Pehea e hoʻohana ai i ka lāʻau Lopirel? > He hoʻomaʻemaʻe a me ke pale aku

ʻO ka hana ikaika o ka lāʻau lapaʻau wae pale i ka molekulu lālani ADP me nā mea ākea e kū pono ana ma ka papa pā helu platelet. ^ E Ha yM. Pēlā, ʻo ka hoʻōla ʻana o ka paʻakikī GPIIb / IIIa a pāwili hui hiki ʻole. Eia pū kekahi clopidogrel hoʻokaʻawale i nā kaʻina o ka hoʻohui ʻana i hoʻoiho ʻia e kekahi nā lāʻau kūleʻa. ^ E Ha yM. Noho mau nā platelets i ka pōʻino a hiki ke hoʻōla a hiki i ka hopena o ko lākou ola ʻana. hoʻohui.

Ma hope o ka loaʻa ʻana o ka wai lāʻau mua, ua hoʻomaka kahi kaʻina antithrombotic, ua hoʻokumu ʻia ke pae o leukocytes e 3-7 lā o ka hoʻokele ʻana. I ka awelika, 5 mau lā ma hope o ka hoʻokuʻu ʻana o ka hoʻōla, platelet aggregation a me ka lōʻihi o ke kahe koko e hoʻi ana i ka pae mua.

Mālama koke ʻia ka lāʻau i loko ʻŌpala Gastrointestinal. ^ E Ha yM. Eia naʻe, ʻo ka ʻona clopidogreli loko o plasma i ka haʻahaʻa haʻahaʻa loa, ʻo 50% o ka ʻōpū o 50%. Hoʻopaʻa maikaʻi ka lāʻau lapaʻau i nā protein plasma koko.

Hoʻomili ka Clopidogrel i loko o ka ate, ma kahi o 80% o nā metabolites i loaʻa i ka plasma ʻaʻole he hana. ʻO ka metabolite hoʻoikaika, ka mea e hāʻawi ai i ka pono anti-aggregate hana, i hoʻokumu ʻia e kahi ʻōnaehana oxidation, pili isoenzyme o ka Petoʻi P450 - 2B6 a me 3A4. ^ E Ha yM. Hoʻoikaika koke ka metabolite me ka Nā kīlā a ʻaʻole ʻike i loko o ke kō koko.

ʻO ka hapalua kahi 6 mau hola no ka waiwai ikaika a me 8 no ka mea hikiʻole ke hana i ka metabolite. Hoʻopau nui ʻia nā huahana me ka urine a me nā mea momona.

ʻO nā poʻe e loaʻa nei me ka hiki ʻole o ka pilikia hana kino, kahi hōʻemi i ka hopena o ka lāʻau lapaʻau ma 25% i hoʻohālikelike ʻia me nā poʻe olakino.

Nā manaʻo no ka hoʻohana ʻana o Lopirel

Hoʻohana ʻia ka lāʻau lapaʻau e pale ai he ʻōpala paʻū i nā poʻe e loaʻa ana i ka ʻeha coronary syndrome:

Hoike ʻia no ka hoʻohana ʻana Hoʻoponopono nā hihia i nā maʻi i hōʻeha ʻia myocardial infarction, he pohoai maʻi maʻi peripheral arterial. ^ E Ha yM. I kēia hihia, hoʻohana ʻia ke lāʻau lapaʻau ma ka mea he prophylaxis.

Nā Hoʻohui

ʻAʻole i kuhikuhi ʻia ka lāʻau lapaʻau.

i kela ulu ana pūpū hema,
wahine hapai a me nā wahine hāpai
ma ʻōpū maʻi hemorrhagic,
ma ʻōpū kikohoʻe, ʻōpū ʻōpūaole maopopo ulitisative colitis, pūpū māmā, piʻi a pālahalaha hyperphibrinolysis,
keiki malalo o 18 makahiki
ma nā pepeke ma luna o nā māhele o ka lāʻau lapaʻau,
me ka hakakā ʻole galactosa.

Pono e hoʻomaʻemaʻe ʻia i ka wā e hoʻopili ʻana i ka lāʻau lapaʻau me ka acetylsalicylic acid, Nā NSAID, heparin, holomoana, me nā renal a me ka maʻi hepatic, ma mua o ka hoʻokō ʻana.

Lopirel, nā ʻōlelo aʻoaʻo no ka hoʻohana (ʻano a me ke ʻano)

Lawe ʻia nā papa papaʻaina, me kahi laʻa o ka hoʻoponopono.

Nā ʻōkuhi no ka hoʻohana Lopirel (75 mg)

Ma ke kānāwai, me myocardial infarctionis strokeic stroke, i nā mea maʻi me nā maʻi ʻimi i loko o ka pōkole ua kuhikuhi ʻia 1 papa 1 manawa i ka lā.

Ka lōʻihi o ka hoʻokomo ʻana ma hope puʻuwai puʻuwai - mai 1 a hiki i ka 25 lā, ma hope māhā - 7 lā a 6 paha mahina.

Inā nā mea maʻimaʻi coronary syndrome me ka hoʻokiʻekiʻe ST a i hoʻopaʻa ʻia ke hoʻokūkū coronary, laila e hoʻomaka ka mālama ʻana i kahi maʻi o 300 mg, a laila 75 mg (hoʻokahi papa) i kuhikuhi ʻia i hoʻokahi manawa i hoʻokahi lā no nā mahina 3 (ʻo ka papa e hiki ke hoʻonui ʻia i hoʻokahi makahiki). I kēlā mau maʻi, e like me ke lula, ua hoʻākāka ʻia aka, akacetyl salicylic acidʻO ka dosice i ʻōlelo ʻia ʻia ʻo 100 mg.

E hoʻokuʻu i ke ʻano a me ka ʻano

Loaʻa ia Lopirel i loko o ke ʻano o nā papa i loko o kahi kiʻi ʻoniʻoni: pōpilikia, biconvex, pink, me kahi kiʻi "I" ma kahi ʻehā (7 a 10 mau papa i loko o kahi pā kihi: ma kahi pūpū palaka o 1, 2, 4 a i 8 blisters, 7 mau papa a i ʻole 1. 2, 3, 5, 6, 9 a 10 mau blisters no 10 papa, i loko o kahi pahu kāleka no kahi haukapila 10, 20, 30 a 40 mau blisters).

1 papa o Lopirel ka:

mea waiwai: clopidogrel - 75 mg,
nā mea waiwai: microcrystalline cellulose, lactose, talc, glyceryl dibehenate, crospovidone (type A),
shell: Opadry II 85G34669 Pink talc, polyvinyl alkohol, macrogol 3350, titanium dioxide (E171), dye iron oxide red (E172), lecithin (E322).

Nā hana hana i ka hana

Hoʻokomo ka Clopidogrel i ka māhele o nā mea hana. ʻO kekahi o kāna metabolites ka mea paʻa paʻa o ka platelet aggregation: pale i ka hoʻopaʻa ʻana o ka adenosine diphosphate (ADP) a me P2Y₁₂na platelet receptor i ukali ʻia e ka ADP-hoʻololi i hoʻohui ʻia o ka paʻakikī o ka glycoprotein IIb / IIIa, kahi mea e hoʻoneʻe ai i nā hui platelet. Ka hāmeʻa ʻana e hiki ai i ka mīkini ke pale aku i ka platelets i ka pale ʻana i ka hoʻoulu ʻana i ka ADP ma ko lākou ola (ma kahi o 7-10 lā). Hoʻihoʻi ʻia ka hana maʻamau o nā platelets ma muli o ka wikiwiki o kā lākou hoʻonui.

Hōʻalo ʻia ka lāʻau lapaʻau i ka hoʻohui platelet i kumu ʻia e nā agonist e like me ADP. Ma muli o ka hana o nā isoenzymes o ke ʻano ka P₄₅₀, a ma muli he mau ʻokoʻa like ʻole isoenzymes i polymorphism a i hoʻopaʻa ʻia e nā lāʻau ʻē aʻe, ʻaʻole nā maʻi āpau i lawa ka pale ʻana o ka hui platelet.

ʻO nā hiʻohiʻona Pharmacodynamic

Kahi kikowaena o clopidogrel i kēlā me kēia lā o 75 mg e hāʻawi i kahi nui o ke koikoi ʻana o ka ADP-induced platelet aggregation mai ka lā mua o ka hoʻokele ʻana. Hoʻolaha, ma ke ʻano o 3-7 lā, hoʻonui ʻia ke ʻano o ka hoʻokā ʻana, hiki i ka pae mau loa ma hope o ka hōʻea ʻana i ke kāʻā ʻana o ka waiwai. Ke lawe nei i kahi lā maʻi o kēlā me kēia lā he 75 mg ma ka kūlike, hoʻopau ʻia nā platelet e ka 40-60%. Ma ke kumu o 5 mau lā ma hope o ka hoʻokuʻu ʻana i ka lāʻau lapaʻau, hiki ke kahe manawa a me ka hōʻuluʻulu ʻana o ka platelet i ka pae mua.

He ʻoihana hana / palekana

Kāpopopala ʻo Clopidogrel i ka hoʻomohala ʻana o ka atherothrombosis i kekahi ʻōnaehana o nā loina varo atherosclerotic (no ka laʻana, me nā leʻaleʻa o ka coronary, peripheral a i ʻole cerebral arteri).

I kahi hōʻike ACTIVE-Ka hōʻike hōʻike maʻi maʻi, hōʻike ʻia inā inā he atrium wā fibrillation i nā mea maʻi i loaʻa i hoʻokahi a keu paha ke ʻano no ka hoʻopiʻi vascular akā hiki ke lawe i nā anticoagulants kūlohelohe, ka hui pū ʻana o ka clopidogrel a me acetylsalicylic acid (hoʻohālikelike ʻia i ka acetylsalicylic acid monotherapy) i hōʻemi i ka pinepine me lawe i ka myocardial infarction, stroke, thromboembolism ʻōnaehana ma waho o ka ʻōnaehana o loko a i ʻole make vascular, ma muli o ia i ka emi ʻana o ka hōʻeha o ka ʻeha. ʻO ka hopena o ka hoʻokele ʻana o ka clopidogrel a me ka acetylsalicylic acid i hōʻike pono iā ia iho a hoʻomau i ka 5 mau makahiki. ʻO ka emi ʻana o ka hiki ʻana o ka hoʻopiʻi nui ʻana i ka hoʻopiʻi vascular nui i nā maʻi e lawe ana i ka acetylsalicylic acid a me ka clopidogrel i hāʻawi nui ʻia e nā hōʻemi nui ʻana i ka hakahaka o nā hahau. I ka wā o nā lāʻau lapaʻau me kēia mau lāʻau lāʻau, ua hōʻemi ʻia ka hōʻeha o kahi hōʻeha o kekahi hōʻeha, aia kekahi manaʻo i ka hoʻohaʻahaʻa i ka hōʻeha o ka wā myocardial infarction, akā ʻaʻohe ʻano ʻē aʻe o ka hopena o ka thromboembolism ma waho o ka pūnaehana puni waena a i ʻole ka make vascular. Me kēia, lawe i ka clopidogrel a me acetylsalicylic acid i hōʻemi ʻia i ka manawa o ka hale hoʻomaha ma ka poʻe maʻi me nā pilikia o ka ʻōnaehana cardiovascular.

Kapehu

E like me ka pākahi, a me ka papa papa lāʻau o clopidogrel ma kahi momona o 75 mg i kēlā me kēia lā, wikiwiki koke ke ʻano o ka waihona. I ka awelika, ka lōʻihi o ka piʻi ʻana o ka clopidogrel i hoʻololi ʻia i loko o ke kaila koko ua hōʻea a ma kahi o 45 mau minuke ma hope o ka lawelawe waha a me ka pae mai 2.2 a 2,5 o / ml. ʻO ka komo ʻana o nā clopidogrel e nā keiki (e like me ka laʻa o nā metabolites) ma ka liʻiliʻi o 50%.

