov nta

Los ntshav thiab mob ntshav tsis xis nyob.

Vim txoj kev pheej hmoo ntawm los ntshav thiab hematological tsis haum, kev kuaj ntshav ntxaws 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. Zoo ib yam li lwm cov tshuaj tiv thaiv kab mob, clopidogrel yuav tsum tau siv nrog ceev faj hauv cov neeg mob uas muaj kev pheej hmoo los ntshav vim los ntawm kev raug mob, phais lossis lwm yam mob, nrog rau cov neeg mob siv acetylsalicylic acid (ASA), heparin, IIb / IIIA glycoprotein inhibitors lossis tsis siv tshuaj tiv thaiv kab mob. suav nrog COX-2 inhibitors. Nws yog ib qho tsim nyog yuav tsum tau ua tib zoo saib kom pom tseeb tias cov tsos mob los ntshav hauv cov neeg mob, suav nrog zais zais, tshwj xeeb tshaj yog nyob rau thawj lub lim tiam ntawm kev kho thiab / lossis tom qab cov txheej txheem muaj kev cuam tshuam ntawm lub siab thiab kev phais. Tsis tas li qhov kev siv clopidogrel nrog tshuaj tiv thaiv qhov ncauj tsis zoo, vim tias nws tuaj yeem ua rau kom ntshav khov ntau ntxiv (saib Ntu "Kev cuam tshuam nrog lwm cov tshuaj thiab lwm yam kev sib cuam tshuam").

Yog tias tau npaj kho kev phais mob, yog hais tias lub txiaj ntsig antithrombotic ua rau tsis txaus siab ib ntus, kev kho mob nrog clopidogrel yuav tsum tau tsum txiav 7 hnub ua ntej kev phais mob. Cov neeg mob yuav tsum qhia rau cov kws kho mob thiab kws kho hniav uas lawv tau noj clopidogrel ua ntej kev phais mob lossis ua ntej siv tshuaj tshiab. Clopidogrel ncua sijhawm ntev los ntshav, yog li nws yuav tsum 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 hauv kev sib xyaw nrog ASA), los ntshav yuav tso tseg lig dua li ib txwm, uas lawv yuav tsum qhia tus kws kho mob txog txhua kis mob txawv txav (los ntawm qhov 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 qhov mob ua rau neeg tuag taus uas yuav tsum tau kho tam sim ntawd, tshwj xeeb plasmapheresis.

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 ). Tshuaj Kho Mob.

Cov neeg mob uas lub caj ces ua haujlwm tsis sib haum ntawm CYP2C19 muaj qis qis ntawm cov ua haujlwm clopidogrel metabolite hauv cov ntshav ntshav thiab tsis tshua muaj cov kab mob antiplatelet, ntxiv rau, lawv muaj ntau dua lub plawv kev cuam tshuam tom qab myocardial infarction piv rau cov neeg mob uas ua haujlwm tsis zoo ntawm CYP2C19.

Txij li thaum clopidogrel yog metabolized ua ntej qhov kev tsim nws cov nquag metabolite hauv ib feem los ntawm CYP2C19, kev siv cov tshuaj uas txo qis cov kev ua haujlwm ntawm cov enzyme no yuav ua rau txo qis ntawm cov concentration ntawm cov nquag metabolite ntawm clopidogrel hauv ntshav ntshav. Txij li thaum lub luag haujlwm tseem ceeb ntawm kev cuam tshuam no tsis tau qhia meej meej, kev siv cov tshuaj ib txhij uas thaiv qhov kev ua haujlwm ntawm CYP2C19 yuav tsum zam (saib Ntu "Kev cuam tshuam nrog lwm cov tshuaj thiab lwm yam kev sib cuam tshuam").

Cross-reactivity ntawm thienopyridines.

Cov neeg mob yuav tsum raug txheeb xyuas txog keeb kwm ntawm kev tiv thaiv tsis haum rau lwm cov thienopyridines (xws li ticlopidine, prasugrel), vim tias muaj kev tshaj tawm qhia txog cov khaub thuas sib cuam tshuam ntawm thienopyridines (saib ntu “Cov kev tsis haum”). Thienopyridines tuaj yeem ua rau mob me me mus rau kev txhaum fab hnyav, xws li tawm pob xoo, Quincke's edema, lossis hematologic tshua, xws li thrombocytopenia thiab neutropenia. Cov neeg mob uas muaj keeb kwm ua xua thiab / lossis hematologic tsis haum rau ib qho thienopyridine yuav muaj kev pheej hmoo ntawm kev tsim kom muaj tib txoj kev sib txawv los ntawm lwm cov thienopyridines. Pom zoo soj ntsuam rau cov cim ntawm qhov tsis txaus siab nyob hauv tus neeg mob tsis haum rau thienopyridines.

