Keʻano lāʻau Clopidogrel C3: kuhikuhi i ka hoʻohana > He hoʻomaʻemaʻe a me ke pale aku

ʻO ka wehewehe e pili ana i 28.01.2015

Palapala Latin: Laka>

ʻO ka papa o ka lāʻau Clopidogrel ka hopena o 75 mg o nā mea hana like ma ka ʻano o ka hydrosulfate.

Nā kumuwaiwai hou: prosalv, lactose monohala, colloidal silicon dioxide, sodium croscarmellose, sodium fumarate.

Ka hana hui: pink opadray II (hypromellose, lactose monohydrate, titanium dioxide, carmine, dye yellow iron oxide, macrogol), silicone emulsion.

E hoʻokuʻu i ke ʻano

ʻO nā papa nā uhi poli a puni ke biconvex i ka like, keokeo-ʻeleʻele ma kahi ʻāpana.

14 papa no nā pākī, 1 a i ʻole 2 mau ʻāpana i kahi pā pepa.
7 a he 10 paha mau papa i ka pā, 1, 2, 3 a i ʻole 4 mau ʻāpana i kahi pā pepa.
7 a he 10 mau papa i loko o kahi pōpō; 1, 2, 3 a i ʻole 4 mau blisters i loko o kahi ʻāpana pepa.
14 a 28 mau papa i loko o kahi pahu polū, 1 pahu i loko o kahi pā.
14 a 28 mau papa i ke polū, hiki i 1 i loko o kahi pā.

Pharmacodynamics a me ka pharmacokinetics

Ua hoʻoikaika ikaika ʻia ka lāʻau lapaʻau i ka hoʻohui ʻana o platelet me ka hoʻokaʻawale mau i ka paʻa o ka adenosine diphosphate (ADP) i nā ʻāpana platelet, a he hōʻemi pū nō hoʻi i ka hiki ke hana i nā mea kūlike glycoprotein ma lalo o ka hana adenosine diphosphate. ʻO ka lāʻau lapaʻau e hōʻemi i ka pilina o nā platelets, ka mea i loaʻa e kekahi mau antagonist, ke kāohi nei i kā lākou hoʻoweliweli hou ʻia e ka ADP. Hoʻohui nā molekole o nā lāʻau me nā mea i hoʻonui ʻia i ka platelet ADP, ma hope o ka lilo ʻana o nā platelets mau loa i ko lākou manaʻo i ka hoʻoulu ʻana ADP.

Kūpono ka hopena o ka hoʻopili ʻana i ka palaki platelet i ʻelua mau hola ma hope o ke ʻano o ka ʻōlelo mua. ʻO ke kiʻekiʻe o ke pani ʻana o ka hoʻohui ʻana e hoʻonui i loko o 4-7 mau lā a hiki i kona kiʻekiʻe i ka hopena o kēia manawa. I kēia hihia, pono ke komo ʻana o ka lā i kēlā me kēia lā he 50-100 mg i kēlā me kēia lā. Inā loaʻa ka hōʻino o ka atherosclerotic vascular, a laila lawe i ka lāʻau lapaʻau e pale i ka holomua o ka maʻi.

Ma hope o ka lawe ʻana i ka lāʻau lapaʻau i kahi manawa pōkole e hoʻopili i ka gastrointestinal tract. ʻO ka bioavailability o ka lāʻau he 50%; ʻaʻole i pili ka ʻai i ka pae. Ka huelo o ka hana huakaʻi i loko o ke akea. I loko o ke kō koko, hiki ke loaʻa nā waiwai nui loa i hoʻokahi hola ma hope o ka lawe ʻana i ka lāʻau lapaʻau. ʻO ka pau ʻana o ka hapalua ola-ʻewalu mau hola, kahi i hoʻopā ʻia e nā keiki a ma o nā ʻāpana ʻole.

Nā ʻōlelo kikoʻī

Pili ka hoʻohana ʻana i ka lāʻau lapaʻau me ka pono o ka mālama mau ʻana i ke ʻano o ka mea maʻi. Loaʻa nā ʻano kikoʻī penei:

I ka poʻe maʻi ʻoi aku ka nui o kona mau makahiki he 75 mau makahiki, e ʻoki ʻia ke kānāwai o ka nui o ka maʻi mua.
I ke kaʻina o ka lāʻau, pono ʻoe e hahai i nā ʻōuli o ka ʻōnaehana kiʻekiʻe, e kaohi i ke ʻano hana o ke akea.
Hoʻohana me ka mālama ʻana i nā maʻi i loaʻa i ka nui o ke neʻe o ke koko no ka hōʻeha ʻana a i nā kumu ʻē aʻe.
Ma mua o nā maʻi e pili ana i ka nalowale o ke koko, pono ia e noʻonoʻo i ka lāʻau e hoʻolōʻihi i ka manawa koko.
Ke hoʻokele nei i nā kaʻa, ʻike e hiki paha i ka clopidogrel ke hoʻohālikelike.

I ka wā hāpai

I kēia lā, ʻaʻohe kumu o nā noi holo piha a me ka papa hōʻike no ka hopena o ke clopidogrel i ka wā hāpai a me ka hoʻomohala ʻana i ka pūpū. No kēia kumu, ʻaʻole ke kuhikuhi ʻana i ka lāʻau i ka wā hāpai. ʻAʻohe mea hōʻike i ka hoʻoili ʻana i loko o ka lāʻau i loko o ka waiū umauma, no laila, ʻaʻole i ʻōlelo ʻia ʻo Clopidogrel i ka wā o ka ʻōpū.