Hāpai

Hoʻā ka nui o ka mea ola ma ka kō. I ka vivo a i ka vitro, e hoʻomaʻamaʻa ka clopidogrel i ʻelua mau ala: ma o ka esterase i ukali ʻia e ka hydrolysis, ka hopena o ka neʻe ʻana o ka hanana carboxylic acid (85%) mai nā metabolites pōʻai i loko o ka piʻina systemic ma o ka system cytochrome P₄₅₀.

I ka hoʻomaka mua, hoʻohālikelike ʻia ka clopidogrel i kahi metabolite waena - 2-oxoclopidogrel. ʻO ka hoʻoneʻe o ka hoʻoliʻi o ka oxoclopidogrel e hōʻemi i ka hiʻohiʻona o kahi metabolite ikaika, a thiv derivative o clopidogrel. Loaʻa kēia ma ke ala metabolic vitro me ke komo ʻana o nā isoenzymes CYP2C19, CYP3A4, CYP2B6, a me CYP1A2. ʻO ka metabolit thiol ikaika i hoʻokaʻawale i ka vitro hiki ʻole ke hoʻopaʻa koke a hoʻopaʻa ʻia i nā ʻāpana platelet, e pale ana i kā lākou hōʻuluʻulu ʻana.

Ma ka hihia hoʻokahi o ka clopidogrel ma kahi o 300 mg, ʻoi loa ka nui o ke koena o ka metabolite ikaika ʻelua a ʻoi aku ka nui ma mua o ke lawe ʻana i kahi mālama mālama clopidogrel 75 mg no 4 lā. ʻO ka pākuʻi loa o ka metabolite ikaika o ka clopidogrel i hoʻopaʻa ʻia i nā hola 0.5-1 ma hope o ka lawe ʻana i ka lāʻau.

I nā kāne, ma hope o ka hoʻomoʻa waha ʻana o ka clopidogrel 14 C-hōʻailona no ka mau hola 120, ma kahi o 46% o ka radioactivity ka mea i kāpae ʻia e ka ʻōpū a ma kahi o 50% o ka radioactivity ka mea i hoʻopili ʻia e nā keiki. Ma hope o hoʻokahi ka manawa o clopidogrel i kahi maʻa o 75 mg, ʻo ka hapalua-ola kahi aneane 6 mau hola. Me kahi mau pākahi hoʻokahi a me nā ʻōmole kau pinepine, ʻo ka hapalua o nā manawa o ka neʻe nui mau ʻole i ka metabolite nui i loko o ke koko he 8 mau hola.

Lapaʻau lāʻau

ʻO ka metabolite hoʻoikaika o clopidogrel a me ka metabolite waena o 2-oxoclopidogrel i hoʻokumu ʻia me ka hoʻohana ʻana i ka isoenzyme CYP2C19. Hoʻopilikia ka CYP2C19 genenype CenP2C19 i ka hopena antiplatelet a me pharmacokinetics o ka metabolite kaha i ka wā o kahi vivo platelet aggregation study.

E pili ana ka allele o ka huahelu CYP2C19 * 1 i kahi metabolism holoʻokoʻa holoʻokoʻa, a ʻo nā alelē o nā CYP2C19 * 3 a me CYP2C19 * 2 he mau hana a he kumu a hōʻemi i ka hoʻoneʻe ʻana i ka hapa nui o nā mālamalama o Mongoloid (99%) a me nā lāhui Caucasoid (85%). ʻO nā alelima ʻē aʻe e hoʻoulu ai a nele paha i ka metabolism (me ka helu ʻole akā ʻaʻole i kaupalena ʻia i nā alleles o CYP2C19 * 4, * 5, * 6, * 7, * 8 mau keiki) he mea maʻamau. ʻO nā mea maʻi e nāwaliwali nā metabolizers, pono e loaʻa i nā alleles ʻelua i hōʻike i ka hanana me ka nalowale o ka hana. Wahi a nā ʻikepili i paʻi ʻia, ʻo ka pinepine o nā phenotypes o nā metabolizer nāwaliwali CYP2C19 nawaliwali i nā kānaka o ka lāhui Negroid he 4%, ka lāhui Caucasoid - 2%, a me ka Kino - 14%.

No ka loiloi i ka pharmacokinetics a me ka hopena antiplatelet i ka wā e lawe ai i kahi hoʻomaka mua o ka clopidogrel 300 mg a me kāna kōkuhi o 75 mg i kēlā me kēia lā, me ka lawe ʻana i kahi ʻano kumu mua o clopidogrel 600 mg a me kāna hana mua o 150 mg pākahi no kēlā lā no 5 mau lā (a hiki i ke kūpaʻa ʻana. ) kahi hui cross-section i hana ma kahi o ka mea hana 40 mau pūʻulu i ka hui 4 o ka poʻe 10 me 4 mau subtypes o ka CenP2C19 isoenzyme (ultrafast, ikaika, nāwaliwali a i ʻole ka waena waena o nā metabolizers). Ma muli o ka hopena, ma waena, a waena o waena, a me nā mea hana hope loa, ʻaʻole i waena o ka ʻike ʻana o ka metabolite hoʻoikaika, a me nā waiwai kūlike o ka hoʻoweliweli ʻana o ka platelet aggregation (induced ADP). ʻO ka weheʻana o ka metabolite ikaika i nā metabolizer nāwaliwali i hoʻohālikelike ʻia me nā metabolizers ikaika i hōʻemi ʻia e 63-71%. Ma ka hihia o ka 300 mg / 75 mg regimen, ke ʻano antiplatelet nāwaliwali nāwaliwali e hōʻemi ana me nā helu platelet aggregation inhibition, ʻo ia ka 24% (ma hope o 24 mau hola) a me 37% (i ka lā 5) i hoʻohālikelike ʻia me nā kumu platelet aggregation inhibition in neʻe (39% - ma hope o 24 hola a me 58% - ma ka lā 5) a me ke kikowaena (37% - ma hope o 24 mau hola a me 60% - ma ka lā 5). I ka hihia o ka hoʻohana ʻana i ka hana 600, ʻo ka CYP2C19 * 1 gene allele e hāʻawi i kahi metaboline holoʻokoʻa holoʻokoʻa mg / 150 mg, ʻo ka wehe ʻana o ka metabolite ikaika i nā metabolizer nāwaliwali ʻoi aku ka kiʻekiʻe ma mua o kahi hoʻolālā 300 mg / 75 mg. Ma ke ʻano o ka platelet aggregation inhibition he 32% (ma hope o 24 mau hola) a me 61% (ma ka lā 5), ʻoi aku ka nui o ka waihona like o ka 300 mg / 75 mg regimen, akā like nā hui like o nā mea maʻi me ka hoʻonui nui CYP2C 19- ka hoʻonoho, ka mea i loaʻa i ka hana ma muli o ka hoʻolālā 300 mg / 75 mg. Pono e hōʻike ʻia, i ka hoʻopaʻa ʻana, e noʻonoʻo ana i ka hopena lāʻau lapaʻau no nā poʻe maʻi o kēia hui, ʻaʻole kū ʻia ka dosage regimen o clopidogrel.

A meta-analysis o ʻeono mau noiʻi, e loaʻa ai nā ʻikepili mai 335 mau mea i loaʻa i ka clopidogrel a noho mau ʻia ma ka noho ʻana o ka ʻai kaulike, hōʻike ʻia ka hōʻike ʻana o ka metabolite ikaika i nā metabolizer nāwaliwali i hōʻemi ʻia e 72%, a i loko o nā huina waena - - 28%, ʻoiai ke kumukūʻai o ka hoʻoweliweli ʻana o ka platelet aggregation hoemi ʻia ka hoʻohālikelike ʻana me nā metabolizer pili i ka 21.4 a me 5.9%, ʻokoʻa.

ʻO ka pilina ma waena o ka genotype CYP2C19 a me nā hopena hopena i nā maʻi i loaʻa i ka clopidogrel ʻaʻole i loiloi ʻia i loko o nā hanana kūpono, hoʻomalu, hoʻokolohua, akā, i kēia manawa, he nui nā noiʻi retrospective. Hoʻopuka ʻia nā ʻikepili mai kekahi mau noiʻi cohort, a me nā hopena o ka genotyping i nā haʻawina ʻoihana hauʻoli: CHARISMA (n = 2428), CURE (n = 2721), TRITON-TIMI 38 (n = 1477), CLARITY-TIMI 28 (n = 227), AKO- A (n = 601).

ʻEkolu mau noiʻi cohort (Giusti, Collet, Sibbing) a me ke aʻo ʻana ʻo TRITON-TIMI 38 i ka poʻe maʻi o ka hui pū ʻana me kahi nāwaliwali nāwaliwali a me ka hōʻuluʻulu ʻana o ka metabolism ua hoʻopaʻa i kahi kiʻekiʻe loa o nā hoʻopiʻi cardiovascular (myocardial infarction, stroke, death) a i ʻole stent thrombosis e hoʻohālikelike i nā mea like. nā ikepili e pili ana i nā metabolizer ikaika.

I ka hoʻopaʻa ʻana o Simon cohort a me ka haʻawina ʻo CHARISMA, ua hōʻike ʻia kahi pane o ka hoʻopiʻi ʻana i nā maʻi cardiovascular wale nō i ka nāwaliwali nāwaliwali (inā hoʻohālikelike ʻia me ka ikaika).

Ma ka hoʻopaʻa noi ʻana o Trenk cohort a me CLARITY, CURE, ACTIVE-A aʻo, ʻaʻohe hui o nā ʻōkuhi cardiovascular me ka nui o ka metabolism CYP2C19.

Ua hoʻokele ʻia nā haʻawina hauoli a hiki i kēia lā ke loaʻa i ka nui o ka hopena i ʻike ʻia i nā hopena kūkaʻi i ka hopena o nā mea maʻi me ka haʻahaʻa isoenzyme CYP2C19 haʻahaʻa.

Nā Kūlana Kūʻai Kūʻai kūikawā

ʻO nā pharmacokinetics o ka metabolite ikaika o ka clopidogrel no nā hui pilikino i aʻo ʻole ʻia.

Ma nā haʻawina e pili ana i nā limahana ʻelemakule (ma mua o 75 mau makahiki), ke hoʻohālikelike ʻia me nā ʻikepili o nā ʻōpio ʻōpio, ua ʻike ʻole ʻia nā kahe koko a me ka hōʻiliʻili ʻana o platelet. No ka mālamaʻana i nā maʻi maʻi maʻi, ʻaʻole pono ka hoʻoponopono ʻana o ka maʻi Lopirel.

ʻAʻole paʻa ʻia nā pharmacokinetics o clopidogrel i nā maʻi i lalo o nā makahiki he 18.

Ma kaʻeha hōʻeha o ka nui (me ka hana ʻana o creatinine mai 5 a 15 ml / min) ma muli o ka hoʻohana pinepine ʻana o ka clopidogrel ma kahi pāʻaiʻi he 75 mg i kēlā lā, ʻo ke ʻano o ka hoʻomaka ʻana o ka paʻakai platelet ADP-induced he 25% mau haʻahaʻa ma mua o ka mea hana olakino olakino, akā naʻe, noho mau ka wā koko. like me kēia mākaukau no nā mea hana olakino maikaʻi e loaʻa i kēlā me kēia lā he mau clopidogrel 75 mg. Ua hoʻomanawanui maikaʻi ʻia ka lāʻau i nā maʻi āpau.