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 qhov tsawg, yog li, cov neeg mob zoo li no tau sau tseg nrog kev ceev faj (saib Ntu "Kev Noj Tshuaj thiab Txoj Haujlwm")

Lub siab ua haujlwm tsis zoo.

Cov kev paub ntawm kev siv cov tshuaj nyob rau hauv cov neeg mob uas muaj mob rau daim siab mob siab thiab muaj peev xwm hemorrhagic diathesis tsuas yog muaj tsawg. Yog li no, clopidogrel yuav tsum tau kho rau cov neeg mob zoo li no nrog kev ceev faj (saib Ntu "Dosage thiab Administration").

Cov tshuaj muaj lactose. Cov neeg mob uas tsis tshua muaj kab mob galactose tsis txaus ntseeg, Lapp lactase deficiency, cuam tshuam cov piam thaj-galactose malabsorption yuav tsum tsis txhob siv cov tshuaj no.

Cov tshuaj muaj hydrogenated cov roj taum pov tseg, uas tuaj yeem ua rau plab zom mov thiab plab zom mov.

Yog tias tus neeg mob tsis nco qab noj ntau dua ntawm qhov tshuaj thiab nws tsawg dua 12:00 tom qab kev npaj tau noj, tom qab ntawd cov tshuaj yuav tsum noj sai li sai tau, tom qab ntawd cov tshuaj ntxiv yuav tsum noj raws sijhawm. Yog tias ntau dua 12:00 tau dhau mus, koj yuav tsum hla kev noj tshuaj uas tsis nco qab lawm thiab rov qab noj dua ntxiv kom ncav sijhawm. Nws tsis tuaj yeem lees txais qhov coj ob zaug ntawm cov tshuaj.

Thaum kho, koj yuav tsum tsis txhob haus cawv vim tias qhov muaj teeb meem ntawm txoj hnyuv los ntshav ntau dua.

Kev ceev faj tshwj xeeb rau kev pov tseg cov seem thiab cov khib nyiab. Txhua yam khoom siv tsis siv lossis cov pov tseg yuav tsum muab pov tseg nyob rau hauv raws li cov cai hauv zos.

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

Qhov ncauj anticoagulants kev siv ua ke nrog clopidogrel nrog tshuaj tiv thaiv qhov ncauj, suav nrog warfarin, tsis pom zoo, vim tias kev sib txuam no tuaj yeem ua rau ntau ntxiv los ntshav.

Glycoprotein IIb / IIIa Cov Tshuaj Hluav Taws Xob: clopidogrel yuav tsum siv nrog ceev faj hauv cov neeg mob uas muaj kev pheej hmoo los ntshav vim yog kev raug mob, kev khiav haujlwm, lossis lwm yam kab mob pathological uas glycoprotein IIb / IIIa inhibitors siv tau tib lub sijhawm.

Acetylsalicylic acid (ASA): acetylsalicylic acid tsis hloov pauv kev cuam tshuam ntawm clopidogrel ntawm ADP-vim platelet aggregation, tab sis clopidogrel txhim kho cov nyhuv ntawm ASA rau ntawm collagen hob platelet aggregation. Txawm li cas los xij, kev siv ib txhij ntawm 500 mg ntawm ASA ib zaug ib hnub rau ib hnub tsis ua rau muaj qhov tseem ceeb hauv lub sijhawm los ntshav, lub sijhawm ntev vim clopidogrel. Txij li muaj kev pheej hmoo ntxiv los ntshav yog tau, kev siv cov tshuaj no ua ke kom ceev faj. Txawm li cas los xij, muaj kev paub siv clopidogrel thiab ASA ua ke mus txog ib xyoos.

Heparin: hauv txoj kev tshawb nrhiav nrog cov neeg ua haujlwm noj qab haus huv, kev siv clopidogrel tsis tas yuav muaj kev hloov pauv hauv cov tshuaj heparin thiab tsis hloov pauv ntawm heparin ntawm kev sib xyaw. Kev siv txhij ib txhij ntawm heparin tsis hloov pauv qhov cuam tshuam ntawm clopidogrel ntawm platelet aggregation. Txij li thaum pharmacodynamic kev sib cuam tshuam ntawm clopidogrel thiab heparin muaj peev xwm ua tau nrog kev pheej hmoo los ntshav ntau, kev siv cov tshuaj no ib zaug yuav tsum ceev faj.

Thrombolytic tshuaj: kev nyab xeeb ntawm concomitant siv clopidogrel, fibrin-specific los yog fibrin-specific thrombolytic agents thiab heparin raug soj ntsuam nrog kev koom tes ntawm cov neeg mob uas muaj myocardial infarction. Qhov tshwm sim ntawm qhov tseem ceeb ntawm kev tso ntshav los tau zoo ib yam li qhov tshwm sim uas tau pom thaum noj cov tshuaj thrombolytic thiab heparin nrog ASA.