Nā hōʻailona no ka hoʻohana ʻana

Kāohi i nā hanana atherothrombotic ma hope o nā maʻi ma hope o ka maʻi myocardial (mai ka lā mai a hiki i 35 mau lā), he ischemic stroke (mai 7 mau lā a hiki i 6 mau makahiki ka nui) a i ka poʻe paha i kahi maʻi peripheral arterial occlusion maʻi.

Kāohi i nā hanana atherothrombotic (i hui pū me ka acetylsalicylic acid) i nā mea maʻi me ka maʻi coronary syndrome:

- me ka hōʻea ʻole o ka māhele ST (neʻe ʻole aina ʻole a myocardial infarction me ka Q wave), me ka poʻe maʻi e hoʻomau ana me ka ʻanā e pili ana i ka interutan coronary.

- me ka piʻi ʻana o ka ʻāhai ST (ʻoiʻi myocardial infarction) me ka loaʻa ʻana o ka lāʻau lapaʻau a me ka hiki ʻana o thrombolysis.

Nā Hoʻohui

- ka huhū maʻi (no ka laʻana, kahe koko mai i ka uluna peptic a i ʻole hemorrhage intracranial).

- ka lahui lactose lula, lactase ka hapa lactase a me ka malabsorption glucose-galactose,

- nā keiki a me nā ʻōpio ma lalo o 18 makahiki o ka makahiki (ʻaʻole i hoʻokumu ʻia ka palekana a me ka pono),

- Hypersensitivity i clopidogrel a i ʻole nā mea hoʻohiki o ka lāʻau lapaʻau.

- ka huakaʻi kaoole maʻa mau, kahi e hopohopo ai ke koko i hiki ke ʻokoʻa (ʻokoʻa i ka ʻike mākia)

- ka maʻi hakahaka (maopopo i ka ʻike kikī)

- nā maʻi i loaʻa ka predisposition i ka hoʻomohala ʻana i ke koko (e pili ana i ka gastrointestinal a i ʻole intraocular).

- ka hui pū ʻana o nā lāʻau non-steroidal non-inflammatory, komo koho koho COX-2

- ka hoʻohana like o warfarin, heparin, glycoprotein IIb / IIIa inhibitors,

Pehea e hoʻohana ai: dosis a me ke ʻano o ka mālama ʻana

ʻO nā poʻeʻelemakule a me nā mea maʻi maʻi me ka hana maʻamau o ka CYP2C19 isoenzyme

Pono e lawe ʻia i Clopidogrel-SZ ma ke ʻano pono, me ke ʻano o ka kō ʻana o ka meaʻai.

ʻO ka maʻi Myocardial infarction, ka maʻi ischemic, a hōʻike i ke maʻi peripheral arterial occlusion maʻi

Lawe ʻia ka lāʻau lapaʻau ma 75 mg 1 mau lā / lā.

I ka poʻe maʻi me ka myocardial infarction (MI), hiki ke mālama ʻia ka mālama ʻana mai nā lā mua a hiki i ka lā 35 o MI, a me nā mea maʻi me ka ischemic stroke (II) - mai 7 mau lā a hiki i 6 mau mahina ma hope o MI.

Ka maʻi coronary eʻae me ka ʻole o ka paukū st (kahi paʻa, ka myocardial infarction a ʻole Q wave)

Pono e mālama ʻia me ka Clopidogrel-SZ me hoʻokahi dosis o ka hoʻouka ʻana o 300 mg, a laila hoʻomau ʻia ma kahi pākeke o 75 mg 1 manawa / lā (i hui pū me ka acetylsalicylic acid ma ke ʻano he antiplatelet agent ma nā inika o 75-325 mg / lā). Mai ka hoʻohana ʻana o ka acetylsalicylic acid ma nā koina nui e pili ana i ka nui o ka pohō o ke koko, ʻo ka nui o ke ʻano o ka acetylsalicylic acid e pono e nui aku i ka 100 mg. ʻO ka hopena therapeutic kiʻekiʻe e nānā ʻia e ke kolu o ka malama o ka mālama ʻana. ʻO ka papa aʻo o ka mālamaʻana a hiki i ka 1 makahiki.

Ka maʻi coronary e pili ana i ka pae kiʻekiʻe ST

Ua koho ʻia ʻo Clopidogrel ma kahi mahele o 75 mg 1 mau lā / lā me kahi pākaukau hoʻokahi o ka hoʻouka ʻai ʻana i ka hui pū me ka acetylsalicylic acid ma ke ʻano he antiplatelet agent a me ka thrombolytics (a i ʻole thrombolytics). Hoʻomaka ka lāʻau hoʻohui i ka manawa like ma hope o ka hoʻomaka ʻana o nā hōʻailona a hoʻomau mau no ka liʻiliʻi o 4 mau hebedoma. I nā mea maʻi ma luna o ka makahiki 75, pono e hoʻomaka ʻia ke mālama ʻana me Clopidogrel-SZ me ka ʻole o ka lawe ʻana i kahi poka.

ʻO nā maʻi me ka genetically hoʻemi ʻia CYP2C19 Isoenzyme function

ʻO ka nāwaliwali o ka hana metabolism e hoʻohana ana i ka isoenzyme CYP2C19 hiki ke alakaʻi i ka hoʻohemo ʻana i ka hopena antiplatelet o clopidogrel. ʻO ka regimen dosage kiʻekiʻe loa no nā maʻi me ka nāwaliwali nāwaliwali me ka hoʻohana ʻana i ka isoenzyme CYP2C19.