Ma ka hōʻeha kino o ka puʻuwai ma muli o ka lawe ʻana i ka clopidogrel ma kahi o ka nui o 75 mg i kēlā me kēia lā 10 mau lā, ʻo ka nui o ka hōʻemi ʻana o ka ADP-induced platelet aggregation like me ia i nā mea hana olakino olakino.Ua hoʻohālikelike ʻia nā hui ʻelua i ke ʻano koko.

ʻO ka nui o nā kuʻekuʻe o nā genenster CYP2C9, nona ke kuleana no ka hoʻohaʻahaʻa a me ka waena o nā metabolism, ma waena o nā māka o nā hui like ʻole. No nā mea ʻelele o ka lāhui Mongoloid, he liʻiliʻi liʻiliʻi nā kaona puke ʻikepili i ʻole e ʻae ʻia kahi loiloi o ka genotyping nui o CYP2C19 isoenzyme e pili ana i ka hoʻolālāʻana o ka hoʻopiʻi ischemic.

Ka hana lāʻau lapaʻau

ʻO ka hana ikaika o ka lāʻau Lopirel selectively pale i ka hoʻopili ʻana i ka molekī ADP i nā poʻe receptors e loaʻa i ka papa o nā platelets. No laila, ʻo ka hiki ʻana o ka hōʻuluʻulu o ka GPIIb / IIIa paʻakikī a me ka hōʻiliʻili ʻana o platelet i lilo i hiki ʻole. Hoʻopili nā Clopidogrel i nā hana hoʻohui i hoʻoiho ʻia e nā mea antagonist. A hiki i ka pau ʻana o ke ola, holo mau nā platelets a hiki ʻole i ka hōʻuluʻulu.

Hoʻomaʻamaʻa maikaʻi ka lāʻau lapaʻau i loko o ka huina. Eia nō naʻe, he haʻahaʻa loa ka ʻike ʻana o ka clopidogrel i ka plasma, ʻo ka 100% o ka hoʻouka ʻana. Hoʻopaʻa maikaʻi ka lāʻau lapaʻau i nā protein plasma koko.

Hoʻomili ka Clopidogrel i loko o ka ate, ma kahi o 80% o nā metabolites i loaʻa i ka plasma ʻaʻole he hana. ʻO ka metabolite hoʻoikaika, ka mea e loaʻa ai ka hopena antiaggregatory pono, i hoʻokumu ʻia e ka hopena o ka hopena okena, me ka komo ʻana o ka cytochrome P450 isoenzyme 2B6 a me 3A4. Hoʻopuka koke ka metabolite me ka platelets a ʻaʻole i ʻike ʻia i ka plasma koko.

ʻO ka hapalua kahi 6 mau hola no ka waiwai ikaika a me 8 no ka mea hikiʻole ke hana i ka metabolite. Hoʻopau nui ʻia nā huahana me ka urine a me nā mea momona.

ʻO nā poʻe e loaʻa nei me ka hiki ʻole o ka pilikia hana kino, kahi hōʻemi i ka hopena o ka lāʻau lapaʻau ma 25% i hoʻohālikelike ʻia me nā poʻe olakino.

Nā ʻōkuhi no ka hoʻohana

Pono e lawe ʻia nā papa lopirel ma ke alo pono ʻole, me ka mālama ʻole o ka meaʻai.

ʻO nā mea maʻi i loaʻa i ka stroke ischemic / myocardial infarction a i ʻole he maʻi maʻi peripheral e loaʻa he 75 mg i hoʻokahi lā. Ma hope o ka hōʻeha ʻana o ka puʻuwai, hoʻomaka ka lāʻau mai nā lā mua a mau a hiki i ka 35 mau lā, a ma hope o kahi hōʻeha - mai 1 wiki i 6 mau mahina.

I ka loaʻa ʻana o ka maʻi coronary maʻa me ka piʻi ʻana o ka hoʻāla ST ST (me nā poʻe maʻi me ka mālama ʻana i ka wā o ka interutan coronary percutaneous), hoʻomaka ʻia ke ʻano me ka puʻu ʻana o 300 mg (hoʻohana hoʻokahi), a laila huli lākou i ka 75 mg ma 24 mau hola i ka 1 inē (e hui pū me ka acetylsalicylic acid i kahi dosis ʻaʻole ʻoi aku i ka 100 mg). ʻO ka papa hana a hiki i ka 1 makahiki.

Ma ka maʻi coronary syndrome me ka kahi o ka pae ST ST (i hui pū ʻia me nā aspirin a me nā mea thrombolytic), ua kau ʻia nā papa i hoʻokahi manawa ma ka nui o 75 mg no 24 mau hola no ka 1 noi me ka hoʻohana mua ʻana i kahi palapala kūmole (hoʻokahi, me ka thrombolytics a me aspirin). Hoʻomaka ka hoʻomaʻamaʻa ʻana ma ke ʻano e hiki ai a hoʻomau no kahi 1 mahina ʻē aʻe ma ka liʻiliʻi. ʻAʻole hoʻohana ʻia ka dosage ukana ma hope o nā makahiki 75.

Nā hopena hopena

lymphatic and circulatory system: pinepine - - eosinophilia, leukopenia, thrombocytopenia, jarang neutropenia (komo neutropenia nui), luhi loa aplastic, thrombotic thrombocytopenic purpura, agranulocytosis, pancytopenia, thrombocytopenia, granulocy
kalima: He hopena ʻole loa - ka hopena o ka anaphylactoid, maʻi maʻi serum, ʻike pinepine ʻole ʻia ka ulu ʻana o ka hopena o ka hypersensitivity me ka thienopyridines (no ka laʻana, me ka ticlopidine a me prasugrel).
musculoskeletal a me ka hoʻopili hoʻohui: paʻakikī loa - ʻeha, hemarthrosis (hemorrhage i ka musculoskeletal system), myalgia, arthralgia,
nāūna nūlāwila: pinepine - ʻeha, hopohopo, intracranial hemorrhage (kekahi mau hihia me ka hopena o ka make), haunaele, paresthesia, aneane ʻole - ʻono ʻino,
ʻili a me ka ʻōpio ʻākalaokele: pinepine - wili, pinepine, - hōʻeha, hoʻoluhi, purpura, ʻokoʻa loa - angioedema, bullous dermatitis (erythema multiforme, Stevens-Johnson syndrome, nā toxic epidermal necrolysis), ʻ hyplelo hopuna hypersensitivity syndrome, erythematic a exfoliative syrup lapas me nā ʻōnaehana hōʻailona a me nā eosinophilia, urticaria, lichen planus, eczema,
ka ʻike: pinepine - nā ʻōpū o ka maka (ma ke kiko o ka maka, conjunctiva, retina),
akea a me ka maʻi pāpaʻi: aʻeha loa - hepatitis, hoʻonāukiuki mākaʻikaʻi ole, abnormalities i loko o nā noiʻi hana o ke kūlana hana o ka ate,
mea hana a me nā haʻawina ʻoihana: pinepine - ka hoʻohaʻahaʻa o ka neutrophils, he nui ka manawa e hoʻokaʻina i ke koko, he manawa hōʻemi i ka nui o nā platelets.
nā pilikia ma ka wahi i hoʻopaʻa ʻia ai a me nā maʻi maʻamau: pinepine - kahe koko mai ka pūnaewele puncture, kahi liʻiliʻi loa - nā maʻi,
lohe
psyche: luhi loa - kūleʻa, ʻike.
gastrointestinal tract: pinepine ka maʻi, ka huhui o ka gastrointestinal, dyspepsia, ʻeha ʻeha, hōʻeha mau i ka maʻi hōʻeha, ka ʻōpū a me ka ʻākā duodenal, ka maʻi pākaʻi, ka luaʻi, ka lemulewa, constipation, ʻeha pinepine ka hoʻokaʻina o retroperitoneal, ʻokoʻa loa ka retroperitoneal a me ka ʻeha o ka gastrointestinal ka hoʻowalewale o ka ʻōpū, colitis (me ka lymphocytic a i ʻole ulcerative), pancreatitis, stomatitis,
ʻūnaehana hanu: pinepine - nosebleeds, ʻokoʻa loa - bronchospasm, kahe koko mai ka ʻōpū o ka ʻōpū (ʻōpū pulmonary hemorrhage, hemoptysis), eosinophilic pneumonia, ʻōpū o ka ʻulaʻawa,
nā pēpē a me nā urinary tract: pinepine - hematuria, ʻokoʻa loa - ka hoʻonui ʻana i ka ʻike o nā mea hana i loko o ke koko, glomerulonephritis,
nā kīʻaha koko: pinepine - hematomas, lohi loa - hoʻōki mai kahi hōʻeha hana, ke koko ikaika, hoʻemi i ke koko, vasculitis.

Nā ʻōlelo kikoʻī

ʻO ka hemahema o ka puʻuwai: i kahi ʻōpū i maʻalahi - me ka makaʻala, ma ke koʻikoʻi - ua contraindicated.

Hōʻano ʻia ka overdose e ka piʻi ʻana o ke kahe koko. I kēia kūlana, loko o ka hoʻōla ʻana i loko o ka mea i hoʻokaʻawale ʻia o ka platelet mass, no ka mea ʻaʻohe mea antidote.

ʻO nā hihia o ka pehu huhū i ka manawa o ka hoʻohana like ʻana me ka Lopirel acetylsalicylic acid, a me ka heparin hoʻi, ua kākau ʻia.
ʻO ka hana pāpaʻi: ua lawe ʻia ka hana me ka akahele me ka maʻi haʻahaʻa o nā maʻi.
He mea nui ka mālama ʻana ma nā mea maʻi e hōʻemi i ke koko no nā ʻano kumu a i ʻole ka hoʻohana ʻana i kekahi lāʻau lapaʻau.
Ma nā hana hoʻomalu, i ka wā e hiki ʻole ai ke ʻano antiplatelet, ua pau ka papa hana i ka 1 wiki ma mua o ka lā o ka hoʻomaʻamaʻa ʻana.
Hoʻomaopopo ka poʻe maʻi i ka mālama mau ʻana no ke koko huna.
Ke hoʻokele nei i nā halihali a me nā ʻāpana paʻakikī: ʻaʻole i pili.
Loaʻa i ka Clopidogrel ka hana i ka pale ʻana i ka hana o ka isoenzyme CYP2C9, no laila hiki ke loaʻa ka nui o ke kaila o ka dugo tolbutamide a me ka phenytoin. ʻO ka hoʻopili paʻa ʻana i kēia mau mea hana me Lopirel e palekana.
Pono ka mea ʻike e hoʻonui i ka manawa o ke kaʻina o ke koko, no laila pono e ʻike kekahi kauka i ka lāʻau.
Ma ka hopena wānana ischemic, ʻaʻole i aʻo ʻia ka lāʻau lapaʻau no ka hoʻohana (ma lalo o 1 pule).
Ma lalo o ke ʻano o 18 makahiki, ua pāpā ʻia ka lāʻau lapaʻau.
I ka mālamaʻana i nā poʻe maʻi me ka maʻi myocardial infarction (me ka piʻi o ka mahele ʻo ST), ʻaʻole i hoʻomaka ka mālama ʻana i nā lā mua o ka wā ma hope o ka hoʻomohala ʻana i ka myocardial infarction.

I nā hihia e pehu ai ka nānā ʻana i ke koko a me ka hana o ka ʻōpū.

Hoʻohui nūhou

Hiki ke hoʻohui ʻia ka lāʻau lapaʻau me ka atenolol, fenobarbital, estrogens, cimetidine a i kahi nifedipine.