Nonsteroidal anti-inflammatory tshuaj (NSAIDs): nyob rau hauv txoj kev tshawb nrhiav rau cov neeg ua haujlwm noj qab haus huv, kev siv tib txhij ntawm clopidogrel thiab naproxen nce ntau cov latent gastrointestinal los ntshav. Txawm li cas los xij, vim tias tsis muaj kev kawm txog kev sib cuam tshuam ntawm cov tshuaj nrog lwm cov NSAIDs, nws tseem tsis tau meej meej, kev pheej hmoo ntawm txoj hnyuv ntshav nce ntxiv thaum siv clopidogrel nrog lwm cov NSAIDs. Yog li, ceev faj yog qhov tsim nyog nrog kev siv NSAIDs ib txhij, suav nrog COX-2 inhibitors, nrog clopidogrel.

Kev siv ua ke nrog lwm cov tshuaj: txij li clopidogrel yog metabolized ua ntej qhov kev tsim nws cov nquag metabolite hauv ib feem los ntawm CYP2C19, kev siv cov tshuaj uas txo qis cov kev ua haujlwm ntawm cov enzyme no yuav txo qis qis ntawm lub cev metabolite ntawm clopidogrel hauv ntshav ntshav. Cov kab mob tseem ceeb hauv kev cuam tshuam ntawm qhov kev sib txuam no tsis meej, yog li ntawd, kev siv cov tshuaj ib txhij uas thaiv qhov kev ua si ntawm CYP2C19 yuav tsum zam.

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

Proton Twj Tso Kua Mis (PPIs): qhov ua tau zoo ntawm antithrombotic kev ua ntawm clopidogrel tuaj yeem txo los ntawm yuav luag ib nrab thaum sib xyaw nrog PPI. Txawm hais tias cov neeg kawm ntawv qib kev tiv thaiv ntawm CYP2C19 kev ua hauv qab qhov kev txiav txim siab ntawm ntau yam tshuaj uas yog rau PPI chav kawm tsis zoo li qub, kev tshawb fawb qhia tias muaj kev cuam tshuam nrog yuav luag txhua tus neeg sawv cev ntawm chav kawm no. Hauv qhov no, qhov tsis sib xws hauv kev tswj hwm ntawm lub sijhawm tsis cuam tshuam qhov txo qis hauv kev ua tau zoo ntawm clopidogrel. Yog li, kev siv tib lub sijhawm PPI yuav tsum zam tshwj tsis yog muaj kev cheem tsum tiag tiag.

Cov ntaub ntawv ua pov thawj tias lwm cov tshuaj uas txo cov kua qaub tsim hauv plab, xws li

H 2 blockers (tshwj tsis yog cimetidine uas tiv thaiv qhov kev ua ntawm CYP2C19) lossis tshuaj tiv thaiv kab mob , cuam tshuam rau cov haujlwm antiplatelet ntawm clopidogrel, tsis muaj.

Ua ke nrog lwm cov tshuaj: Ib tug xov tooj ntawm cov kev tshawb fawb ntawm clopidogrel thiab lwm yam tshuaj tau ua los kawm txog qhov muaj peev xwm sib raug zoo pharmacodynamic thiab pharmacokinetic, uas tau qhia tias thaum siv clopidogrel nrog:

atenolol, nifedipine lossis nrog ob qho tshuaj, tsis muaj kev sib cuam tshuam los ntawm lub chaw muag tshuaj,
phenobarbital thiab tshuaj estrogen tsis muaj qhov cuam tshuam tseem ceeb ntawm cov chaw muag tshuaj ntawm clopidogrel,
digoxin lossis theophylline: tsis pub hloov pauv tshuaj pharmacokinetic,
Antacids: tsis muaj kev cuam tshuam los ntawm theem ntawm kev nqus ntawm clopidogrel
phenytoin thiab tobutamide: carboxyl metabolites ntawm clopidogrel tuaj yeem tiv thaiv kev ua si ntawm cytochrome P450 2C9, uas muaj peev xwm nce plasma ntau ntau ntawm cov tshuaj xws li phenytoin , tolbutamide thiab NSAIDs uas yog metabolized 450 2C9. Tab sis txawm tias qhov no, phenytoin thiab tolbutamide tuaj yeem siv nyab xeeb ib txhij nrog clopidogrel,
diuretics, β-blockers, ACE inhibitors, calcium antagonists, cov roj ntsha ua rau cov kab mob ntshav tsawg, cov roj ntshav ua haujlwm, cov tshuaj tiv thaiv kab mob hypoglycemic (suav nrog insulin), tshuaj antiepileptic, kev hloov kho tshuaj hormone thiab GPIIb / IIIa kev thaiv kev: hauv kev tshawb fawb hauv chav kho mob, tsis muaj qhov tshwm sim hauv chaw mob loj pom.

