Clopidogrel teva

ʻĀpana Pharmacological

ʻO nā māka Antithrombotic. Nā hui Antiplatelet. Kiwi ATX B01A C04.

Kākoʻo o ka atherothrombosis i nā pākeke

• i nā maʻi i loaʻa i ka infarction myocardial (ʻo ka hoʻomaka ʻana o ka mālama ʻana i kekahi lā, akā, ʻaʻole i hala ma mua o 35 mau lā ma hope o ka hoʻomaka), hōʻeha ʻo ischemic (ʻo 7 ka hoʻomaka ʻana o ka mālama ʻana i nā lā 7, akā ʻaʻole ia ma mua o 6 mau mahina ma hope o ka hoʻomaka) a i ʻole ka mea i hōʻike ʻia e ka maʻi mai. peripheral arteri (hoʻopōʻino i nā aʻa, a me ka atherothrombosis o nā moku o nā lalo haʻahaʻa),
• i nā mea maʻi me ka maʻi coronary syndrome (ACS):
• me ka hopena o ka coronary syndrome me ka ʻole o ka kahi ST ST i ʻole (unstable angina or myocardial infarction without Q wave), me nā poʻe maʻi e hoʻomāloʻi ana i ka shunting i ka wā ʻoiʻo ka coroniary coronary, me ka hui me ka acetylsalicylic acid (ASA)
• me ka maʻi myocardial infarction me kahi kiʻekiʻe ST kahi, i hui pū me ka acetylsalicylic acid (i nā poʻe maʻi e loaʻa ana i ka lāʻau lapaʻau maʻamau a e hōʻike ʻia ana ka lāʻau thrombolytic).

Kāohi i nā hanana atherothrombotic a me ka thromboembolic i ka fibrillation atrial:

• clopidogrel i hui pū me ASA i hōʻike ʻia ma ka poʻe maʻi nā maʻi me ka fibrillation atrial, nona ka liʻiliʻi ma kahi o ke kūkaʻi no ka hanana ʻana o nā hanana vascular, a he mau contraindications e mālama ai me ka vitamin K antagonist (AVK) a me ka mea he pilikia haʻahaʻa o ke kahe, no ka pale ʻana i nā hanana atherothrombotic a me ka thromboembolic. e komo pū me ka uha.

ʻLoe a me ke kākele

Nā pākeke, pāʻoihana nā maʻi maʻi maʻi. Kuhi ʻia nā clopidogrel he 75 mg 1 mau manawa i kēlā me kēia lā, ʻaʻohe o ka meaʻai o ka meaʻai.

Hoʻohana ʻia ka Clopidogrel i nā maʻi me Hoʻokiʻi ka ACS me kahi ʻole o ka paukū ST (kaomi pectoris kuʻi ʻole a i ʻole ka miʻi mokulele ʻole Q me ka nui o ka ECG) e hoʻomaka me ka pahu hoʻoulu ʻana ma kahi o 300 mg, a laila hoʻomau ʻia ma kahi o ka 75 mg hoʻokahi i hoʻokahi lā (me ka acetylsalicylic acid (ASA) ma kahiʻu o 75 325 mg / lā). Ma muli o ka hoʻohana ʻana o nā papa kiʻekiʻe o ka ASA e hoʻonui i ka nui o ke kahe, a ʻōlelo ʻia e ʻaʻole e hoʻonui i ka nui o ka acetylsalicylic acid o 100 mg. ʻAʻole paʻa i ka lōʻihi o ka mālama ʻana. Loaʻa nā pono o ka hoʻohana ʻana i ka lāʻau a hiki i ka 12 mau mahina, a ua nānā ʻia ka hopena kiʻekiʻe ma hope o 3 mau mahina o ka mālama ʻana.

ʻEha me ka wahī myocardial infarction me ka hoʻāla kiʻekiʻe ST Ua kau ʻia ʻo clopidogrel i 75 mg hoʻokahi manawa i ka lā, e hoʻomaka me ka hoʻokahi pākēneka o 300 mg i hui pū me ASA, me ka ʻole o nā lāʻau thrombolytic. Hoʻomaka ka mālamaʻana i nā mea maʻi ma mua o 75 mau makahiki me ka loaʻa ʻole o ka ʻai ʻana o ka clopidogrel. Pono e hoʻomaka ʻia ka hoʻohui ʻana me ka hoʻomaka ʻana ma hope o ka hoʻomaka ʻana o nā hōʻailona a hoʻomau mau no ka liʻiliʻi o nā pule he ʻehā. Loaʻa nā pōmaikaʻi o ka hoʻohana ʻana i ka hui pū ʻana o clopidogrel me ASA no hoʻokahi mau makahiki ʻehā me kēia maʻi.