Ka hana lāʻau lapaʻau

Hoʻopiha āpau Antiplatelet. ʻO Clopidogrel he prodrug, kekahi o nā metabolite ikaika o ia ka mea pale i ka hui platelet. ʻO ka clopidogrel metabolite ikaika e kāohi i ka paʻa ʻana o ka adenosine diphosphate (ADP) i ka pīpī ʻeke o ka P2Y12 a ma hope o ka hoʻōla ʻana o ADP-mediated o ka pūlea GPIIb / IIIa, e alakaʻi ana i ka hoʻopaʻa ʻana i ka hoʻohui platelet. Ma muli o ke kau palena ʻole ʻia, mālama ʻia nā platelets i ka hoʻoulu ʻana o ka ADP no ke koena o ko lākou ola (ma kahi o 7-10 lā), a me ka hoʻoulu hou ʻana o ka hana platelet maʻamau i kahi wikiwiki e like me ka hōʻano hou o ka platelet. ʻO ka hui platelet i hoʻoulu ʻia e nā agonist e ʻokoʻa i ka ADP ke kī ʻia ʻia hoʻi e ka blockade o ka hoʻonui ʻana o ka platelet i hoʻonui ʻia e ADP. No ka mea ka hana ʻana i kahi metabolite ikaika me ka hoʻohana ʻana i ka isoenzymes P450, a ʻokoʻa paha kekahi o ka polymorphism a i hoʻopaʻa ʻia paha e nā lāʻau lapaʻau ʻē aʻe; ʻaʻole paha i nā maʻi āpau i loaʻa nā kīkala platelet.

Nā hopena hopena

Mai ke kikowaena waena a me ka peripheral nervous system: pinepine - i ka ʻeha, ka maʻi ʻana a me ka paresthesia, ʻaʻole aneane - vertigo, aneane ʻole - ka pale hewa ʻana i ke ʻano o ka naʻau.

Ma ka ʻāpana o ka ʻōnaehana cardiovascular: ka liʻiliʻi loa - vasculitis, hōʻailona i ka hoʻokaʻina ʻana o ke koko, ka hemorrhage intracranial, hemorrhage ocular (conjunctival, i ka iwi a me ka retina), hematoma, nosebleeds, ka huhū mai ka ʻōpū o ka ʻōpū, ka hoʻokaʻa ʻana o gastrointestinal, hemorrhage retroperitoneal me ka ʻeha. ka hopena, hemorrhages ma nā ʻeha a me nā ʻāpana, hematuria.

Mai ka pūnaehana hanu: ākea loa - bronchospasm, perstonitis interstitial.

Mai ka papa hana ʻana: pinepine - ka ʻeha, ka ʻeha o ka ʻōpū, ka ʻōpū, ka maʻi maʻamau - he ʻōpū o ka ʻōpū a me ka ʻōpio duodenal, gastritis, maʻiʻa, luaʻi, constipation, flatulence, ʻokoʻa loa - pancreatitis, colitis (me ka ulcerative a i ʻole lymphocytic colitis). stomatitis, waha o ka ate ole, hepatitis.

Mai ka ʻōnaehana urinary: jarang loa - glomerulonephritis.

Mai ke ʻano piʻipiʻi koko: pinepine - hoʻonui i ke kahe koko.

Mai ka ʻōnaehana hemopoietic: pinepine - thrombocytopenia, leukopenia, neutropenia a eosinophilia, loa jarang - thrombocytopenic thrombohemolytic purpura, thrombocytopenia nui (platelet counts a ʻoi paha ma kahi o 30 × 109 / l), agranulocytosis, granulocytopenia,

Ma ka ʻāpana o ka ʻili a me nā kiko o ka subcutaneous: pinepine - maʻamau ka ʻili o ke kino a me ka ʻeha, ʻike pinepine loa - angioedema, urticaria, erythematous rash (pili me ka clopidogrel a i acetylsalicylic acid), i aneane loa - dermatitis bullous (erythema multiforme, Stevens-Johnson syndrome, ʻonaʻawa, ka ʻona ), eczema a me ka licus planus.

Mai ka ʻōnaehana musculoskeletal: loa loa - arthralgia, arthritis, myalgia.

Ma ka ʻāpana o ka ʻōnaehana pale: ākea loa - kūʻai i ka anaphylactoid, maʻi serum.

Hoʻohui

Hiki i ka lawelawe ʻana me ka clopidogrel ke hoʻonui i ka nui o ke koko, no laila ʻaʻole ʻae ʻia ka hoʻohana ʻana o kēia hui.

Hoʻohana ʻia ka hoʻohana ʻana o nā blockers receptor IIb / IIIa i hui pū me ka clopidogrel e makaʻala i nā poʻe maʻi e loaʻa ka nui o ke kahe koko (me nā hōʻeha a me nā hana hōʻemi a me nā kūlana pathological paha).