Cov Menyuam Yaus

Cov lus qhia rau kev siv Atrogrel

cov tshuaj uas nquag: clopidogrel,

1 ntsiav tshuaj muaj clopidogrel nyob rau hauv daim ntawv ntawm clopidogrel bisulfate, hauv 100% clopidogrel - 75 mg.

Cov muaj mob: croscarmellose sodium, microcrystalline cellulose, lactose, hydrogenated cov roj taum,

zaj duab xis membrane: hypromellose, lactose, titanium dioxide (E171), triacetin, carmine (E120).

Kev tiv thaiv ntawm kev nthuav tawm atherothrombosis: hauv cov neeg mob uas tau myocardial infarction (kev pib kho yog ob peb hnub, tab sis tsis pub dhau 35 hnub tom qab tshwm sim), ischemic stroke (pib kho yog 7 hnub, tab sis tsis pub dhau 6 lub hlis tom qab qhov tshwm sim) lossis cov uas tau muaj tus mob peripheral arterial mob, nyob rau cov neeg mob uas muaj mob hlab ntaws: muaj tus mob chwv leeg sai sai uas tsis muaj tus kabmob ST tsis muaj qib (tsis khov kho lub hlwb lossis myocardial infarction tsis muaj yoj), suav nrog cov neeg mob uas tau muaj tus mob nt thaum lub sij hawm percutaneous transluminal coronary angioplasty, nyob rau hauv ua ke nrog nrog acetylsalicylic acid, nrog mob myocardial infarction nrog ST ya nce nyob rau hauv ua ke nrog nrog acetylsalicylic acid (nyob rau hauv cov neeg mob uas tau txais txuj kev noj tshuaj thiab uas thrombolytic txoj kev kho).

Kev tiv thaiv ntawm atherothrombotic thiab thromboembolic cov xwm txheej hauv atrial fibrillation.

Cov tshuaj Atrogrel: cov lus qhia rau kev siv

Atrogrel yog cov tshuaj uas muaj cov nyhuv antiplatelet. Nws yog siv los kho thiab tiv thaiv thawj, cov mob plawv nres, mob stroke hauv lub xub ntiag ntawm lub siab xav ua ntej rau cov neeg mob. Cov tshuaj yuav pab tshem tawm vascular atherosclerosis vim yog lub zog physicochemical ntawm clopidogrel hauv inhibiting platelet kev sib sau ua ke. Nws yog ib qho tseem ceeb uas xav txog tias thaum kho, lub sijhawm txwv kom ntshav nce ntxiv.

Cov Tshuaj Pharmacokinetics

Tom qab kev tswj hwm, cov tshuaj tau sai sai los ntawm txoj hnyuv plab hnyuv. Qhov siab nyob hauv cov ntshav ntshav yog qhov tsis zoo thiab tom qab 2:00 tom qab kev thov tsis tau txiav txim siab (qis dua 0.025 μg / l). Nrawm biotransformed hauv lub siab. Nws lub cev metabolite (85% ntawm lub plasma circulating compound) yog qhov tsis voos. Lub nquag ua thiol metabolite khi tau sai thiab nrawm rau platelet receptors. Hauv cov ntshav ntshav, nws tsis yog kuaj pom. Clopidogrel thiab lub ntsiab nthuav dav metabolite khi rov qab rau cov ntshav protein.
Tom qab noj, kwv yees li 50% ntawm cov koob tshuaj tau tawm hauv cov zis thiab 46% hauv cov quav li ntawm 120 teev tom qab thov. Ib nrab-lub neej ntawm cov metabolite tseem ceeb yog 8:00.
Qhov tshwj xeeb ntawm cov tshuaj metabolite tseem ceeb hauv plasma hauv cov neeg laus (75 xyoo thiab laus dua) yog qhov ntau dua, txawm li cas los xij, ntau dua ntshav siab tsis yog nrog cov kev hloov hauv platelet sib sau thiab lub sijhawm los ntshav.

Tso cov ntaub ntawv thiab cov nyob ua ke

Cov tshuaj yog tsim hauv cov qauv ntsiav tshuaj. Chav tsev ntawm cov tshuaj yog zaj duab xis-txheej, pleev xim dawb. 1 ntsiav tshuaj muaj 75 mg ntawm lub nquag sib xyaw - clopidogrel bisulfate. Cov khoom siv ntxiv muaj xws li:

microcrystalline cellulose,
cov roj cam tau hydrogenated,
mis nyuj qab zib
croscarmellose sodium.

Lub plhaub sab nraud muaj carmine, hypromellose, lactose qab zib, titanium dioxide, triacetin.

Cov tshuaj yog tsim hauv cov qauv ntsiav tshuaj. 1 ntsiav tshuaj muaj 75 mg ntawm lub nquag sib xyaw - clopidogrel bisulfate.