No ka poʻe maʻi me ka fibrillation atrial, hoʻohana ʻia ka clopidogrel i loko o kahi pākahi o 75 mg. Me ka clopidogrel, pono e hoʻomaka ka hoʻohana ʻana o ASA a hoʻomau ʻia (ma ke ʻano o 75-100 mg pākahi) i kēlā me kēia lā.

Ma ka hihia o ka nalo ana:

• inā ua emi iki ma mua o ka 12:00 i hala mai o ka manawa i pono ai e lawe i ka hopena hou aʻe, e lawe koke ka mea maʻi i ka hala i hala, a pono hoʻi ke kiʻi ʻia ka hopena hou aʻe i ka manawa maʻamau.
• inā he keu ma mua o ka hala ʻana o ka ʻenemi, pono e lawe ka mea maʻi i ka hopena hou aʻe i ka manawa maʻamau akā ʻaʻole e pāpālua i ka nui o ka hopena e uku ai no ka pōʻai ʻole.

ʻO Renal hiki ʻole . ^ E Ha yM. Hoʻolaha ka ʻike i ka lāʻau lapaʻau e hoʻohana ai i ka lāʻau lapaʻau i nā mea maʻi me ka pilikia ʻole.

ʻO ka hana hema ʻole . ^ E Ha yM. ʻO ka ʻike ʻana i ka lāʻau lapaʻau e hoʻohana ai i ka lāʻau lapaʻau i nā mea maʻi me nā maʻi maʻi hōʻemi a me ka hiki ʻana o ka hemorrhagic diathesis.

ʻO nā hopena ʻino

I hōʻike ʻia he koko maʻi ka mea maʻamau a pinepine i ka malama mua o ka mālama ʻana.

Hoʻokaʻawale ʻia nā hopena ʻino ma waena o nā ʻōpū, ua wehewehe ʻia ka lōʻihi o ko lākou hanana ʻana ma lalo nei: ma pinepine (mai ³ 1/100 a ≤ 1/10), pinepine pinepine (mai ka ³ 1/1000 a ≤ 1/100), ʻokoʻa (mai ³ 1/10 000 a ≤ 1/1000), loaʻa pinepine ka ʻike (ʻike ʻana Hoʻopāka

Pākuʻi helu

ʻO nā papa kiʻi ʻoniʻoni 75 mg

Aia ma ka papa papa

mea waiwai: clopidogrel hydrosulfate 97.857 mg,

like me ka clopidogrel 75.00 mg

nā mea pōkole: lactose monohala (200 mesh), microcrystalline cellulose (Avicel PH 101), selulosa hydroxypropyl (Klucel LF), cellulose microcrystalline (Avicel PH 112), crospovidone (Collidon CL), ka ʻano ʻaihue hydrogenated I (Sterotex-Dritex) laulea laulea

ʻĀpana molino: lactose monohidrat, hypromellose 15 cP, titanium dioxide (E171), polyethylene glycol 4000, ulaula pōkāleʻa (E172), hao hāleʻa kahe (E172), indigotine (E 132, indigo carmine alumunium varnish FD&C kahalaha ka 2)

Hoʻonohonoho ʻia nā papa papa mai ka māpani kukui me ka ulaula, i hana ʻia i ka capsule, hōʻailona ʻia "93" ma kekahi ʻaoʻao a "7314" ma kekahi ʻaoʻao.

ʻO nā waiwai Pharmacological

Ma hope o ka lawelawe waha, clopidogrel e hoʻopili koke ʻia ana mai ka gastrointestinal tract. Loaʻa nā pae plasma kiʻekiʻe o ka clopidogrel i loli ʻole (ma kahi o 2.2-2.5 ng / ml ma hope o hoʻokahi pāʻaiʻi he 75 mg) e loaʻa i 45 mau minuke ma hope o ka lawe ʻana i ka lāʻau. Hoʻoholo ʻia ka pane ʻana mai ka renal eliminations o nā clopidogrel metabolites ma kahi o 50%.

ʻO Clopidogrel a me kāna hana nui (hana ʻole) ka hāmeʻe i loko o ke koko, hana i kahi pilina me ke ʻano o ka protein plasma kanaka (98% a me 94%, kahi). ʻAʻole paʻa nā Binding i nā ʻano ākea ākea.