ʻAʻole ka hoʻololi o ka acetylsalicylic i ka hopena o ka clopidogrel, ka mea e pale ai i ka hui platelet ADP-induced, akā ʻo ka clopidogrel potentiates ka hopena o ka acetylsalicylic acid ma ka collelet-induced platelet aggregation. Eia nō naʻe, ʻaʻole i hoʻopiʻi nui ka hoʻohana ʻana i ka acetylsalicylic acid me ka clopidogrel e lilo i mea antipyretic mākaʻi o 500 mg 2 mau manawa / lā no 1 lā ʻaʻole i hoʻoulu nui i ka wā koko i hoʻoneʻe ʻia e ka ʻoihana clopidogrel. Ma waena o ka clopidogrel a me ka acetylsalicylic acid, hiki ke hoʻokūkū pharmacodynamic, kahi e hiki ai ke hoʻonui i ka pohō. No laila, me kā lākou hana like ʻana, pono e mālama ʻia, ʻoiai ma nā noiʻi haumania, ua loaʻa i nā mea maʻi ke ʻano hui me clopidogrel a me ka acetylsalicylic acid a hiki i hoʻokahi makahiki.

Wahi a kahi haʻawina hōʻike i mālama ʻia me nā mea hana olakino olakino, i ka wā e lawe ai i ka clopidogrel, ʻaʻohe pono e loli i ka nui o ka heparin a me kāna hopena anticoagulant, ʻaʻole i loli. ʻO ka hoʻohana like ʻana o ka heparin i hoʻololi i ka hopena antiplatelet o ka clopidogrel. Ma waena o ka clopidogrel a me ka heparin, hiki i kahi hoʻopihapiha pharmacodynamic hiki ke hoʻonui i ka hōʻalo o ke kahe, no laila ʻo ka hoʻohana like ʻana i kēia mau lāʻau e pono ai ka makaʻala.

Nā ʻōkuhi no ka hoʻohana

Hoʻohana ʻia ka Clopidogrel i nā maʻi pākeke 1 mau manawa i ka lā (ma mua o ka ʻaina awakea, ma hope o ka ʻaina awakea), ʻaʻohe o ka meaʻai. ʻAʻole hoʻi e ʻawa ʻia ka papa papa. E inu i ka wai o ka wai (palena liʻiliʻi maʻa 70 ml). ʻO ka laʻana e hōʻike ʻia ai e ka hopena o ka lāʻau lapaʻau ʻo 75 mg i kēlā me kēia lā.

Ka hana noi no ka maʻi naʻau puʻuwai: nā pākeke ma ke keʻena cardiology ma lalo o ka mālama ʻana i nā maʻi lapaʻau i kuhikuhi mua ʻia he 300 mg o clopidogrel. Ma hope aku, hoʻomau ʻia ka hoʻomau i ke kahu mālama ʻana o ka 75 mg, ʻoi aku ka pinepine i nā hui pū ʻana me ka acetylsalicylic acid i loko o nā huina mai 0,075 a 0.325 g.

Nui! No ka pale ʻana i ke kahe, lawe hou aku i ka 100 mg o ka acetylsalicylic acid.

ʻAʻole maopopo ia ka lōʻihi o ke komo ʻana. Ke hoʻomau nei ka lāʻau lapaʻau a hiki i ke ʻano o ka mea maʻi i ka maʻamau i ke ʻano o ke kauka e hele ana.

ʻO ke papa o ka mālama ʻana i ka wā o ka hopena o ka hōʻeha ʻana o ka puʻuwai: ʻo ke kumu o ka clopidogrel he 75 mg i kēlā me kēia lā, ʻoiai ka hoʻomaka ʻana o ka haʻahaʻa o 300 mg i hui pū me nā acetylsalicylic acid a me nā lāʻau thrombolytic.

Nui! He mea nui ia no nā poʻe maʻi ma hope o ko 75 mau makahiki o ka makahiki e wehe i ka hoʻohana ʻana i ke kaomi ʻana i nā helu ʻana o ka lāʻau.

ʻO ka lōʻihi ma hoʻokahi mahina.

I kahi o ka pauku ole, penei e hana ia:

Ināʻoi aku ma mua o 12 mau hola i waiho ʻia ma mua o ka lawe ʻana i ka pōkole hou, inu koke i ka paila.
Inā ma mua o ka noi ʻana i ka hopena hou o clopidogrel e emi iho ma mua o 12 mau hola - e lawe i ka maʻi aʻe ma hope i ka manawa kūpono (ʻaʻole e hoʻonui i ka nui).

Ka pāpā ʻia i ke kuʻikahi a me ka hoʻokau ʻana i ka hoʻohana ʻana i ka clopidogrel, no ka mea e iʻoi aku ka weliweli o ke ʻano o ka mea maʻi.

Ke keu

ʻO ka hoʻohana hewa ʻana o nā palapala kiʻekiʻe o clopidogrel hiki ke hele pū me nā hopena like ʻole:

kahe koko
hoʻonui hoʻonui koko.

Hoʻomaʻamaʻa ka hoʻomaʻemaʻe overdose. ʻOi aku ka maikaʻi o ka hoʻololi ʻana o nā lāʻau lapaʻau e pili ana i ka hāliʻiliʻi platelet.

Me ka waiʻona

I ka pili o ka launa pū me ka waiʻona, hiki i ka ʻeha o ka ʻāʻī ʻana o ka ʻōpū a me nā ʻōpū, e like hoʻi me ke ʻano o ke koko e ulu ai. No laila, pono e hoʻokaʻawale ʻia ka hui ʻana o ke clopidogrel a me ka waiʻona no ka hoʻopulapula haʻahaʻa loa.