Pharmacological kev txiav txim

Cov tshuaj txwv tsis pub muaj qhov khi ntawm adenosine diphosphate mus rau cov tshuaj tiv thaiv sib haum nyob rau saum npoo ntawm platelet membrane, vim tias qhov kev ua haujlwm ntawm cov ntshav plasmaets txo. Raws li kev ua tiav ntawm clopidogrel, platelet sib sau thiab adhesion yog txo qis, tshwm sim los ntawm qhov tshwm sim los yog cuam tshuam los ntawm tus ntawm lwm cov tshuaj. Tus txheej txheem kho tau sau cia hauv qhov kev tshawb fawb 2 teev tom qab qhov ncauj tswj hwm ntawm cov tshuaj.

Nrog kev sib txuas ntxiv theem nrab, cov nyhuv ntawm cov tshuaj yog txhim kho thiab qub dua tsuas yog tom qab 3-7 hnub ntawm kev kho tshuaj. Nyob rau tib lub sijhawm, qhov nruab nrab ntawm kev txwv tsis pub platelet nce mus txog 45-60%.Cov nyhuv ua rau cov tshuaj kho tau ntev li ib lub lim tiam, tom qab ntawd cov kev sib sau ua ke ntawm cov ntshav thiab cov ntshav dej ua kom rov zoo li qub. Qhov no yog vim qhov rov ua dua tshiab ntawm cov ntshav hlwb (lub neej platelet yog 7 hnub).

Dab tsi pab?

Cov tshuaj yog siv los ntawm kev tiv thaiv kev kho mob ntawm atherothrombosis rau cov neeg laus thiab kom tshem tawm cov kev mob hauv qab no:

cov kab mob ntawm cov hlab ntsha txhaws nyob rau lub sijhawm txhim kho cov txheej txheem pathological vim yog atherothrombosis hauv qis qis,
mob hlwb txhim kho lub plawv tawm tsam lub plawv nres nrog qhov tsis muaj Q y rau ntawm ib qho hluav taws xob electrocardiogram (ECG) lossis nyob rau ntawm qhov tsis khov tsis khov,
kev tiv thaiv ntawm theem nrab myocardial infarction thiab ua kom sai rau kev kho kom rov qab ntawm lub plawv mob (cov tshuaj siv tsis pub dhau 35 hnub tom qab tshwm sim ntawm pathology),
kev tiv thaiv tam sim ntawd tus mob coronary,
mob myocardial infarction thaum nce qib ST ntawm ntu ntawm ECG nrog kev saib xyuas nrog kev kho mob nrog acetylsalicylic acid,
ischemic stroke thaum pib kho mob tom qab 7 hnub (tsis pub dhau 6 lub hlis) los ntawm kev tsim kho cov kab mob pathology.

Cov tshuaj yog siv los ua kev tiv thaiv hauv kev kho tus mob atherothrombosis hauv cov neeg laus.
Tsis tas li, cov tshuaj siv los tiv thaiv tus kabmob myocardial infarction lwm yam.
Atrogrel raug samfwm rau cov neeg mob rau kev tiv thaiv ntawm kev tuag sai li sai tau.
Qhov qhia txog kev siv tshuaj yog ischemic stroke thaum pib kho mob tom qab 7 hnub (tsis pub dhau 6 hli) los ntawm kev txhim kho cov kab mob pathology.

Cov tshuaj siv los tiv thaiv qhov tshwm sim ntawm kev mob atherothrombotic thiab txhaws (embolism) ntawm lumen ntawm lub nkoj los ntawm kev mob plab zais thaum lub sij hawm atrial fibrillation. Hauv qhov xwm txheej no, nws raug nquahu kom siv txoj kev kho ua ke ntawm acetylsalicylic acid nrog clopidogrel.

Nrog saib xyuas

Xyuam xim yog qhia rau cov neeg mob uas muaj feem yuav los ntshav ntau heev vim los ntawm kev siv tshuab, kev phais mob, thiab kev tsis txaus ntawm cov kua qaub-puag nyob hauv lub cev. Nkag ntawm Atrogrel yog qhov tsis txaus siab rau cov neeg mob uas lub siab tsis ua haujlwm, vim tias yuav muaj kev pheej hmoo los tsim hemorrhagic diathesis.

Cov tshuaj tsis yog kws kho rau cov txheej txheem pathological loj hauv lub siab.
Atrogrel tsis siv rau qhov mob txhab ntawm lub plab thiab duodenum hauv cov qib mob sai.
Cov tshuaj tsis pom zoo kom noj thaum lub sijhawm pub niam mis thiab poj niam cev xeeb tub.
Ceev faj yog qhia nyob rau hauv cov neeg mob uas muaj kev pheej hmoo siab los ntshav.