Hoʻopili nā Clopidogrel i nā hana kūlohelohe pili i ka pili ole. Hoʻopili ʻia ka Clopidogrel i ʻelua mau ala nui: ka mea i palahalaha e nā esterases a alakaʻi i ka hydrolysis me ka hoʻokumu ʻana o kahi kumalā o kahi huahua carcarylic acid (85% o nā metabolites i ke kahe koko), nā mea ʻē aʻe i pihi ʻia e nā cytochromes P450 āpau. 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. ʻO kēia ala metabolic kahi i hoʻoili ʻia e CYP3A4, CYP2C19, CYP1A2 a me CYP2B6. ʻO ka metabolit thiol ikaika e hoʻopaʻa koke a kūlike ʻole i nā ʻāpana platelet, a laila hoʻoweliweli i ka hoʻohui platelet.

Hāpai ʻia ʻo Cmax o ka metabolite ikaika e 2 mau manawa, ʻelua ma hope o ka ʻai ʻana i hoʻokahi hapaha o clopidogrel 300 mg, a ma hope o ka lawe ʻana i ka nui o ka mālama ʻana o 75 mg no 4 mau lā. Hānā ʻia ʻo Cmax ma kahi o 30-60 mau minuke ma hope o ka hoʻokele ʻana.

Ma hope o ka lawe ʻana i ka clopidogrel, ma kahi o 50% e hoʻopiʻi ʻia ai i loko o ka pāʻai a ma kahi o 46% me nā feces i loko o 120 mau hola ma hope o ka hoʻokele ʻana. Ma hope o hoʻokahi kahe waha waha o 75 mg, ʻo ke kinai o ka hapalua o ke ola o ka clopidogrel ma kahi o 6 mau hola. ʻO ka hapaʻelua o ka metabolite nui (hana ʻole) ka hūnā i loko o ke koko he 8 mau hola ma hope o ke ʻano hoʻokahi a kū hoʻi i ka lawelawe.

Hoʻololi ʻia ʻo CYP2C19 i ka hoʻokumu ʻana o ka metabolite ikaika a me kahi metabolite takahi, 2-oxo-clopidogrel. ʻO nā hopena o ka pharmacokinetics a me nā antiplatelet o ka metabolite ikaika o ka clopidogrel ikaika e kūlike i ka genotype 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 ka alleles CYP2C19 * 2 a me CYP2C19 * 3 no ka hapa nui o nā alleles me nā hana i hōʻemi ʻia i ka hana o ʻEulopa (85%) a me ʻAsia (99%) nā metabolizers wikiwiki. ʻO nā alelila ʻē aʻe e pili ana i ka lilo ʻole a i hōʻemi paha i ka hoʻoneʻeneʻa ʻana me ka liʻiliʻi ʻole a loaʻa iā CYP2C19 * 4, * 5, * 6, * 7 a me 8. ʻO ka pae nui o ka alleles CYP2C19, e hoʻopiʻi ana i kahi hōʻemi haʻahaʻa a me ka wikiwiki o ka CYP2C19, ʻokoʻa ka hilinaʻi ʻana i ka lāhui / ʻano. Loaʻa nā ʻikepili palapala kūwaho no ka lehulehu o ʻAsia, ʻaʻole ia e ʻae iā mākou e loiloi i ka hopena o ka genotyping CYP2C19 ma ka hopena o ka hanana.

ʻO kahi mea maʻi me ke kūlana o ka metabolizer lohi e loaʻa i nā alleles me kahi hana nalowale, e like me ka mea i hōʻike ʻia ma luna nei. ʻO ka maʻamau o ka genotype o ka slow CYP2C19 metabolizer he like me 2% no ʻEulopa, 4% o nā lāhui Aferika a me 14% ka hopena o Kina. Aia nā hoʻokolohua e hoʻoholo ai i ka genotype CYP2C19 o ka mea maʻi.