Ua hoʻohālikelike ʻia ka hoʻohana ʻana o kēlā me kēia lā i ka acetylsalicylic acid (a hiki i ka 1000 mg i kēlā me kēia lā) a me ka clopidogrel ʻaʻole i pili i ka waiwai o ka lāʻau. Akā, ʻaʻole pono ʻoi aku ka lōʻihi o ka lawelawe ʻana o nā lāʻau nei ma mua o ka makahiki 1 (pono e mālama ʻia ka mālama).

Ke hui pū ʻia me nā anticoagulants waha, i loko o kahi warfarin, hiki i ka nui o ka ulu ʻana a me ka lōʻihi o ke kahe koko.
ʻAʻole pū ʻia ka hui pū ʻana o ka lāʻau me ka thrombolytics, no ka mea ʻaʻole i hoʻopaʻa pono ʻia ka palekana o kēlā hui.
ʻOiai nā hopena maikaʻi o nā haʻawina loiloi o ka hoʻoweliweli ʻana o ka lāʻau me ka heparin, pono e hoʻomaʻamaʻa ka mālama ʻana i ka wā e lawe ai iā lākou i ka manawa like.
I nā mea pilikino i ka piʻi nui o ka koko a me ka lawe ʻana iā Lopirel, ʻaʻole ʻia ia e hāpai i ka lawe ʻana i ka mea paʻa glycoprotein IIb / IIaa.
Malia paha ka hui pūʻana o ka lāʻau me digoxin, theophylline, antacids.

Ke pale aku nei ka lāʻau lapaʻau i nā hana o ka lāʻau lapaʻau ka mea nāna i hoʻohālikelike i ka pharmacokinetic i ka isoenzyme CYP2C9. ʻO keʻano kūikawā, hiki i kahi lāʻau lapaʻau ke hoʻonui i ka neʻe o ka plasma o phenytoin a me ka tolbutamide. E mālama pono ʻia.

Ua hōʻoia ʻia ua hoʻohui ʻia ka hui ʻana o ka clopidogrel - naproxen i ka uluʻana o ka hoʻomohala ʻana i ka pehu gastrointestinal. Eia nō naʻe, ma ka hihia o nā NSAID ʻē aʻe, ʻaʻole i hoʻohālikelike ʻia kēia ʻano. Ma kēia e pili ana, me ka hui pū ʻana o kēia mau lāʻau e mālama pono.

Nā inoa o ka lāʻau Lopirel

E hoʻoholo ke ana i ke kumuhana:

Plavix,
Aggregal
Sylt,
Pauku
Hōʻino,
Kūpono
Deplatt 75,
Helina,
Detrombe
Ua pilau wau
Kāleka,
Targetek
Klopilet,
Clapitax
Clopidogrel,
Lirta
Helu 75,
Hihiwai,
Kāleka
Lopirel,
Plogrel,
Klopirel.

Hoʻokomo pū ʻia nā hui o antiplatelet i nā kikowaena:

Kapuai
Aggregal
Pentilin
ʻO Agrenox
Ayferol
Helina,
Clopidogrel,
Clapitax
Kāleka,
ʻO Parsedil
Integrilin
Lirta
Agrilin,
Lopirel,
Tiklo
Aklotin,
ʻAwaʻawa
Kūpono
Pentomere
Persantine
Methylethylpyridinol,
Klopilet,
KUKAI
Radomin
Brilinta
Pauku
Targetek
Cardiomagnyl
Koolina,
Cardioxypine,
Eifitol
Ka waikawa Acetylsalicylic
Kauhi
Coplavix,
Vixipin
ʻO Agapurin
Doksilek,
Akonol,
ʻOkoʻa
Emoxibel
Clopirel
Ena,
Nahele
Ginkio
Aspinat
Kālepela
Nā leoʻeha
Emoxipin
Ibustrin
Tiklid,
Mikristin
Hōʻino,
Pentoxifylline
Tagren
Plavix,
Cilostazol
Helu 75,
Monafram
Ke Akua
Muse
Laspal
Auwahi
Xanthinol Nicotinate,
Pentamon
Kauoha,
Kāleka
Kaaumua
Ventavis.

Ke keu

Me ka nui o nā lāʻau lapaʻau, hiki i ka nui o ke kau ʻana i ke kahe a me ka hōʻino ʻana i ke kūlana.

Hana - e like me nā hōʻailona.

Haka kikoʻī hoʻololi pū ʻia ʻaʻole pono ka lāʻau. I nā hihia paʻakikī, hiki i ka pau ʻana o ka lāʻau i ke kahe ʻana i ka mea maʻi. pāleʻa pālani.

Hoʻohui

Ke hui pū me lākou anticoagulants wahama ko ano nui warfarin, e ulu aʻe ka hopena o ka ulu ʻana a me ka lōʻihi o ke koko.

I ka poʻe e loaʻa ana ka hopena o ke kahe a lawe aku iā Lopirel, ʻaʻole ʻia ia e hoʻohui glycoprotein IIb / IIІa inhibitors.

Hoʻohui hui clopidogrel – naproxen hoʻonui i ka pilikia o ke koko gastrointestinal. Akā naʻe, i ka hihia o nā mea'ē aʻe Nā NSAID ʻaʻole i hoʻohālikelike ʻia kēlā ʻano hiʻohiʻona. Ma kēia e pili ana, me ka hui pū ʻana o kēia mau lāʻau e mālama pono.

ʻOiai ʻo nā hopena maikaʻi o ka hoʻopaʻa noi ʻana o nā lāʻau lapaʻau e pili ana i ka hoʻopili ʻana me ka heparin, i ko lākou hoʻokipa pinepine ʻana e pono e makaʻala.

ʻO ka hui pūʻana o ka lāʻau lapaʻau me holomoana, no ka mea, ʻaʻole paʻa ka palekana o kēlā hui.

Hoʻomaopopo i ka hoʻohana ʻana i kēlā me kēia lā acetylsalicylic acid(a i kahi 1000 mg i ka lā) a clopidogrel ʻaʻole e hoʻopilikia a hoʻohui ʻia nā wahi o ka lāʻau lapaʻau. Akā, ʻaʻole pono ʻoi aku ka lōʻihi o ka lawelawe ʻana o nā lāʻau nei ma mua o ka makahiki 1 (pono e mālama ʻia ka mālama).

Hoʻōmi ka lāʻau i ka metabolism o nā lāʻau lapaʻau, pharmacokinetic nā kuhikuhi e pili ana i isoenzyme CYP2C9. ^ E Ha yM. I keʻano kūikawā, nui paha ka lāʻau lapaʻau e hoʻonui i ke kaila o ka plasma aiaiiaih a tolbutamide. ^ E Ha yM. E mālama pono ʻia.

Malia paha he hui pū me nā mea hana digoxin, theophylline, antacids.

Lanakā Lopirela

Nā ʻano o ka lāʻau lapaʻau. Clopidogrel, Avix, Atrogrel, Deplat, Zilt, Karum Sanovel, Clopidale, Klopikor, Lopigrol, Orogrel, Plavigrel, Plagril, Reodar, Tessiron, Trombone, Flamogrel 75, Aterocardium, Gridoklein, Deplatt, Cardogrel, Medrelel, Plogril Neo, Plavix, Platogril, Reomax, Trombeks.

ʻLoe a me ke kākele

No ka pale ʻana i ka maʻi ischemic i loko o nā mea maʻi ma hope o ka myocardial infarction, ischemic stroke a ua ʻike ʻia ka maʻi maʻi pāpaʻi peripheral, ua ʻōlelo ʻia nā pākeke (me nā poʻe maʻi maʻi he 75 mg 1 mau manawa / lā, e pili ana i ka intake kai. Pono e hoʻomaka ʻia ka mālama ʻana mai kekahi mau lā a hiki i 35 mau lā ma hope o kahi infarction myocardial me ka hoʻokumu ʻana o ka neʻe pathological Q a mai 7 mau lā a hiki i 6 mau mahina ma hope o kahi maʻi ischemic.

Hoʻohana ma ka pākeke a me nā mea maʻi maʻi me ka hana maʻamau o ka isoenzyme CYP2C19

Me ka myocardial infarction, ischemic stroke, a loaʻa i nā maʻi peripheral arterial occlusion maʻi, 75 mg o Lopirel i ʻōlelo pinepine ʻia i ka lā.

I ka maʻi coronary syndrome me ka wailua ʻole o ka paukū ST (myocardial infarction me ka Q Q, ka uka paʻa ʻole), pono ke hoʻomaka ʻia ka mālama ʻana me kahi maʻi kū hoʻokahi (300 mg), a ma hope o ka 75 mg e kuhikuhi ʻia i hoʻokahi lā (me ke ʻano o ka lā pākahi o nā lā he 75-325 mg acetylsalicylic acid ) Ma ka hoʻohana ʻana i nā kumuwaiwai kiʻekiʻe nui o ka acetylsalicylic acid e hoʻonui i ka nui o ka hoʻokahe, ke kahe o ka acetylsalicylic acid i ʻōlelo ʻia no kēia hōʻike, ʻaʻole pono e oi aku i 100 mg. ʻAʻole kuhi ʻia ka lōʻihi o ka malama o ka maʻi. Wahi a nā noiʻi noiʻi, pono e lawe i ka lāʻau i ka 1 makahiki. ʻO ka hopena kūpono maikaʻi loa e nānā ʻia e 3 mau mahina o ka mālama.

I ka hoʻohuiʻana i ka coronary syndrome me ka ST-segment elevation (maʻa myocardial infarction e hōʻike ʻia ana e ka huaʻī ST-section), ua hoʻopau ʻia ka nui o ka nui o 300 mg i hoʻokahi manawa, ʻoli ʻia e 75 mg i hoʻokahi lā i ka lā me ka acetylsalicylic acid (i hui pū me ʻole me ka thrombolytics). I ka mālamaʻana o nā mea maʻi i nā makahiki he 75 a ʻoi aku ka ʻoihana, pono e hoʻokō ʻia ka lāʻau Lopirel me ka ʻole o ka lawe ʻana i ka wai. Hoʻomaka koke ʻia nā lāʻau lapaʻau ma hope o ka hoʻomaka ʻana o nā hōʻailona a lōʻihi i mau hebedoma 4 mau wiki. ʻO ka maikaʻi o ka hui ʻana o ka acetylsalicylic acid a me clopidogrel me kēia mau mea hōʻike i ʻoi aku i nā 4 hebedoma ʻaʻole i aʻo ʻia.

Me ka fibrillation atrial (atrial fibrillation), 75 mg o Lopirel i kuhikuhi ʻia i hoʻokahi lā i ka lā. Me ka clopidogrel, pono e hoʻomaka ka hoʻohana ʻana i ka waikawa acetylsalicylic a hoʻomau ʻia (hoʻomau ka lā (75-100 mg) kēlā me kēia lā.

Inā e poina ʻoe i ka hopena aʻe o Lopirel, pono ʻoe e hoʻokau i nā ʻōlelo ʻōlelo i lalo nei:

inā ua emi iki ma mua o 12 mau hola ma hope o ka hoʻolilo ʻana i ka ʻōlelo, e lawe koke ʻoe i ka lāʻau o Lopirel, a lawe i nā ʻōhua ma lalo aʻe e like me ka maʻamau.
inā he mau hola aku ka hala ma mua o 12 mau hola ma hope o ka hoʻolewa ʻana i ka ʻōlelo, pono e lawe ʻia ke ʻano hou aʻe o Lopirel e like me ka hana maʻamau.