Hoʻopuka nā lāʻau lapaʻau i nā pono Clopidogrel:

ʻAno,
Gridoklein,
Ather,
Avix,
Clopidogrel o nā mea hana like - Izvarino, Tatkhimpharmpreparaty, Canon Pharma, Severnaya Zvezda (SZ), Biocom (Rūkīlani Mīkini Clopidogrel), Teva, Gideon Richter, Ratiopharm, Zentiva,
Atrogrel
Kāleka
Diloxol
Sylt,
Holoi,
Deplatt
Noclot,
Kiʻi,
Clorelo
Clopix
Clopidal
Lodigrel,
Orogrel
Helina,
Kūkulu
Lopirel
Plavix,
Reodar,
Trombix,
Plaglir,
Trombeks,
Nā Pūnaewele
Kāleka
Reomax
Trombone,
Clopidex
Plavigrel
Flamogrel.

ʻAʻole like nā loli a pau o kēia mau lāʻau i ka hoʻopili ʻana a me ka hewa o ka mea ikaika. Aia ka hoʻokoʻa ma nā mea hana a me nā kumu kūʻai.

Lapaʻau lāʻau

Hoʻopau Ma hope o kēlā me kēia kīnā waha a 75 a i kēlā me kēia lā, hopu koke ke kelepona i ka clopidogrel. Ka awelika ʻana ka nui o ka plasma kiʻekiʻe o ka pūhui nui (ma kahi o 2.2-2.5 ng / ml ma hope o hoʻokahi kiʻi waha o 75 mg) i nānā ʻia ma kahi o 45 mau minuke ma hope o ka lawelawe ʻana.Hoʻokumu ʻia i nā metabolite clopidogrel i hoʻopuka ʻia i loko o ka urine, aia ka liʻiliʻi ma kahi o 50%.

Kahele. ʻO Clopidogrel a me ka nui (hana ʻole) ka lihilihi i ka metabolite hoʻi e hōʻole hou i nā protein plasma i lokovitro (98 a me 94%, kekona). Ke paʻa nei kēia paʻa paʻa. i lokovitro maluna o nā wahi he nui.

Hāpai. Hoʻopili koke ʻo Clopidogrel i loko o ka ate. Ivitro a i lokovivo Hoʻopili ʻia ka clopidogrel i ʻelua mau ala nui: ka mea i palahalaha ʻia e nā esterases a alakaʻi i ka hydrolysis i kahi kumulāʻau ʻano o kahi waikawa carboxylic. ʻO ka mea, hoʻopili ʻia ka clopidogrel i kahi metabolite waena, 2-oxo-clopidogrel. ʻO ka hoʻololiʻana o ka metabolite ka hopena o ka metabolite waena o 2-oxo-clopidogrel e alakaʻi i ka hoʻokumuʻana o kahi metabolite ikaika, kahi derivative thiol o clopidogrel. Ivitro ʻO kēia ala metabolic i hoʻomāhele ʻia e CYP3A4, CYP2C19, CYP1A2 a me CYP2B6. ʻO ka thiol metabolite kaawale i hoʻokaʻawale i lokovitro wikiwiki a hiki ʻole ke hoʻopili pono ʻia, e hoʻopili me ka hoʻopili ʻia o nā platelet receptors, me ka pale ʻana i ka platelet aggregation.

Me ka_max ʻoi aku ka nui o ka metabolite maʻa ʻelua mau manawa kiʻekiʻe ma hope o hoʻokahi ka manawa o ka hoʻouka ʻana o 300 mg o clopidogrel ma mua o ʻehā mau lā o kahi mālama mālama ʻo 75 mg. Me ka_max nānā i ka manawa 30-60 mau minuke ma hope o ka lawe ʻana i ka lāʻau lapaʻau.

Hoʻopau. Ma kahi o 50% o ka lāʻau lapaʻau e kāpae ʻia i loko o ka pāʻai a ma kahi o 46% me nā feces i nā hola 120 ma hope o ka hoʻokō ʻana. Ma hope o hoʻokahi kahe waha waha o 75 mg, ʻo ia ka hapalua o ka hapalua o ke ola o ka clopidogrel he 6 mau hola. ʻO ka hapalua ola o ka metabolite koʻikoʻi nui he 8 mau hola ma hope o ke ʻano hoʻokahi a hoʻokahi.

Lapaʻau lāʻau. Hoʻololi ʻo CYP2C19 i ka hoʻokumu ʻana i kahi metabolite ikaika a me kahi metabolite waena waena, 2-oxo-clopidogrel. ʻO ka hopena Pharmacokinetics a me nā hopena antiplatelet o ka metabolite ikaika o ka clopidogrel e like me ke ana ma ka hōʻike ʻana o ke ʻano platelet exvivo, kūlike ia i ka genotype o CYP2C19.

ʻO ka CYP2C19 * 1 allele e pili ana i kahi metabolism holoʻokoʻa holoʻokoʻa, aʻo CYP2C19 * 2 a me CYP2C19 * 3 alleles i ʻole hana. ʻO ka account alleles CYP2C19 * 2 a me CYP2C19 * 3 ka helu no ka hapa nui o nā alleles me ka hōʻemi ʻana i ka hana ma ke keʻokeʻo keʻokeʻo (85%) a me nā poʻe ʻAmelika (99%) me ka lawa ʻole o ka metabolism. ʻO nā mea āpau ʻē aʻe me ka hana a i ʻole ka hoʻemi ʻana i ka lawelawe, i waena pū me CYP2C19 * 4, * 5, * 6, * 7 a me 8 ʻO nā mea maʻi me ka hoʻohaʻahaʻa metabolic function he mau halihali ʻelua o nā alleles pono ʻole. Wahi a nā hōʻike i paʻi ʻia, ʻo ka pinepine o ka hanana o ka genotype me ka hana haʻahaʻa haʻahaʻa o CYP2C19 ma kahi o 2% i ka lāhui Caucasoid, 4% i ka lāhui Negroid a me 14% i ka lāhui Mongoloid.