ʻAʻohe mea nui i ʻike i ka pālahalaha o ka metabolite hoʻoikaika a hiki i ka pohi pākaha o nā platelet aggregation (PAT) ma waena o ka ultrafast, ka wikiwiki a me ka metabolizers waena. I ka hoʻololiʻana i ka metabolizer, ke hoʻohaʻahaʻa nei ka weheʻana o ka metabolite ikaika e 63-71% hoʻohālikelike me nā metabolizers wikiwiki. Ma hope o ka hoʻokomo ʻana i ka regimen 300 mg / 75 mg dosis, ka emi ʻana o ka pane antiplatelet i ka minamina hoʻolimalima ka nānā ʻana, me ka awelika ʻo PAT (5 μM ADP) ka 24% (24 mau hola) a me 37% (lā 5) hoʻohālikelike ʻia me 39% PAT (24 hola) ) a me 58% (lā 5) o nā metabolizer wikiwiki a me 37% (24 hola) a me 60% (lā 5) o nā metabolizers medium. Ke hele nei ka nui o nā metabolizer i ka 600 mg / 150 mg regimen, ka nui o ka ʻike i ka metabolite ikaika e ʻoi aku ka nui ma loko o ka waihonaimen 300 mg / 75 mg. Eia kekahi, ʻo 32 ka nui (24 hola) a me 61% (lā 5), ʻoi aku ka nui ma mua o ka hoʻololi ʻana o ka poʻe metabolizer i ke kiʻekiʻe o ka 300 mg / 75 mg, akā like like me nā poʻe ʻē aʻe o nā metabolism CYP2C19 e pili ana i ka regimen 300 mg / 75. mg ʻAʻole paʻa i kahi papa kau palena kūpono no kēia heluna kanaka hoʻomanawanui.

Hoʻololi ka ʻike i kahi metabolite ikaika e 28% i nā mea hoʻomohala medium e a me ka 72% i ka metabolizer wikiwiki, ʻoiai ke kaohi ʻana o ka platelet aggregation (5 μM ADP) me ka hoʻokaʻawale ʻana me ka PAT o ka 5.9% a me 21.4%, kēlā, inā ua hoʻohālikelike ʻia me ka wikiwiki nā mea hana i hoʻoponopono ʻia.

ʻAʻole maopopo ka ʻike i nā pharmacokinetics o ka metabolite ikaika o ka clopidogrel i loko o kēia mau (me ka pelemaha paʻa a me ka hana o ka ʻōpū) ʻike papalua.

Hola paʻa kino hana

Ma hope o nā kau pinepine ʻana o ka clopidogrel ma 75 mg i kēlā me kēia lā i nā mea maʻi me ka maʻi ʻeha o ka maʻi kino (ʻo ka hana maina mai ka 5 i ka 15 ml / min), ʻo ka hoʻomakeke ʻana o ka hui platelet i hōʻea ʻia e ADP (adenosine diphosphate) i nā nāwaliwali (25%) ma mua o nā kumuhana olakino, akā, ʻo ka hoʻonui ʻia ʻana o ka manawa ua like ke koko e like me ke kahe o ke koko i nā kumuhana olakino i loaʻa iā 75 mg o clopidogrel i kēlā me kēia lā. Eia kekahi, aia kahi hōʻaiʻē maikaʻi o nā maʻi āpau i nā maʻi āpau.

Hōʻeha ka hana ʻoluʻolu

Ma hope o nā hana pinepine o ka clopidogrel ma 75 mg i kēlā me kēia lā no 10 mau lā i ka poʻe maʻi me ka hana i hoʻopaleha i ka hana o ka puʻuwai, pale ʻia i ka ʻōpū platelet i hoʻokumu ʻia e ADP e like like me nā kumuhana olakino. ʻO ka lōʻihi o ka lōʻihi o ke kaila o ke koko i hoʻololi ʻia.

ʻO Clopidogrel kahi mea mua o ka waiwai hana, kekahi o nā metabolites kahi o ka mea pale o ke kōpana platelet.Hoʻopili ʻia nā Clopidogrel e nā enzyme CYP2C19, ka hopena i ka hoʻokumu ʻana o ka metabolite ikaika e kāohi ana i ka hoʻohui platelet. ʻO ka clopidogrel metabolite ikaika e paʻa i ka paʻa ʻana o ka adenosine diphosphate (ADP) i kāna neʻe platelet P2Y12 a me ka hoʻomohala hou ʻana mai o ka hoʻopihapiha glycoprotein GPIIb / IIIa i hoʻoneʻe ʻia e ADP, e pale i ka hōʻiliʻili ʻana o platelet. Ma muli o ka hiki ʻole o ka hoʻopili ʻana, e pōʻino ana nā platelets e ʻike ʻia no ke koena o ko lākou ola (ma kahi o 7-10 lā), a ua hoʻihoʻi hou ʻia ka hana maʻamau o nā platelets ma ka uku i pane ʻia me ke alaka o ka platelet. ʻO ka hui platelet i hoʻopiʻi ʻia e nā agonists ʻē aʻe i kahi ADP ke pani ʻia e ka pale ʻana i ka hoʻonui ʻana i ka hoʻāla ʻana o ka platelet e ka hōʻike ʻana i hoʻokuʻu ʻia ka ADP

No ka mea ke hoʻomohala ʻia ka hana metabolite me ka hoʻohana ʻana i nā enzyme CYP450, ʻo kekahi o lākou he polymorphic a i hoʻopaʻa ʻia hoʻi e nā mea lapaʻau ʻē aʻe, ʻaʻole ka mea maʻi āpau i loaʻa ke kīkala platelet suppression.