Nā hiʻohiʻona noi

Pono e hoʻokolohua kahi hōʻike koko ma ka hebedoma mua o ka mālama ʻana i ka hui pū ʻana o ka clopidogrel me ka acetylsalicylic acid, nā NSAIDs, heparin, IIb / IIIa glycoprotein inhibitors a i nā fibrinolytics, a me ka mea i nā mea maʻi me ka piʻi nui o ke kahe (hōʻeha, hōʻeha hoʻoweliweli a me nā kūlana pathological).

Ma muli o ka hōʻeha o ke kahe a me nā hopena hematological, inā i hōʻike ʻia e nā maʻi neʻe i kēia manawa i ka wā o ka mālama ʻana, kahi hōʻike koko (APTT, helu platelet, nā hana hoʻoliʻi hana platelet) a me ka hana hana lawelawe pono e hana koke.

Ma kahi o nā mea hōʻiliʻili o nā mea hōʻemi, inā he hopena anti-aggregation, ʻaʻole pono, ʻo ka clopidogrel e hoʻokuʻu ʻia 7 lā ma mua o ka hoʻomaʻamaʻa ʻana.

Pono e hoʻohana ʻia ka Clopidogrel me ka makaʻala i nā mea maʻi me ka hopena o ke koko (ʻoi loa ka gastrointestinal a me intraocular).

Hoʻomaopopo ka poʻe maʻi e hoʻomaopopo lākou i ke kauka e pili ana i kēlā me kēia hihia i ke kahe.

Ma muli o ka lawa ʻole o ka ʻike, ʻaʻole pono ke kipi ʻo ka clopidogrel i ka manawa koʻikoʻi o ka maʻi ischemic (i nā lā 7 mua).

ʻO nā mea mālama palekana

Ua kuhikuhi ʻia me ka akahele i ka poʻe maʻi me ka nui o ka ʻeha o ke kahe (ʻo nā hōʻeha, ka hōʻemi ʻana o nā hōkele, a me nā mea hou aku) a me ka maʻi lēpa ʻole a me ka hana hepatic (hemorrhagic diathesis e ulu).

ʻAʻole paʻa i ka palekana a me ka hopena i nā poʻe maʻi ma lalo o ka makahiki 18.

Ke loaʻa nei ka lāʻau i ka lactose, no laila ʻaʻole pono e lawe ʻia e nā poʻe me ka intolerance lactose genetic.

ʻO Clopidogrel kahi mea i hana ʻia e hoʻohuli ai i ka hoʻohuli ʻana i ka metabolic e pili ana i ka nui o nā huina o nā ate. ʻO ka lawelawe like ʻana o nā lāʻau lapaʻau e hoʻokaʻawale i ka hana o ka enzyme CYP2C19 hiki ke alakaʻi i kahi hoʻololi i ke hoʻokumu ʻana o ka metabolite ikaika a, no laila, he hōʻemi i ka hopena therapeutic. ʻO ka ʻike ʻana i nā clopidogrel a me nā poloka pāʻai proton i nā manawa like ʻole o ka lā ʻaʻole i hoʻopilikia i ka hoʻomohala ʻana o ka hopena o ka pilina.

Pono ka hoʻokaʻina ʻana o nā clopidogrel me nā mea huna proton pumpers, no ka mea ke hōʻike nei ko lākou hiki ke loaʻa i ka hopena therapeutic o clopidogrel, ka laʻana o ka omeprazole.

Inā pono ka mea maʻi e lawe i nā mea huna o nā mea huna i ka wā e lawe ana i ka clopidogrel, pono ke ʻano o ka lāʻau o kēia pūʻulu o ka ʻae loa e hiki ai ke launa. ʻO kekahi o kēia mau lāʻau he pantoprazole.

E hoʻokuʻu i nā palapala a me ka ʻano

Loaʻa ka lāʻau lapaʻau i nā papa i loaʻa iā ia kahi 1 punetue kaha (clopidogrel hydrosulfate) a me nā mea kuono, ʻaʻohe hopena antiplatelet. ʻO ka paʻa ʻana o ka hoʻopiʻi kumuʻuhele he 97.87 mg. Pili pū kēia kālā ma ka 75 mg o clopidogrel. Aia ka pā papa i kahi pūpū kūikawā, ma muli o ke ʻano o ka hopena o ka lāʻau. I kēia hihia, hoʻokuʻu wale ʻia ka mea ikaika e hoʻowalewale ʻia, hoʻopili ʻia ka ʻili o ka ʻawaʻawa. Nā māhele liʻiliʻi:

crospovidone
lactose
mikuleka
glyceryl dibehenate
Opadry II 85 G34669 pink,
ka leʻaleʻa talcum.

ʻO ka pahu pahu he 14, 28 a 100 mau papa.

Loaʻa ka lāʻau lapaʻau i nā papa i loaʻa iā lākou he 1 ʻano hana.

Lapaʻau lāʻau

Hoʻomaka ka lāʻau lapaʻau e hana koke ma luna o ke kahua o ka hoʻokele - ma hope o 2 mau hola he nui ka emi ʻana o ka ulu ʻana o ke kōpana. ʻOi aku ka nui o ka waiū, ʻoi aku ka wikiwiki o ka hoʻomaikaʻi. Ke hoʻopau nei nā hōʻailona koʻikoʻi o ka maʻi, ua emi ka nui o ka lāʻau. ʻO kahi hopena, ma hope o ka lawe ʻana i nā dora mālama mālama pono o Lopirel no 4-7 mau lā, hiki ke kiʻekiʻe kiʻekiʻe i ka ʻike o ka mea kanu. Mālama ʻia ka hopena i ka wā o ke ola o nā pū koko (5-7 mau lā).

ʻO ka wikiwiki o ka clopidogrel he wikiwiki, aʻo ka nakinaki ʻana i nā protein plasma he kiʻekiʻe loa (98%). ʻO ka huli ʻana o kēia mau mea i loko o ke kua. Hoʻomaopopo ia i 2 mau ala: ma o ka esterases me ka wehe hou o ka waikoki carboxylic (ʻaʻole i hōʻike i ka hana), me ka komo ʻana o ka cytochrome P450. ʻO ke kaʻina o ka hoʻopili ʻana i nā receptors platelet e hele mai ma lalo o ka mana o nā metabolites.

Pono e noʻonoʻo i ka lawe ʻana i ka lāʻau i loko o kahi hapa nui (300 mg hoʻokahi) e alakaʻi i ka piʻi nui o ka piʻi. ʻOi aku ka nui o kēia hōʻailona ma mua o ka nui o ka pae ʻai kiʻekiʻe ma nā hihia i ka wā e lawe ʻia ai nā doses mālama (75 mg) no 4 mau lā.

ʻO ka ʻāʻī o nā mea i loaʻa i ke ʻano o nā lāʻau lapaʻau e hele mai ana ma o nā keiki.

ʻO ka hoʻohui ʻana o nā mea i loaʻa i ka hana o ka lāʻau lapaʻau e hiki mai ana ma o nā ʻōpū a me nā ʻōpū (ma kahi like like). Lohi kēia kaʻina. Hoʻopau pinepine ka hana hoʻopau i nā mea ikaika i ka lā 5 ma hope o ka lawe ʻana i ka make ma hope o Lopirel.

Me ka mālama pono

Inā hoʻolālā ʻia ka hana, ʻaʻole i kuhikuhi ʻia ka lāʻau lapaʻau ma muli o ka hopena o ke kahe. ʻO nā kūlana kulekele ʻē aʻe i kau ʻia ma ka pūʻulu o nā contraindications pili:

nā maʻi e like me ka hopena o ke koko he kiʻekiʻe nui, no ka laʻana, me ka hana ʻino ʻana i nā mea o nā lālā a ʻo ka gastrointestinal tract paha,
kekahi mōʻaukala o nā kaila i ka thienopyridines.

No ka hemorrhage cerebral, e lawe ana iā Lopirel i contraindicated.
Lāʻoki ʻia ʻo Lopirel i ka exacerbation o ka ʻē peptic.
Me ka hanaʻino o ka hoʻowalewale, pono e mālama ʻia ʻo Lopirel.

Pehea e lawe ai iā Lopirel

I ka nui o nā hihia, ua hoʻoholo ʻia ʻo 0,075 g i hoʻokahi lā. Nā ʻōkuhi no ka hoʻohana ʻana i ka lāʻau lapaʻau i nā mea'ē aʻe:

ʻO ka maʻi coronary e piʻi pū ana me ka piʻi ʻana o ka lā ST: i ka 0,075 g i kēlā me kēia lā mai ka lua o ka lā, ʻo ka hopena mua he 0.3 g hoʻokahi, ʻoi aku ka lōʻihi o ka mālama ʻana ma mua o nā hebedoma 4, ʻaʻole i hoʻokumu ʻia ka hopena haumania o ka mālama lōʻihi.
coronary syndrome ʻole nā hōʻailona o ke kiʻekiʻe ST: he like ke ʻano, akā hiki ke lōʻihi ka lōʻihi o ke kau (a hiki i 12 mau mahina).
Fibrillation atrial: 0,075 g i kēlā me kēia lā.

I kēlā me kēia kūlana, ke kuhikuhi ʻia ka hoʻohana ʻana o ASA. Eia nō naʻe, aia nō nā palena: ʻaʻoleʻoi aku ma mua o 0.1 mg i ka lā.

Lawe i ka lāʻau lapaʻau no ka maʻi maʻi maʻi

Hoʻohana ʻia ka hoʻohana ʻana i ka lāʻau no kēlā maʻi, akā e pono e hoʻomaʻemaʻe ʻia no ka lactose o ia ʻāpana. Eia kekahi, e kū i ke kua o ke ahulau o ka maʻi maʻi, ka hopena o ka ulu ʻana o kahi hōʻeha, hoʻonui ʻia ka hala o myocardial infarction. ʻO ka lāʻau Antiplatelet kahi hana koʻikoʻi i ka mālama ʻana i kēia maʻi, ka maʻi wale nō i hoʻoholo ʻia hoʻokahi, e noʻonoʻo ana i ke ʻano o ke kino.

Hoʻohana ʻia ka hoʻohana ʻana i ka lāʻau lapaʻau no ka maʻi maʻi, akā e hoʻomaʻamaʻa ʻia ka akahele i ka wā e lawe ai.

ʻŌpala Gastrointestinal

Hoʻonui ʻia ka ʻōpū, ka ʻeha i loko o ka ʻōpū, nā loli i loko o ke ʻano o ka kahi i hōʻike pinepine ʻia, hiki ʻole i ka nausea. Hoʻololi pinepine ʻia ka hoʻomohala ʻana o ka ʻōpū i ka ʻōpū ma mua, ua paʻakikī ka hele ʻana o ke kīʻaha, ʻoi aku ka ulu kino ʻana. I kekahi manawa ua ʻike ʻia kahi maʻa maʻi, hiki mai ka luaʻi. ʻOi aku ka maʻamau o nā colitis a me nā pancreatitis.

Pūnaehana pīhoihoi waena

ʻO ka ʻeha, ka ʻeha, ka hoʻoweliweli o ka hōʻeha, kona nalowale pau. Hiki paha nā hui. Kuhi ʻia ka hoʻokele.

I ka wā o ka mālama ʻana me Lopirel, huhū a me ka luaʻi.
ʻO ka haʻuki ka hopena o ka lāʻau Lopirel.
Hiki i ka Lopirel ke hōʻeha i kahi poʻo.
Ke lawe nei ʻo Lopirel, loaʻa paha ke ʻeha ma loko o ka ʻōpū.
ʻO kahi hopena o ka lāʻau Lopirel ka hiʻohiʻona o ka hepatitis.
ʻO ka ʻili kiri ka hopena o ka lāʻau Lopirel.
Hiki paha nā hui i ka wā o ka mālama ʻana me Lopirel.