ʻAʻole lawa ka nui o nā haʻawina e ʻike i nā ʻokoʻa i nā hopena no nā poʻe maʻi me ka lawaʻole o ka clopidogrel metabolism.

Hola paʻa kino hana. ʻO ka ʻai ʻana o ka metabolite nui i ka plasma koko i ka wā e lawe ai i ka 75 mg o ka clopidogrel i kēlā me kēia lā ka haʻahaʻa loa i nā mea maʻi me ka maʻi ʻehaʻeha (ʻo ka cleinine clearance mai 5 a 15 ml / min) hoʻohālikelike ʻia me nā mea maʻi ʻo kā cleinine clearance he 30-60 ml / min a oleio oleio. I ka manawa like, ʻo ka hopena pale i ka hoʻohui ʻana o ka platelet ADP-induction i loko o nā mea maʻi me ka maʻi maʻi o ka maʻi ua hōʻemi ʻia (25%) i hoʻohālikelike ʻia me nā hopena like ʻole i nā kānaka olakino, ua hoʻolōʻihi ʻia ka manawa koko i ka hopena like ma nā poʻe olakino i loaʻa i ka 75 mg clopidogrel i kēlā me kēia lā. Eia kekahi, ʻoi ka maikaʻi o ka pale ʻana ma nā maʻi āpau.

Hōʻeha ka naʻau ʻili. I ka poʻe maʻi me ka maʻi hepatic koʻikoʻi, i ka wā e lawe ai i ka pākahi i kēlā lā i kēia lā he 75 ml o clopidogrel no 10 mau lā, ʻo ka ADP-induction suppression o platelet aggregation i like pū me i ka poʻe olakino. ʻO ka like me ka hoʻonui ʻana i ka manawa koko ua like nō hoʻi ma nā hui ʻelua.

Kāhea. ʻO ka nui o ka alleles CYP2C19, e hoʻohālikelike i ka hōʻuluʻulu waena a me ka metabolism maikaʻi e pili ana CYP2C19, ʻokoʻa i ka lāhui a me ke ʻano ʻē aʻe. Loaʻa wale nā ʻikepili i ka lehulehu ma Asia i loaʻa i ka puke e loiloi i ke ʻano kino o kēia genieype CYP no nā hopena olakino.

ʻŌpū a me ka lactation

ʻO nā haʻawina e pili ana i nā hopena o clopidogrel i ka wā hāpai i mālama ʻia i nā holoholona, ʻaʻole i hōʻike i ka hopena maikaʻi ʻole i ka hapai ʻana, ka hoʻomohala ʻana o ka embryo / fetus, hana a me ka hoʻomohala postnatal.

Haumakua. ʻAʻole i ʻike ʻia inā hoʻopili ʻia ka clopidogrel i loko o ka umauma wai kanaka. Ua hōʻike ʻia nā haʻawina holoholona holoholona i ka lāʻau i loko o ka waiū umauma. E like me ka mua o ka mālama ʻana, pono ka hōʻuluʻulu o ka umauma i ka wā o ka mālama ʻana me ka clopidogrel.

No ka mea nui ka nui o nā lāʻau lapaʻau i loko o ka waiū umauma, a no ka hiki ke hoʻomohala i nā hopena ʻino i nā keiki hānai hānai, ʻoi ka hoʻoholo e hoʻolei i ka lāʻau a hōʻoki paha i ka uwē ʻana, e hana ʻia, hāʻawi ʻia i ka pono no ka clopidogrel therapy i ka makuahine hānai.

Hopu hana. I nā haʻawina holoholona, ʻaʻole i pili ka clopidogrel i ka hana hānau.

ʻLoe a me ke kākele

Kuhi ʻia ʻo Clopidogrel no ka hoʻoponopono waha i kēlā me kēia lā, me kaʻole o ka meaʻai.

Nā ʻōpala

ʻO nā pākeke a me nā poʻe kahiko

ʻO ka paona maʻamau ʻo kēlā me kēia lā he 75 mg maʻamau ma ka lā.

ʻO ka maʻi coronary ʻeha:

- ka maʻi coronary ʻokoʻa ʻole o ka pae kiʻekiʻeST(uniana paʻa indina ʻole myocardial infarction me ka mea ʻole o ka nihoQ): Hoʻomaka ʻia ka lāʻau Clopidogrel me kahi pahu hoʻokahi ʻana o 300 mg, a hoʻomau ʻia me ka houluana o 75 mg hoʻokahi i hoʻokahi lā (me ka acetylsalicylic acid ma kahi kikoʻī o 75-325 mg i hoʻokahi lā). ʻAʻole ia e uku i kahi ʻoi aku o ka acetylsalicylic acid o 100 mg, no ka mea e pili ana nā dosis kiʻekiʻe o ASA me ka nui o ke kahe. ʻAʻole paʻa i ka lōʻihi o ka mālama ʻana. Hoʻopili ka data hoʻokolohua maʻi lapaʻau i ka hoʻohana ʻana o ka hoʻoponopono no nā mahina 12, a ʻo ka nui o ka pōmaikaʻi e nānā ʻia ma hope o 3 mau mahina.