ʻO nā helu pinepine o 75 mg i kēlā me kēia lā mai ke alakaʻi i kahi nui o ka hōʻiliʻili ʻana o ka platelet aggregation i hoʻokumu ʻia e ADP. Hoʻonui ka hopena pale i ka holomua a hiki i ka moku kākoi i 3-7 mau lā. Ma ka lānai o ka kūlike, ʻike ʻia ka pae kiʻekiʻe o ka paʻa ʻana ma ka maʻa he 75 mg i kēlā me kēia lā a i waena mai 40% a 60%. ʻO ka hōʻiliʻili ʻana o ka platelet a me ka hoʻoheheʻe i ka manawa e hoʻi lohi nei i kona pae mua, ʻoi aku ka 5 mau lā ma hope o ka hoʻopau ʻana o ka mālama ʻana.

Kāohi i nā hanana atherothrombotic:

- i nā mea maʻi me ka myocardial infarction (mai kekahi mau lā a i

ʻLoe a me ke kākele

Hoʻopili ʻia ʻo Clopidogrel-Teva ma ke ʻano he ʻano kai.

No nā poʻeʻelemakule a me nā poʻe maʻi maʻi, ʻo clopidogrel-Teva i kuhikuhi ʻia i ka pākahi o 75 mg.

Ma ka hopena o ka coronary syndrome me ka hoʻihoʻi ʻole ʻana i ka mahele o ST (kahi paʻa angina a i ʻole ka myocardial infarction me ka hawewe Q), ua kauoha ʻia ka lāʻau lapaʻau me kahi kaomi ʻai hoʻokahi o 300 mg. ʻO ka papa mālama mālama he 75 mg i kēlā me kēia lā (ma ka hui me ka acetylsalicylic acid ma kahi o nā'āpana 75-325 mg / lā) no 12 mau mahina. ʻO ka hopena therapeutic kiʻekiʻe loa e nānā ʻia ma hope o 3 mau mahina. ʻAʻole ia e kau i kahi ʻoi aku o ka nui o ka acetylsalicylic acid ma mua o 100 mg, ma muli o ke hoʻonui nui o ke kahe.

Ma ka huina myocardial infarction me ka hoʻonui ʻana i ka māhele ʻo ST, ua kuhikuhi ʻia ka lāʻau lapaʻau ma kahi o ka 75 mg i kēlā me kēia lā (i hui pū me ka acetylsalicylic acid) e hoʻomaka ana me hoʻokahi ka wai pākē o 300 mg, me ka ʻole o nā lāʻau thrombolytic. I nā poʻe maʻi ma luna o ka makahiki 75 he mau makahiki, mālama ʻia ka lāʻau Clopidogrel-Teva me ka ʻole o ka hoʻohana ʻana i kahi lāʻau ʻai kū hoʻokahi. Pono e hoʻomaka ʻia ka lāʻau hoʻohui ʻana ma hope o ka hoʻomaka ʻana o nā hōʻailona a hoʻomau mau no ka liʻiliʻi o 4 mau hebedoma.

Me ka atrial fibrillation, ua kuhikuhi ʻia ka lāʻau lapaʻau ʻia ma ke ʻano hoʻokahi o 75 mg, i hui pū ʻia me ka acetylsalicylic acid 75-100 mg i kēlā me kēia lā.

Inā kuhi ʻoe i ka lāʻau lapaʻau ma mua o 12 mau hola mai ka papa maʻamau, pono e lawe i ka mea maʻi i ka papaʻi, a laila e lawe i ka hopena hou i nā manawa maʻamau. Inā hala ma mua o 12 mau hola i hala, pono e lawe ka mea maʻi i ka ʻokoʻa o ka lāʻau ma ka manawa maʻamau i hoʻonohonoho ʻia, ʻaʻole pono e lawe i ka pālua ʻelua.