Nā hopena maikaʻiʻole

Wahi a nā ʻōlelo aʻo, ua hōʻole ʻo Lopirel 75 mg i ka lawe ʻana:

Eosinophilia (kahi maʻi kahi e hoʻonui ai i ka nui o nā eosinophils).
Leukopenia (kahi emi o ka nui o nā keʻa koko keʻokeʻo i loko o ke koko).
ʻO Thrombocytopenia (kahi ʻano i hōʻike ʻia e ke kahe ʻana o ka platelet helu ma lalo o ka maʻamau, ka mea i hui pū ʻia e ke koko a me nā pilikia me ka hoʻokiʻe ʻana i ke koko).
ʻO Neutropenia (hoʻemi i ka pae o neutrophilic granulocytes i ke koko).
ʻOluʻolu a loaʻa ʻole ka pathology koko no ka hoʻopōʻino ʻana i nā aʻa o ka moloka poloka.
ʻO ka forura thrombocytopenic thrombotic (kahi maʻi koʻikoʻi e hōʻike ʻia e ka microangiopathic hemolytic anemia).
ʻʻAla
Granulocytopenia (helu kelepona ʻo ke koko liʻiliʻi).
Anemia
Hoʻopuka intracranial.
ʻO ka hemophilia ka loaʻa ʻana (kahi maʻi ulu hoʻoilina e pili ana me ka coagulation impaired).
Nā hopena hoʻohuli ʻāpono.
Ke kue.
Hōʻailona.
Migraine
Paresthesia (kahi maʻi o ka naʻau, ka mea i hōʻike ʻia e ke ʻano like ʻole o ke ʻano o ka puhi ʻana a me ka holo ʻana o ka goosebumps).
Nā kipi ʻana o ka hoʻāʻo.
He hemorrhage maka.
Hematomas.
ʻO ke koko huhū.
Ke hoʻohaʻahaʻa nei i ke koko.
ʻO Vasculitis (kahi hui o nā maʻi e kau ana ma muli o ka maʻi immunopathological vascular).
ʻO Epistaxis.
Bronchospasm (kahi ala i hiki ke hele a māhuahua nā mākala maʻa o ke kele a ua hōʻemi ʻia ko lākou lumen).
ʻŌpū pulmonary hemorrhage.

Wahi a nā ʻōlelo ʻōlelo iā Lopirel, ua ʻike ʻia, ʻo ka hoʻohui i nā ʻaoʻao like i hōʻike ʻia ma luna nei, hiki i ka lāʻau lapaʻau ke hoʻonāukiuki i kēia mau ʻano maikaʻi ʻole:

ʻO ka pneumonia Eosinophilic (kahi maʻi e hoʻoili ai nā eosinophils i nā alveoli pulmonary).
Hōʻeha ʻo ke ʻano (kahi ala palaki kahi e wikiwiki ai ka hele ʻana o ka mea, aʻo ka mea make i ka wai).
ʻO ka pneumonitis Interstitial (hoʻopukaʻino i ka pūpū, kahi e hoʻopilikia ai ka hana a ke kumu interstitium).
ʻO ka ulia Duodenal (he ulia e hoʻoiho ʻia mai ka hana o ka waikawa a me ka pepsin ma ka membous mucous o ka duodenum i nā poʻe me ka acidity kiʻekiʻe).
Lūlū.
ʻO Gastritis (kahi maʻi i lōʻihi ka mea i hōʻike ʻia e ka maʻi dystrophic a me ka hoʻololi ʻana i ka mucosa gastric, hele mau me ke kaʻe ʻana o ka manamana hou).
Hoʻopilikia ke alo.
ʻO ka huhū Retroperitoneal.
ʻO ka maʻi ākea o ka mucosa kolo.
ʻO ka pancreatitis (kahi maʻi e ʻike ʻia ana ka pilikia o ka pancreas)
ʻO Angioedema (kahi kūlana koʻikoʻi e hōʻike ʻia e ka wikiwiki o ka edema kūloko o ka lua o ka mucous, a me ke kiko subcutaneous a me ka ʻili ponoʻī).
Kālā Nettle.
Hāʻule (kahi maʻi o nā ʻōpū, hui pū ʻia me ka mumū).
Hemarthrosis (hemorrhage i ka lua hoʻohui).
Hoʻokomo ʻia ʻo Arthralgia (ʻeha hoʻohui).
Hematuria (ka heleʻana o ke koko ma ka urine).
ʻO Glomerulonephritis (kahi maʻi ʻeha e hōʻike ʻia e ka palu o ka glomeruli).

Hiki iaʻu ke hoʻohana i ka lāʻau lapaʻau i ka wā hāpai?

Wahi a nā loiloi o Lopirel, ʻike ʻia ʻaʻole i hōʻike ʻia ka clopidogrel i ka hopena maikaʻi loa i ka hapai a me ka hānau ʻana, akā ma muli o ka ʻike ʻole o ka ʻike lapaʻau, kuhikuhi i ka lāʻau i contraindicated no nā wahine hāpai.

Ma ke ʻano o nā haʻawina, ua ʻike ka mea ʻona ikaika a me kāna metabolites e hele i loko o ka waiū o laila, no laila pono e hoʻōki ʻia lactation i ka wā o ka mālama ʻana me ka lāʻau lapaʻau. ʻAʻohe ʻike e pili ana i ka hoʻokaʻawale ʻana o ka clopidogrel me ka waiū o ka makuahine. "Lopirel" a contraindicated no nā keiki ma lalo o nā makahiki he ʻumikumamāwalu makahiki.

Aia kekahi lāʻau lapaʻau Lopirel:

"Plagril."
Egithromb.
Plavix.
"Deplatt 75".
Detrombe.
Clapitax.
"Papa inoa 75".
Luana.
Avix.
"ʻO Orogrel".
Brilinta.
"Platogril."
Reomax.
"Medogrel".
Kāleka.
Tessiron.
"Clorelo."
Klopikor.
Claridol
Gridoklein.

Ma mua o ka hoʻololi ʻana i ka mea mua me ka analogue, e nīnau aku i kahi mea lapaʻau.

Loaʻa ka lāʻau lapaʻau i ke ʻano o nā papa, i pani ʻia me ka poni kiʻi ʻoniʻoni. Loaʻa iā lākou kahi laina, biconvex, ʻulaʻula i ka waihoʻoluʻu. Hoʻopili ʻia nā papa i nā palaka o nā ʻāpana he ʻumi. "Plagril" ke kumu o "Lopirel".

Iʻelua mau hola ma hope o ka lawe ʻana i ka dosage mua - ʻehā haneli milligrams - ʻike ʻia ka pale ʻana o ka platelet aggregation. Loaʻa ka hopena kiʻekiʻe ma hope o nā lā he ʻehiku, me ka hoʻohana mau ʻana i ka lāʻau lapaʻau ma loko o kahi ala o ka hapa ʻelima a hoʻokahi haneri milligrams i kēlā me kēia lā.

Wahi a nā ʻōlelo kuhikuhi no ka hoʻohana ʻana me ka Lopirel analogue 75 mg, ʻike ʻia ʻo ka hopena o ka lālani he ʻumi lā. Ma hope o ka pau ʻana o ka lapaʻau me "Plagril" no 5 mau lā, ke kahe koko a me ka hui ʻana o nā platelets e hoʻi i ko lākou pae mua. Ke pale aku nei ka lāʻau lapaʻau i ka nānā ʻana o nā atherothrombosis i nā poʻe me ka maʻi atherosclerotic vascular.

Pono e hoʻokuʻu ʻia nā lāʻau lapaʻau i nā lā ʻehiku ma mua o ka hoʻomaʻemaʻe ʻana, kahi mea hiki ke loaʻa ka hopena antiplatelet. I kēia hihia, pono ke hōʻike e ke kanaka i ka mea lapaʻau e pili ana i kekahi hihia o ke koko i ka wā o ka hoʻohana ʻana iā Plagril. Eia kekahi, inā e hoʻomaʻamaʻa kekahi ke ʻano i kekahi lāʻau lapaʻau i kauoha ʻia ai, pono hoʻi i ka mea maʻi e haʻi aku i ke kauka e pili ana i ka hoʻohana ʻana o Plagril. I ka wā o ka mālama ʻana, pono ia e nānā i nā hana o ke akeʻa.

Ke kōkua nei ka lāʻau lapaʻau e hōʻemi i ka loko o ke kīwī, kahi i hoʻonāukiuki ʻia e nā agonists ʻē aʻe, me ka pale ʻana i kā lākou hoʻoikaika ʻana e ka adenosine diphosphate i hoʻokuʻu ʻia.

Wahi a nā ʻōlelo kuhikuhi, ua hoʻohana ʻia ka analogue Lopirel no nā kumu prophylactic e pale ai i ka loaʻa ʻana o ka atherothrombosis:

I loko o ka poʻe i loaʻa i ka myocardial infarction, me ka ischemic stroke hoʻi me ka maʻi hōʻeha o ka maʻi pā peripheral.
I nā poʻe pilikino me ka maʻi coronary acute.
I ka poʻe maʻi e loaʻa ana i ka shunting i ka manawa angioplasty coronary.

Eia kekahi, hāʻawi ʻia ʻo Klopikor no nā kumu prophylactic o ka thromboembolic, nā hanana atherothrombotic me ka fibrillation atrial.

Ke lawe nei i kahi lāʻau lapaʻau ma loko o kahi kaoʻehiku-kumamalima milligrams i kēlā me kēia lā, mālama ʻia ka manaʻo nui o ka platelet aggregation mai ka lā mua o ka ʻoihana. No nā lā ʻehiku e hiki mai nei, hoʻonui ʻia kēia hana.

ʻO ke kaohi ʻana o ka hana platelet i ka equilibrium o ka awelika mai ka kanahā a kanaono hapa pākēneka (i ka wā e lawe ai i ka lāʻau lapaʻau ma kahi o ka pāʻina he kanahikukumamālima milligrams i kēlā lā). Ma hope o ka pau ʻana o ke koko, ua hoʻi ka pae o ka hui ʻana o nā platelets i nā pae kīkaha no nā lā ʻelima.

Wahi a nā loiloi, ka hoʻohālikelike o Lopirel 75 mg - kōkua ʻo Zilt i ka pale ʻana i ka hōʻeha ʻana o ka hōʻeha ʻana a i ʻole hōʻeha ʻana i nā mea maʻi me ka valia atherosclerosis.

Hoʻopili koke ʻia ka mea ikaika ma hope o ka pauku waha. ʻO ka ʻike nui loa o ka clopidogrel he awelika o 2.2-2.5 nanograms ma milliliter (ma hope o ka helu ʻana he kanahikukumamālima milligrams o ka lāʻau). ʻO ka manawa e hiki ai i ke koʻo i ka lōʻihi ma kahi o ke kanaha kumamalima mau minuke. ʻO ka pae o ke kīnā ʻana o ka hana ikaika, e like me ka ʻike i ka excretion o nā huahana metabolic o ka lāʻau lapaʻau e nā keiki, he kanalima pākē.

ʻAʻole ia e kuhikuhi i ka lāʻau i nā poʻe me ka maʻi ischemic stroke me kahi papa inoa aʻe o ka liʻiliʻi ma mua o ka hebedoma. "Hoʻoikaika ʻo Zilt" i ka manawa o ke koko, pono kēia e noʻonoʻo i ka wā i hoʻohana ʻia ai me ka "Aspirin", "non-steroidal anti-inflammatory drug," Heparin "a me" Warfarin ". Pono e ʻike ʻia nā mea maʻi e pili ana i ka hoʻonui nui ʻana i ka ticlopidine, prazogrel a me nā thienopyridines ʻē aʻe, no ka mea, he hiki ke hoʻonui ʻia ka hoʻāʻo ʻana ma waena o nā lāʻau lapaʻau o kēia pūʻulu.