- myocardial hoʻonā ʻia me ka kiʻekiʻe kiʻekiʻeST: Ua kau ʻia ka clopidogrel i hoʻokahi manawa i ka lā ma kahi o ka 75 mg e hoʻohana ana i kahi pākaukau mua o 300 mg i hui pū ʻia me ka acetylsalicylic acid i hui pū ʻia a i ʻole me nā thrombolytics ʻē aʻe. No nā mea maʻi i ʻoi aku ma mua o 75 mau makahiki o ka makahiki, pono e mālama ʻia ka lāʻau clopidogrel me ka ʻole o ka hoʻohana ʻana i kahi pāʻālua. Hoʻomaka ka lāʻau hoʻohui me ka hiki ke hoʻomaka ma hope o ka hoʻomaka ʻana o nā hōʻailona a hoʻomau mau no ka liʻiliʻi o nā hebedoma ʻehā. Loaʻa nā pōmaikaʻi o ka hui pū ʻana o clopidogrel me ASA ma hope o nā hebedoma ʻehā i aʻo ʻia i kēia hihia.

Hoʻopili ʻo Atrial: 75 mg clopidogrel hoʻokahi lā i ka lā. Hāʻawi iā ASA (75-100 mg / lā) a hoʻomau i ka lawe pū ʻana me clopidogrel.

Ma ka ʻae ʻana o ke kākā:

- e emi iho ma mua o 12 mau hola ma hope o ka manawa maʻamau o ka hoʻokomo: pono e lawe koke i ka dosis, pono nā lāʻau hou aʻe i ka manawa i hoʻonohonoho ʻia.

- Ponoʻoi aku ma mua o 12 mau hola ma hope o ka manawa maʻamau o ka hoʻokomo ʻana: pono e lawe ʻia ka lāʻau hou aʻe i ka manawa i hoʻonohonoho ʻia, me ke kānalua ʻole.

Na keiki a ʻōpio

ʻAʻole paʻa i ka palekana a me ka hana o ka clopidogrel i ka lahui pediatric.

ʻO ka maʻi me ka hana renal impaired

He liʻiliʻi ka ʻike no ka hoʻomaʻamaʻa ʻana i nā mea maʻi me nā mahi ʻole a pau ʻole.

ʻO nā mea maʻi me ka hana pūlima hemahema

ʻO ka ʻike pono i ka mālama ʻana i nā maʻi me nā maʻi maʻi palupalu i hiki ai i ka hemorrhagic diathesis ka mea liʻiliʻi.

ʻO nā mea mālama palekana

Hoʻolaha a me nā hopena hematologic

Inā hele mai nā ʻōleʻa lapaʻau i ka wā o ka mālama ʻana e hōʻike ana i ka hoʻomohala ʻana o ke koko a me nā hopena hematological, pono ke hana i kahi hōʻike koko. Ma muli o ka piʻi nui o ka huhū, pono e hoʻohana ʻia ka makaʻala i ka wā e hoʻopili pū ai ʻo clopidogrel me warfarin.

Pono e hoʻohana ʻo Clopidogrel me ka makaʻala i nā mea maʻi i ka piʻi nui o ke koko e pili ana i ka trauma, i ka hana ʻana a i ʻole nā kūlana pathological, aia hoʻi i ka hui pū ʻana o ka clopidogrel me ka acetylsalicylic acid, nā lāʻau lapaʻau anti-inflammatory non-steroidal, me nā haukole COX-2, heparin, glycoprotein inhibitors. IIb / IIIa, selotonin reuptake inhibitors (SSRIs) a i nā mea ola ʻē aʻe e pili ana i ka hopena o ke koko, e like me pentoxifylline. Pono ka nānā pono ʻana o ka hōʻike ʻana o nā hōʻailona o ka huhū, me ke komo ʻana i ka pehu latene, e pono no i nā hebedoma mua o ka mālama ʻana a / ai ʻole ma hope o nā hanana cardiac invasse a i ʻole maʻa. ʻAʻole i ʻōlelo ʻia ka hoʻohana pū ʻana o ka clopidogrel me nā anticoagulants waha, no ka mea, he hiki ke hui pū ʻia e hoʻonui i ka nui o ke kahe.

Ma ka hihia o nā mea hōʻiliʻili o ka hopena, inā he hopena antiplatelet e hikiʻole, e hoʻokaʻawale ʻia ke ʻano o ka mālama ʻana me clopidogrel i nā lā 7 ma mua o ka hoʻomaʻemaʻe ʻana. Pono e hōʻike i ke kauka hele ʻana a me nā mea lapaʻau e pili ana i ka lawe ʻana i ka lāʻau lapaʻau inā e hoʻomaʻamaʻa ka mea maʻi a i ʻole ke kuhikuhi ke kauka i kahi lāʻau hou no ka mea maʻi.

Pono e hoʻohana ʻia ka Clopidogrel me ka makaʻala i nā mea maʻi i ka hopena o ke koko (ʻoi loa ka gastrointestinal a me ka intraocular). Ke lawe nei i ka clopidogrel, e hoʻohana akahele i ka hoʻohana ʻana i nā lāʻau hōʻeha e hiki ai i nā maʻi o ke ake o ka ʻokiʻoki (e.g., acetylsalicylic acid a me nā NSAID).

E makaʻala ʻoe no ka mea e hoʻohiolo i ke koko i ka wā e lawe ana i ka clopidogrel (ʻo ia wale nō a i hui pū paha me ASA) pono nui ka manawa, pono ʻoe e hoʻomaopopo i kāu kauka e pili ana i kēlā me kēia hihia o ka maʻamau (ma ke ʻano o ka wahi a me / a lōʻihi paha) koko.