Yuav ua li cas noj Atrogrel?

Cov tshuaj yog npaj rau cov thawj coj hauv qhov ncauj, tsis hais txog ntawm cov khoom noj. Cov qauv txheem tshuaj txhua hnub yog 75 mg ib zaug. Cov neeg mob uas muaj mob ua mob rau txoj hlab ntshav ntawm txoj hlab ntshav tsis xwm yeem, mob hlwb tsis khov thiab myocardial infarction pom zoo kom noj 300 mg ntawm tshuaj rau thawj hnub - 4 ntsiav tshuaj. Cov koob txhaj tshuaj tom qab yog tus qauv.

Lub sijhawm tiv thaiv yog txiav txim los ntawm tus kws kho mob koom nrog ib tus zuj zus, nyob ntawm seb qhov chaw kuaj mob ntawm cov txheej txheem pathological. Kev sib xyaw ua ke nrog lwm cov tshuaj yog tau sau tseg kom sai li sai tau. Kev kho mob siab tshaj plaws yog 4 lub lis piam.

Kev phiv los ntawm Atrogrel

Cov kev xav tsis zoo los ntawm cov plab hnyuv siab raum thiab cov kab ke tsim muaj nyob rau hauv feem ntau yog tias tus neeg mob muaj lub siab xav ua haujlwm rau lub cev tsis ua haujlwm lossis thaum cov ntsiav tshuaj noj tsis raug.

Cov tshuaj yog npaj rau cov thawj coj hauv qhov ncauj, tsis hais txog ntawm cov khoom noj.
Cov neeg mob uas muaj mob ua mob rau txoj hlab ntshav ntawm txoj hlab ntshav tsis xwm yeem, mob hlwb tsis khov thiab myocardial infarction pom zoo kom noj 300 mg ntawm tshuaj rau thawj hnub - 4 ntsiav tshuaj.
Tus mob ntshav qab zib tsis tas yuav hloov pauv kev kho mob nrog tshuaj.

Hematopoietic plab hnyuv siab raum

Tus naj npawb ntawm cov khoom tsim hauv cov ntshav txo qis, kev tsim tawm ntawm leukocytes thiab eosinophilic granulocytes yog cuam tshuam. Lub sijhawm ua kom ntshav nce siab. Thrombocytopenic purpura, anemia, thrombocytopenia thiab agranulocytosis tuaj yeem tsim nrog kev puas tsuaj rau cov kab mob hematopoietic.

Cov neeg mob nco ntsoov qhov kev loj hlob ntawm los ntshav tom qab ib hlis ntawm kev siv tshuaj.

Nruab nrab hauv lub paj hlwb

Nrog rau cov nyhuv ua rau qaug tshuaj rau ntawm cov hlab ntsha hlwb, mob taub hau, kiv taub hau thiab ploj ntawm cov neeg mob siab. Muaj qee zaus, poob ntawm kev tswj hwm kev xav, ua kom tsis meej, tsis meej pem thiab tsis nco qab, chim siab saj cov lus yog tau.

Kev phiv los ntawm Atrogrel nyob rau hauv cov leeg ua ke yog qhia kom pom tseeb hauv txoj kev mob hauv cov leeg nqaij thiab pob qij txha.
Raws li kev phiv los ntawm cov tshuaj, dyspepsia yuav tshwm sim.
Nrog kev siv sijhawm ntev ntawm cov tshuaj, lub sijhawm ua pa luv thiab mob qa tuaj yeem tsim muaj.

Kev ntsuas rau siv

Tshuaj Atrogrel Nws yog siv los tiv thaiv cov tsos mob atherothrombosis hauv cov neeg mob tom qab myocardial infarction (thaum pib kho - ob peb hnub, tab sis tsis pub dhau 35 hnub tom qab qhov tshwm sim), ischemic stroke (pib kho - 7 hnub, tab sis tsis pub dhau 6 lub hlis tom qab qhov tshwm sim) los yog tus neeg tau kuaj pom muaj tus kab mob puas hlwb peripheral arterial
Hauv cov neeg mob uas muaj mob rau lub cev txoj hlab ntaws:
- nrog cov mob hlab ntsha hlwb tsis muaj ST ntu kab mob siab (tsis khov kho lub hlwb lossis myocardial infarction tsis muaj Q yoj), suav nrog rau cov neeg mob uas tau ntsia lub cev tsis nco qab thaum mob caj dab mob plawv, nrog rau cov acetylsalicylic acid
- nrog mob myocardial infarction nrog ST ntu kev nce siab 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 qhia nyob rau hauv kev sib xyaw nrog acetylsalicylic acid rau cov neeg laus cov neeg mob atrial fibrillation nyob rau hauv uas muaj tsawg kawg yog ib qho kev pheej hmoo rau qhov tshwm sim ntawm vascular cov xwm txheej, contraindications rau kev kho mob nrog vitamin K antagonists (AVK), muaj kev pheej hmoo tsawg los ntshav, rau kev tiv thaiv atherothrombotic thiab thromboembolic cov xwm txheej, hauv suav nrog mob stroke.