Ke hōʻike nei i ka moʻolelo olakino e pili ana i ka hoʻonui nui ʻana i nā thienopyridines ʻē aʻe, pono e mālama pono ia i ka wā o ka mālama ʻana e ʻike ai i nā hōʻailona o ka hypersensitivity i ka mea hana. Ke hoʻomākaukau nei i ka mea maʻi no kahi hana i hoʻolālā ʻia, pono e hoʻōki ka hoʻohana ʻana i ka lāʻau no ʻelima a ʻehiku mau lā.

Pono e kuhikuhi ʻia kekahi kanaka e pili ana i ka hiki ʻana o ke kahe lōʻihi o ka manawa i ka wā o ka ʻoihana a me ka pono e hoʻomaopopo i ka lāʻau lapaʻau e pili ana i kēlā me kēia hihia i ke kahe. Ke kūkākūkā me nā kauka hou, pono ʻoe e hōʻike i ka hoʻohana ʻana i ka "Zilt", he mea nui kēia ʻike a i ke kuhikuhi ʻana i nā lāʻau hou, a ke kipa ʻana aku i kahi kanaka hānai.

ʻO kēia kahi lāʻau antithrombotic kahi e hoʻonāukiuki ai i ka hui o platelet, e kaohi ana i ke kaʻina o ka hoʻopili ʻana i ka adenosine diphosphate me nā receptors e loaʻa i ka membrane platelet, a i ka hana pū hou i nā mea kū a glycoprotein. E kōkua ka "Reomax" e hōʻemi i ka hoʻohui platelet, ka mea i hoʻonāukiuki ʻia e nā agonists ʻē aʻe, me ka pale ʻana i kā lākou hoʻouka ʻana e hoʻokuʻu i ka adenosine diphosphate.

Ka hana paʻa (clopidogrel) selly nakinaki a adenosine diphosphate me nā ʻāpana platelet, e pale ana i ko lākou hui ʻana. Hoʻohālikelike ka hoʻopili ʻana i kēia mau mea neʻe i ka nerve, hana ka nui o ke koko i ka holo ʻana o ko lākou holo "ola" holoʻokoʻa. ʻO Egithromb kekahi mea hoʻohālikelike o nā papa Lopirel.

Kuhi ʻia ka hui ʻana ma hope o ʻelua mau hola, a e nānā ʻia ka hopena kiʻekiʻe ma hope o ʻelima a ʻehiku mau lā. ʻAʻole ia e pili i ka hana o ka hui o nā enzymes e hoʻopololi ai i ka mea paʻa phosphodiester.

I ka mua o nā maʻi o ka lolo, kahi e kau ai ka kolamu a me nā ʻōmole ʻē aʻe i ka paia o loko o nā lāʻau i ke ʻano o ka pākaha a me nā pākeke, a ʻo nā paia i lilo i ka ʻoi ʻole a nalowale i kā lākou elasticity, e kōkua ka lāʻau lapaʻau e pale i ka thrombosis.

Ke hōʻike nei ka lāʻau lapaʻau i kahi hui lāʻau lapaʻau o nā lāʻau lapaʻau - nā kāpena antiplatelet. Hoʻohana ʻia ia e pale i nā hoʻopiʻi atherothrombotic ma nā ʻano ʻano holomua o ka maʻi naʻau.

ʻO ka mea kūpono i nā papa Plavix he clopidogrel. Hoʻopili ia i ke kaʻina o ka gluing platelets. ʻO kēia hopena kūlohelohe e pili ana i ka pihi paʻa o ke kaʻina o ke hoʻopili ʻana o ka hoʻoneʻe adenosine diphosphoric i ka hopena o ke akeʻa o nā platelets a me ka hoʻihoʻi hou o ke kaʻina o kā lākou hoʻopili. Hōʻike kēia hopena i ke ola o ke platelet (ʻehiku a ʻehiku mau lā), no laila ke hiki ke hoʻomau ʻia o ka hōʻuluʻulu ʻana ma hope o ka loaʻa ʻana o ke kelepona.

Ke hopena i ka hopena pharmacological o Plavix ma hope o ke hoʻololi ʻana o ka clopidogrel i loko o ka ate, a i hana ʻia ka huahana metabolic ikaika, ka mea e pale ai i ke kaʻina o ka lāʻau platelet. Ma hope o ka hoʻomaka ʻana e hoʻohana iā Plavix, ua hoʻokō ʻia ka hana anti-aggregation hana no ʻelua a ʻekolu mau lā a hiki i ka pae mau ʻana.

Ma hope o ka hoʻokuʻu ʻana i ka hoʻolālā Plavix, hoʻomaka ka hana platelet i nā lā ʻelima a ʻehiku. ʻO ka hoʻohana ʻana i ka lāʻau lapaʻau e hōʻemi nui ana i ka hoʻomohala ʻana i ka ischemia cerebral, a me ka infarction myocardial ma nā ʻano like ʻole o ka puʻuwai a me nā kīʻaha koko, me ka hoʻonui ʻana i nā maʻi atrial, e hoʻonui ana i ka maʻi koko ma kā lākou lua.

ʻO ka lāʻau i loko o ka hui therapeutic o nā lāʻau - nā antiplatelet agents a me nā anticoagulants. Hoʻohana ʻia ʻo Brilinta i ka mālama ʻia o nā maʻi cardiovascular, kahi i hoʻonui ʻia ai ka nui o nā koikoi koko i loko o nā capillaries, kahi e hiki ai i nā cerebral stroke a i ʻole myocardial infarction.

Ma hope o ka hoʻohana ʻana i ka lāʻau, ua hoʻokomo ʻia ka māhele kū o ka lāʻau i loko o ke koko mai ka pā liʻiliʻi. Loaʻa i ka mea lapaʻau lāʻau i loko o ke koko ka iwakālua a kanakolukū mau minuke ma hope o ka hoʻohana ʻia ʻana o ka lāʻau lapaʻau, ʻike ʻia ke koʻo o ka lōʻihi ma hope o hoʻokahi a me ka hapa.

Hāʻalo ka mea ikaika i ka umauma o ke kino holoʻokoʻa, ma ke kahe ʻana o ka palū i loko o ka lolo a me ke kaala o ka placental i loko o ka ʻōpū a me ka waiū i ka wā lactation. Hoʻololi ʻia ka mea ola (ticagrelor) i loko o nā pūpuna o ka pūpū, nā huahana decay i hoʻoili ʻia i loko o ka bile. ʻO ka pau ʻana o ka hapalua-ola he ʻehiku hola.

Hoʻohana ma ka poʻe maʻi me ka hoʻohaʻahaʻa genetically hoʻokeʻaka i ka CYP2C19 isoenzyme

Me nā hana haʻahaʻa o ka isoenzyme CYP2C19, pau ka hopena antiplatelet o clopidogrel. Ke hoʻohana nei i nā inikua kiʻekiʻe (kahi pae ukana o 600 mg, a laila 150 mg i kēlā me kēia lā), hoʻonui ka hopena antiplatelet o clopidogrel. I ka noʻonoʻo ʻana i nā hopena hopena o ka noiʻi, ʻaʻole hiki i ka hoʻomau ke hoʻonohonoho i ka ʻoi i loko ka hopena o ka dosage no nā mea maʻi me ka hoʻohaʻahaʻa i ka metabolism ma muli o ka hana haʻahaʻa o ka isoenzyme CYP2C19.

Hoʻohana i nā mea maʻi i nā ʻano ʻē aʻe

No nā lunakahiko o nā iwi ʻōiwi ʻē aʻe, ʻano like ʻole nā alleles o nā gen genres CYP2C19, nona ke kuleana a me ka hoʻokaʻawale o nā metabolism o nā clopidogrel i ka metabolite ikaika, ʻokoʻa. He palena wale nō nā ʻikepili i nā ʻelele o ka lāhui Mongoloid e pili ana i ka loiloi ʻana o ka pilina ma waena o ka genearype CYP2C19 isoenzyme a me nā hopena lāʻau.

Hoʻohana i ka kāne a me ka wahine

Ke hōʻike liʻiliʻi nei i ka hoʻohālikelike ʻana i nā waiwai pharmacodynamic o Lopirel i nā kāne ʻelua i hōʻike i kahi haʻahaʻa o ka hoʻohaʻahaʻa ʻana o ka ADP-induced platelet aggregation i ka wahine, akā ʻaʻohe ʻokoʻa i ka manawa koko. Ma kahi noiʻi nui o CAPRIE (kahi hui o ka clopidogrel a me acetylsalicylic acid i loko o nā poʻe maʻi me ka hoʻonui nui aʻe o ka hoʻomohala ʻana i nā hoʻopiʻi ischemic) i nā kāne a me nā kāne, ʻo ka pinepine o nā hopena lapaʻau, nā maʻi ʻolua a me nā hana hoʻokolohua mai nā kapu, a he like nā hopena ʻē aʻe.

Nā hopena hopena

Ua mālama ʻia kahi hōʻike palekana e pili ana i nā mea maʻi ma mua o 44,000, ʻoi aku ma mua o 12,000 mau mea maʻi i mālama ʻia no ka liʻiliʻi loa 1 makahiki. ʻO ka hoʻohaʻahaʻa maʻamau o ka clopidogrel e like me ka hoʻomanawanui o ka acetylsalicylic acid, me ka ʻike ʻole o ka lāhui, ka wahine a me nā makahiki o nā maʻi. Kekahi mau noiʻi lāʻau lapaʻau (CURE, CAPRIE, COMMIT, CLARITY, ACTIVE A) i hōʻike ʻia i nā hopena kino i hōʻike ʻia ma lalo nei.

I ka hoʻokolokolo CAPRIE, ʻae ʻia ka clopidogrel (i kēlā me kēia lā o 75 mg) e pili ana i kēlā no ka acetylsalicylic acid (i kēlā me kēia lā o 325 mg). Aia nā ʻōlelo kanalua i nā ʻike e pili ana i ka hopena maikaʻiʻole.

I nā hoʻokolohua olakino a me ka hoʻohana ʻana ma hope o ka hoʻohana ʻana i ka clopidogrel, ua hōʻike pinepine ʻia nā hihia kūwaho (ʻoi aku hoʻi i ka malama mālama mua).

I kahi hōʻike kuloka CAPRIE, ʻo ka nui o ke koko i hoʻoneʻe ʻia me ka hoʻohana ʻana i ka clopidogrel a i ʻole ka acetylsalicylic acid he 9.3%. ʻO ka hoʻopaʻi nui me ka clopidogrel i hoʻopaʻa ʻia me ka huina like o ka acetylsalicylic acid.

Ma kahi hoʻokolohua ʻo CURE me ka hoʻohana ʻana i ka acetylsalicylic acid a me clopidogrel no 7 mau lā ma hope o ka coronary artery bypass grafting i loko o nā mea maʻi i hoʻōki i ka mālama ʻana ma mua o 5 mau lā ma mua o ka ʻoi ʻana, ʻaʻole i ʻike ʻia. I ka poʻe maʻi i hoʻomau i ka lawe ʻana i ka paʻakikī o kēia mau lāʻau i nā lā 5 ma mua o ka hoʻomaka ʻana o ka coronary artery bypass grafting, hōʻeha ʻia ka ʻike me ke kahe o ka 9,6% (no ka hoʻohui o ka acetylsalicylic acid + clopidogrel) a me 6.3% (no ka hui ʻana o ka acetylsalicylic acid + plasebo).