Thrombocytopenic Purpura (TTP)

ʻAʻole loaʻa nā hihia nui o ka thrombocytopenic purpura (TTP) ma hope o ka clopidogrel. Hōʻike ʻia kēia i ka thrombocytopenia a me microangiopathic anemia hemolytic i hui pū ʻia me nā ʻōlima a neurological, ʻokiʻoki a me ke ake maʻi. Hiki i ka hoʻomohala ʻana o TTP ke ola hoʻoweliweli a koi i kahi hana wikiwiki, e komo pū me ka plasmapheresis.

ʻO nā hihia o ka hoʻomohala ʻana i loaʻa ka hemophilia i loaʻa ma hope o ka lawe ʻana i ka clopidogrel. I ka hihia o kahi hoʻonui i hōʻoia ʻia i ka manawa thromboplastin hoʻolaʻa hoʻolaʻa i hoʻolaʻa me ka ʻole ʻole o ke kahe, ke noʻonoʻo pono ʻia ka loaʻa ʻana o ka hemophilia i loaʻa. ʻO ka poʻe maʻi me ka maʻi hōʻoia i hōʻoia ʻia i ka hemophilia i loaʻa ʻia, pono e nānā a mālama ʻia e nā loea, ʻoi aku ka lāʻau clopidogrel.

Ma muli o ka lawa ʻole o ka ʻike, ʻaʻole pono e kuhikuhi ʻia nā clopidogrel i nā lā 7 mua o ka maʻi o ka ischemic stroke.

I ka poʻe maʻi me ka hoʻohaʻahaʻa metabola hana o CYP2C19, ʻo ka clopidogrel i loko o nā koina i ʻōlelo ʻia ai e hāʻawi i kahi hapa liʻiliʻi o ka metabolite ikaika o ka clopidogrel a me ka hopena antiplatelet i haʻahaʻa. ʻO nā mea maʻi me ka hoʻohaʻahaʻa metabola ma ka maʻi coronary syndrome a i ʻole ka mea i loaʻa i ka hoʻoneʻe coronary percutaneous a ke loaʻa nei ka hopena clopidogrel i nā ʻōkena i ʻōlelo ʻia ai, e piʻi paha ka nui o ka hoʻomohala ʻana i nā hoʻopiʻi cardiovascular ma mua o nā mea maʻi me ka hana hana maʻamau o CYP2C19.

No ka mea ka hoʻokaʻina clopidogrel i kahi metabolite ikaika ma kekahi ma o CYP2C19, e manaʻo ʻia e nā lāʻau lapaʻau e ʻoki ana i ka hana o kēia enzyme e alakaʻi ai i ka emi ʻana o ka hōʻalo o ka lāʻau o ka metabolite clopidogrel aktif. ʻAʻole i aʻo ʻia ka maʻi koʻikoʻi o kēia pilina. ʻO ka hoʻohana ʻana i ka ʻōmole mākeke ikaika ʻole CYP2C19 i hoʻopau ʻia.

Pono ʻia ka mālama ʻana i nā mea maʻi e loaʻa pū ana me nā lāʻau clopidogrel - nā kānana o ka isoenzyme CYP2C8.

Allergic cross-reactivity

Pono ka mea maʻi i kekahi mōʻaukala o ka hypersensitivity i nā thienopyridines ʻē aʻe (e.g. ticlopidine, prasugrel), no ka mea aia nā hihia i ka maʻi al-crossactactivity me nā thienopyridines. ʻO nā mea maʻi me ka mōʻaukala o ka hypersensitivity i nā thienopyridines ʻē aʻe e mālama pono ʻia i ka wā o ka mālama ʻana no nā hōʻailona o ka hypersensitivity i clopidogrel. Hiki i nā Thienopyridines ke alakaʻi i ka hoʻomohala ʻana i nā hopena kūlohelohe o nā ʻano paʻakikī, e like me ka pāheʻe ʻana, ka edema o Quincke, a i ʻole hematological cross-reaksi, e like me thrombocytopenia a me neutropenia. ʻO nā mea maʻi i loaʻa i ka mōʻaukala o nā hopena alaka a me / a he hematological paha i hoʻokahi thienopyridine i nui ka piʻi o ka ulu ʻana i like ʻole a i ʻole nā ʻano like ʻole ʻē aʻe i kekahi thienopyridine.

ʻO ka pūnaina o ka lāʻau lapaʻau ka loko o ka waʻa karmuazin (E-122), hiki i nā mea kūlohelohe.

Hola paʻa kino hana

Hoʻohālikelike ka hopena therapeutic me clopidogrel i nā maʻi me nā maʻi renal impaired. Pono e hoʻohana ʻia ka lāʻau i loko o nā mea maʻi me ka akahele.

Hōʻeha ka hana ʻoluʻolu

Pono e hoʻohana i ka Clopidogrel me ka makaʻala i nā mea maʻi me ka hana o ka puʻuwai maʻi i hōʻemi ʻia, ka mea e hōʻeha ai i ka hemorrhagic diathesis.

Hoʻokomo i ka hiki ke lawe i nā kaʻa a me nā mīkini ʻē aʻe e weliweli hou ʻia. ʻAʻole pili a Clopidogrel a i ʻole he hopena iki no ka hiki ke alakaʻi i nā kaʻa a me nā mīkini ʻē aʻe.