Los ntawm cov hlab plawv system

Nrog rau cov tshuaj lom hauv cov tshuaj ntawm cov ntshav ncig, tachycardia zoo nkaus li, kev cuam tshuam ntawm cov hlab ntshav ntawm cov hlab ntshav thiab mob hauv siab.

Nrog rau qhov ua kom mob tshwm sim ntawm cov tshuaj rau ntawm cov ntshav ncig, tachycardia tshwm.
Nrog rau kev txhim kho cov kev mob tshwm sim hauv txoj hnyuv plab, qhov txo qis hauv lub siab yog qhov ua tau.
Feem ntau cov neeg mob tau mob urticaria, tawm pob.

Los ntawm ib sab ntawm cov metabolism

Cov tshuaj tsis muaj qhov cuam tshuam ncaj qha rau cov metabolism, tab sis nrog kev txhim kho cov kev mob tshwm sim hauv lub plab zom mov, qhov txo qis ntawm lub siab yog ua tau.

Hauv cov neeg mob predisposed rau txoj kev loj hlob ntawm anaphylactoid kev tsis haum, nyob rau hauv tsawg zaus muaj kev pheej hmoo ntawm anaphylactic poob siab, Quincke's edema, kub cev tshuaj. Cov neeg mob feem ntau muaj khaus, ua pob, thiab khaus khaus.

Cawv tau zoo

Thaum lub sijhawm kho cov tshuaj, nws tsis pom zoo kom haus dej cawv. Ethyl cawv ua rau muaj kev cuam tshuam ntawm lub hauv nruab nrab cov hlab ntaws thiab cov hlab plawv, ua kom ntau ntxiv ntawm cov kev mob tshwm sim hauv cov hnyuv thiab ua kom cov ntshav los ntev. Ethanol tuaj yeem ua rau mob voos ntawm phab ntsa ntawm lub plab.

Siv thaum cev xeeb tub thiab lactation

Cov tshuaj yog contraindicated rau kev siv los ntawm cov poj niam cev xeeb tub, vim hais tias clopidogrel tuaj yeem cuam tshuam kev tso ntawm cov plab hnyuv siab raum thiab lub cev thaum lub sij hawm txhim kho embryonic lossis nce qhov feem ntau yuav los ntshav thaum ua haujlwm, uas tsim qhov xwm txheej tseem ceeb rau lub neej ntawm leej niam.

Cov tshuaj muaj ntau nyob hauv cov qog ntawm lub plab thiab tawm hauv cov kua mis, yog li ntawd, thaum kho nrog Atrogrel, nws raug nquahu kom tsis pub niam mis.

Tsis tas txhaj tshuaj ntxiv rau lub raum puas yog yuav tsum tau.

Noj tshuaj ntau dhau ntawm Atrogrel

Nrog rau kev quav yeeb tshuaj, kev txhim kho ntawm kev tsis zoo nyob rau hauv cov zom zaub mov (ulcerative erosive lesions, mob hauv thaj av epigastric, raws plab thiab ntuav, hemorrhage mus rau hauv cov plab hnyuv ntawm lub plab zom mov) thiab lub sijhawm ntev los ntshav yog qhov ua tau. Nrog tib lub koob txhaj tshuaj loj, tus neeg raug mob yuav tsum hu rau lub tsheb tos neeg mob. Nyob rau hauv cov mob hauv chaw ruaj khov, qhov txhab ntshav tau ua rau ua kom sai sai ntawm qhov rheological cov ntshav.

Yog hais tias tus neeg mob tau noj ntau ntau cov ntsiav tshuaj tsis pub dhau 4 teev, tom qab ntawd tus neeg mob yuav tsum ua kom qaug dab peg, yaug lub plab ntawm lub plab thiab muab cov tshuaj kom nqus kom txo qhov nqus ntawm clopidogrel.

Yog tias ib qho yeeb tshuaj tsis raug tsim txom, tsis zoo hauv lub plab zom mov, piv txwv li, ntuav, kuj yuav tshwm sim.
Nrog tib lub koob txhaj tshuaj loj, tus neeg raug mob yuav tsum hu rau lub tsheb tos neeg mob.
Nyob rau hauv cov mob hauv chaw ruaj khov, qhov txhab ntshav tau ua rau ua kom sai sai ntawm qhov rheological cov ntshav.
Qhov kev coj ntawm cov hemorrhages hauv cov plab hnyuv khoob khoob yog txhim kho los ntawm kev ua ntawm Warfarin.