Ua hōʻike ka hōʻike hoʻokolohua ʻo CLARITY i ka nui o ka hoʻokahe koko no ka acetylsalicylic acid + clopidogrel pūʻulu hoʻohālikelike i ka hui acetylsalicylic + placebo hui. I nā hui ʻelua, like ka nui o ke koko kaumaha me ka hoʻokaʻawale kūʻokoʻa o ke ʻano o ka heparin a i ʻole ka fibrinolytic therapy a me nā hiʻohiʻona mua o nā maʻi.

Ma kahi hoʻokolohua klinū COMMIT, ʻo ka nui o ka loaʻa o ka hemorrhage cerebral a i ʻole ka hemorrhage non-cerebral ma lalo a ʻaʻole iʻokoʻa ʻole no nā pūʻulu ʻelua.

Ma ka ACTIVE-Ka hoʻokolohua hoʻokolohua, ʻoi ka nui o ke kahe koko nui loa no ka acetylsalicylic acid + clopidogrel pūʻulu ma mua o ka acetylsalicylic acid + hui plasebo (6.7% a me 4.3%, kēlā me kēia). Kahi, ka huila nui o nā hui ʻelua i ka extracranial (5.3% a me 3,5%, kela) kekahi, ʻoi pinepine ka ulu ʻana o ke koko gastrointestinal (3.5% a 1,8%, kekahi). I loko o ka acetylsalicylic acid + clopidogrel pūʻulu, ʻoi aku ka maʻamau o ka hemorrhages intracranial i ka hoʻohālikelike ʻana me ka hui acetylsalicylic + plasebo (1.4% a 0.8%, kekahi). ʻAʻole nō hoʻi nā ʻokoʻa kūhelu statistically no kēia mau hui i ka loaʻa ʻana o ka ʻōpū hemorrhagic (0.8% a me 0.6%, kēlā me kēia) a me ka hōʻeha o ke koko (1.1% a 0.7%, kū hoʻokahi).

I nā haʻawina hōʻike maʻi a me nā hōʻike pili pili, ua hoʻopaʻa ʻia nā hopena maikaʻi ʻole:

lymphatic and circulatory system: pinepine - - eosinophilia, leukopenia, thrombocytopenia, jarang neutropenia (komo neutropenia nui), luhi loa aplastic, thrombotic thrombocytopenic purpura, agranulocytosis, pancytopenia, thrombocytopenia, granulocy
kalima: He hopena ʻole loa - ka hopena o ka anaphylactoid, maʻi maʻi serum, ʻike pinepine ʻole ʻia ka ulu ʻana o ka hopena o ka hypersensitivity me ka thienopyridines (no ka laʻana, me ka ticlopidine a me prasugrel).
psyche: luhi loa - kūleʻa, ʻike.
nāūna nūlāwila: pinepine - ʻeha, hopohopo, intracranial hemorrhage (kekahi mau hihia me ka hopena o ka make), haunaele, paresthesia, aneane ʻole - ʻono ʻino,
ka ʻike: pinepine - nā ʻōpū o ka maka (ma ke kiko o ka maka, conjunctiva, retina),
lohe
nā kīʻaha koko: pinepine - hematomas, lohi loa - hoʻōki mai kahi hōʻeha hana, ke koko ikaika, hoʻemi i ke koko, vasculitis,
ʻūnaehana hanu: pinepine - nosebleeds, ʻokoʻa loa - bronchospasm, kahe koko mai ka ʻōpū o ka ʻōpū (ʻōpū pulmonary hemorrhage, hemoptysis), eosinophilic pneumonia, ʻōpū o ka ʻulaʻawa,
gastrointestinal tract: pinepine ka maʻi, ka huhui o ka gastrointestinal, dyspepsia, ʻeha ʻeha, hōʻeha mau i ka maʻi hōʻeha, ka ʻōpū a me ka ʻākā duodenal, ka maʻi pākaʻi, ka luaʻi, ka lemulewa, constipation, ʻeha pinepine ka hoʻokaʻina o retroperitoneal, ʻokoʻa loa ka retroperitoneal a me ka ʻeha o ka gastrointestinal ka hoʻowalewale o ka ʻōpū, colitis (me ka lymphocytic a i ʻole ulcerative), pancreatitis, stomatitis,
akea a me ka maʻi pāpaʻi: aʻeha loa - hepatitis, hoʻonāukiuki mākaʻikaʻi ole, abnormalities i loko o nā noiʻi hana o ke kūlana hana o ka ate,
ʻili a me ka ʻōpio ʻākalaokele: pinepine - wili, pinepine, - hōʻeha, hoʻoluhi, purpura, ʻokoʻa loa - angioedema, bullous dermatitis (erythema multiforme, Stevens-Johnson syndrome, nā toxic epidermal necrolysis), ʻ hyplelo hopuna hypersensitivity syndrome, erythematic a exfoliative syrup lapas me nā ʻōnaehana hōʻailona a me nā eosinophilia, urticaria, lichen planus, eczema,
musculoskeletal a me ka hoʻopili hoʻohui: paʻakikī loa - ʻeha, hemarthrosis (hemorrhage i ka musculoskeletal system), myalgia, arthralgia,
nā pēpē a me nā urinary tract: pinepine - hematuria, ʻokoʻa loa - ka hoʻonui ʻana i ka ʻike o nā mea hana i loko o ke koko, glomerulonephritis,
mea hana a me nā haʻawina ʻoihana: pinepine - ka hoʻohaʻahaʻa o ka neutrophils, he nui ka manawa e hoʻokaʻina i ke koko, he manawa hōʻemi i ka nui o nā platelets.
nā pilikia ma ka wahi i hoʻopaʻa ʻia a me nā maʻi maʻamau: pinepine - kahe koko mai ka pūnaewele puncture, kahi liʻiliʻi loa - ka maʻi.

Hoʻopili ʻia nā maʻi hematological

Ke hōʻike ʻia nei nā hōʻailona haukapila e hōʻike ana i ka hoʻomaka ʻana o ke koko a me ka hoʻonaninani ʻana i nā hopena i makemake ʻole ʻia, pono e hana koke i ka hoʻokaʻina koko lapaʻau, hoʻoholo i ka manawa tromboplastin hoʻōla ʻia, hoʻāla helu platelet, hana hana platelet, a me nā haʻawina kūpono.

Hoʻohana ʻia Lopirel me ka makaʻala i nā mea maʻi me ka piʻi nui o ke kahe e pili ana i ka hōʻuluʻulu ʻana o nā hōʻola, nā mea hōʻeha, nā kūlana pathological, a i nā mea maʻi e loaʻa ana i nā lāʻau anti-inflammatory non-steroidal (ma ke ʻano, ka acetylsalicylic acid, heparin, COX-2 inhibitors, glycoprotein IIb / IIb / inhibitors. ʻO IIIa a i ʻole nā selotonin reuptake inhibitors.

I loko o nā hebedoma mua o ka mākaʻi o Lopirel a i ʻole ma hope o kahi hanana cardiological invasive a i ʻole hōʻino ʻana i ka hoʻomaʻamaʻa ʻana, mālama pono i nā hōʻailona o ke koko, e komo pū i ka latent.

Ma muli o ka hoʻonui hiki o ka huhū, ʻaʻole i ʻae ʻia ka hoʻohana ʻana o Lopirel a me warfarin. ʻO nā mea ʻē aʻe he loaʻa i nā kūlana kulekele: ʻo ka hele ʻana o ka ventricle hema o kahi thrombus e holo ana, e noho ana i nā mea maʻi me ka atrial fibrillation, etc.

Ma ka hihia o ka hana hoʻolālā hoʻolālā e hoʻolālā ʻia ana a i ka nele o ka pono e hōʻoia i ka hopena antiplatelet, e kau ʻia ka hoʻokele Lopirel i ka 7 mau lā ma mua o ke komo ʻana.

Ma mua o ka hoʻomaka ʻana i kekahi mau lāʻau lapaʻau hou a ma mua o ka hōʻino ʻana e hiki mai ana, pono ka mea maʻi e hoʻomaopopo i ke kauka (me ka dentist) e pili ana i ka lawe ʻana iā Lopirel.

Hoʻonui i ka lāʻau hoʻomohala i ka manawa koko, no laila, pono e hoʻohana me ka akahele me ka poʻe maʻi me nā maʻi e hoʻomaka ana i ke koko (ʻoi loa ka hana intraocular a me ka gastrointestinal).

Pono ke ʻano o ka mea maʻi e mālama iā Lopirel (i loko o ka monotherapy a i ka hoʻohui pū ʻana me ka acetylsalicylic acid), ʻo ka hana ʻana i ke kaila e pono ai ka manawa hou aku. Inā hele ʻole ke kahe koko ʻole (ma o ka manawa a i ʻole localization), pono ʻoe e nīnau me kāu kauka.

Thrombocytopenic Purpura (TTP)

ʻOiai ma hope o ka pau ʻana o ka clopidogrel pōkole, he mau hihia nui loa o ka thrombocytopenic purpura, kahi i hōʻike ʻia e ka thrombocytopenia, microangiopathic hemolytic anemia, i hoʻopili ʻia e ka maʻi renal lēʻaila, ke ʻano, ka maʻi, a me ka maʻi neurological. Manaʻo ʻo TTP i kahi hanana hoʻoweliweli i hiki i ke ola ke koi nei i ka mālama ʻana, me ka plasmapheresis.

Loaʻa ka hemophilia

I ka wā o ka mālama ʻana me ka clopidogrel, ua hoʻopaʻa ʻia nā hihia o ka hemophilia i loaʻa. I ka hōʻoia ʻana i ka elongation o ka manawa thromboplastin activated me ka ʻole o ka hoʻomoʻa ʻana i ka pehu, a i ʻole me ia, pono ʻoe e noʻonoʻo i ka hopena o ka hemophilia i loaʻa, a inā ua hoʻokō ʻia kahi maʻi kūpono, e kāpae i ka lawe ʻana iā Lopirel a hoʻomaka i ka mālama kūpono.

ʻO ka wili ischemic hou

ʻAʻole ia e hāʻawi ʻia ʻo Lopirel i ka wā e kuhikuhi ana i ka lāʻau ischemic stroke a hiki i ka 7 mau lā i hala aku nei ma muli o ka nele o ka ʻikepili i kāna hoʻohana ʻana i kēia kūlana.ʻO ka hui hoʻohui me ka acetylsalicylic acid a me clopidogrel i nā mea maʻi me ka puʻuwai ischemic transient hou a ischemic stroke a ʻoi aku ka hopena kiʻekiʻe o ka hoʻoulu ʻana i nā hanana atherothrombotic ʻaʻole mea e ʻoi aku ka maikaʻi ma mua o ka monotherapy me ka clopidogrel, akā he nui aʻe ka hopena o ke kahe nui.

ʻŌpū a me ka lactation

ʻAʻole i hōʻike ʻia nā haʻawina holoholona i kahi hopena a me ka hiki ʻole o ka clopidogrel i ka hoʻomohala ʻana i ka embryonic, ka hapai, ka hānau ʻana, hoʻomohala postnatal, akā ma muli o ka nele o nā ʻike pili kino, ua hoʻohana ʻia ka hoʻohana ʻo Lopirel i nā maʻi hāpai.

I ka hoʻomakaʻana o ka noiʻi ʻana i nā mea nui, ka mea i ʻike ʻia e clopidogrel a me nā metabolites i loko o ka waiū o ka waiū, no laila, i ka loaʻa ʻana o ka maʻi me Lopirel, pono e hoʻopau ʻia ka umauma. ʻAʻohe ʻikepili i ka hoʻokuʻu ʻana o clopidogrel me ka umauma umauma o ke kanaka.