Kev cuam tshuam nrog lwm yam tshuaj

Nrog rau kev siv Arthrogrel nrog rau lwm cov tshuaj, kev sib cuam tshuam tshuaj hauv qab no:

Thaum noj cov tshuaj tsis-steroidal los tiv thaiv kev tiv thaiv, muaj qhov nce ntxiv ntawm kev yuav los ntshav ntau dua hauv txoj hnyuv. Qhov kev coj ntawm cov hemorrhages hauv cov plab hnyuv khoob khoob yog txhim kho los ntawm kev ua ntawm Warfarin.
Lub plasma concentration ntawm phenytoin thiab tolbutamide nce. Hauv qhov no, qhov tsis zoo los ntawm lub cev tsis pom.
Heparin thiab acetylsalicylates tsis cuam tshuam rau kev kho ntawm Atrogrel.

Tsis muaj tshuaj lom neeg hauv kev sib xyaw ua ke nrog beta-adrenoreceptor blockers, diuretics, antiepileptic thiab hypoglycemic tshuaj.

Cuam tshuam rau lub peev xwm los tswj cov tshuab

Cov tshuaj tsis txhaum kev ua lub siab thiab ua haujlwm ntawm lub cev pob txha. Yog li no, nyob rau lub sijhawm kho, tsav tsheb, tswj hwm cov txheej txheem nyuaj thiab lwm yam dej num uas xav kom tus neeg mob ceev ntawm lub cev kev xav thiab lub siab xav tau.

Atrogrel hloov chaw suav nrog cov tshuaj hauv qab no, nrog cov khoom sib txuam zoo ib yam thiab cov tshuaj pharmacological:

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

Tshuaj ntsiav tshuaj Cardiomagnyl thiab qej Clopidogrel Cardiomagnyl Muaj Qhia

Thaum tsis siv tshuaj kho thaum noj tshuaj Atrogrel, nws yuav tsum sab laj nrog koj tus kws kho mob txog kev hloov cov tshuaj. Hloov pauv mus rau lwm cov tshuaj ib leeg tsis pom zoo.

Hnub tas sij hawm

Cov tshuaj yeeb tshuaj nrov yog Cardiomagnyl.
Yog tias tsim nyog, cov tshuaj tuaj yeem hloov nrog Zilt.
Ib qho muaj pes tsawg leeg zoo sib xws yog Clopidogrel.

Chaw tsim tshuaj paus

JSC Lub Tsev Kawm Ntawv Tshawb Fawb thiab Kho Mob "Borshchagovsky Chemical and Pharmaceutical Plant", Ukraine.

Oleg Hvorostnikov, hnub nyoog 52 xyoo, Ivanovo.

Ntawm kev pom zoo ntawm tus kws kho mob, nws pib noj 1 lub tshuaj ntawm 75 mg thaum tsaus ntuj hauv kev sib txuas nrog kev kuaj mob ntawm atherosclerosis ntawm qhov qis qis. Cov tshuaj pab, qhov tsis txaus ntseeg tau pib tsawg dua. Tab sis hnub 5 ntawm kev kho mob Kuv yuav tsum tau hu rau lub tsheb tos neeg mob. Hemorrhage hauv cov kab noj hniav ntawm lub plab tau pib. Kuv tsis pom zoo kom cov tib neeg nws muaj mob kev mob plab thiab mob txhab. Hauv kuv tsev neeg, qhov no yog qhov yuam kev.

Victor Drozdov, 45 xyoos, Lipetsk.

Ib tug phooj ywg uas, tom qab kev mob stroke, ua rau neeg xiam oob khab, tau raug 1 ntsiav tshuaj ntawm Atrogrel rau 2 lub lis piam. Tom qab mob hlab ntsha, ischemia pib, yog li ntawd sab tes xis tau tsis hnov. Thaum kawg ntawm thawj lub lim tiam ntawm kev kho, tingling pib hauv nqua. Cov tshuaj tau muab ib qho txiaj ntsig. Cov kws kho mob tau hais tias cov tshuaj tau txo cov hlab ntsha thiab muaj ntshav ntxiv hauv thaj chaw ischemic. Kuv tso lus pom zoo.

Daim ntawv tso tawm

Atrogrel - ntsiav tshuaj.
10 ntsiav tshuaj nyob hauv ib lub hlwv, 1 hlwv hauv ib pob, 10 ntsiav tshuaj hauv ib lub hlwv, 3 hlwv hauv ib pob.

1 ntsiav tshuajAtrogrel muaj clopidogrel nyob rau hauv daim ntawv ntawm clopidogrel bisulfate, hauv 100% clopidogrel - 75 mg.
Cov muaj feem xyuam: croscarmellose sodium, microcrystalline cellulose, lactose, castor hydrogenated zaj duab xis membrane roj: hypromellose, lactose, titanium dioxide (E171), triacetin, carmine (E120).