Hola paʻa kino hana

Hoʻopili ka ʻike hana Clopidogrel i nā mea maʻi me ka hana renal impaired. No laila, i ka loaʻa o nā mea maʻi, pono e hoʻohana ʻia ka lāʻau lapaʻau me ka mālama aka.

Hōʻeha ka hana ʻoluʻolu

Hoʻohana ʻia ka ʻike ma ka hoʻohana ʻana i ka lāʻau lapaʻau i nā mea maʻi me ka hana aho o ka naʻau i ʻole e hōʻemi ʻia, paʻa i ka hemorrhagic diathesis. I kēia mea, i kēia heluna, pono e hoʻohana ʻia ka lāʻau lapaʻau me ka mālama aka.

Nā hopena hopena

ʻO ka pīhoihoi ka hopena maʻamau loa i hoʻopaʻa ʻia ma nā hoʻokolohua lapaʻau a ma ka wā kūʻai aku ma kahi o ka kūʻai ʻana, kahi i hoʻopaʻa nui ʻia ai ka malama mua o ka mālama ʻana.

ʻO nā hōʻike ʻinoʻino i hōʻike ʻia i loko o nā hoʻokolohua hoʻokolohua a i ʻole hōʻike ʻia ma nā hōʻike pili lōkahi ma lalo nei.

Nā Hoʻohui

- Nā maʻi lahilahi i ka mea ikaika a i ʻole nā ​​mea waiwai o ka lāʻau lapaʻau

- kelepona paʻakikī

- ka huhū ʻeha (ulia ʻōpū, ka hemorrhage intracranial)

- Intolerance galactose, Lapp lactase kakali a i ʻole ka malabsorption glucose-galactose

- ka wahine a me ka lactation

- nā keiki ma lalo o 18 makahiki

Hoʻopili i nā lāʻau lapaʻau

Anticoagulants oral. ʻO ka hoʻohana pinepine ʻana o ka clopidogrel me nā anticoagulants waha, ʻaʻole i ʻōlelo ʻia, ʻoiai ua hiki i kēia hui ke hoʻonui i ke koko. ʻOiai ka lawe ʻana o ka 75 mg o clopidogrel i kēlā me kēia lā ʻaʻole i hoʻololi i ka pharmacokinetics o S-warfarin a i ʻole ka internationalization ratio pae (INR) i nā poʻe maʻi e lawe ana i warfarin i kahi lōʻihi, ʻo ka manawa ka manawa o ka clopidogrel a me warfarin e hoʻonui i ka hopena o ke kahe koko ma muli o nā hopena o nā mea ʻelua ma ka hemostasis ka lāʻau lapaʻau.

ʻO Glycoprotein IIb / IIIa inhibitors: pono e hoʻopili ʻia ka clopidogrel i ka poʻe maʻi e loaʻa pū ana me IIb / IIIa inhibitor glycoprotein.

Acetylsalicylic acid (ASA): ʻAʻohe hoʻololi o ASA i ka clopidogrel-induksi inhibitions o platelet aggregation i hoʻihoʻi ʻia e ADP, akā hoʻonui ka clopidogrel i ka hopena o ASA ma ka platelet aggregation i hoʻoiho ʻia e collagen. Eia nō naʻe, ʻaʻole ka hoʻopiʻi nui ʻana i ka mālama like ʻana o ASA ma 500 mg ʻelua i ka lā o ka lā a puni. 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, pono e hoʻohana ʻia nā hana like ʻole o kēia mau lāʻau. Eia nō naʻe, ʻike pū ʻia ka clopidogrel a me ASA no hoʻokahi makahiki.

Heparin: ʻaʻole hoʻopili ʻo clopidogrel i ka hoʻololi o ka heparin a ʻaʻole i hoʻopilikia i ka hopena o ka heparin i ka coagulation koko. ʻO ka hoʻohana pinepine ʻana o ka heparin ʻaʻole i pili i ka pale ʻana o ka hoʻohui platelet i hoʻolilo ʻia e clopidogrel. Ma waena o clopidogrel a me ka heparin, hiki i kahi hōʻiliʻili pharmacodynamic kahi i hiki ke piʻi i ka nui o ke kahe. No laila, pono e hoʻohana ʻia nā hana like ʻole o kēia mau lāʻau.

ʻO nā hui thrombolytic: ʻo ka palekana o ka hoʻokele ʻana o ka clopidogrel me nā mea kikoʻī a me nā fibrin-spibrin-spibrin a me nā heparins i hoʻopaʻa ʻia i loko o nā mea maʻi me ka hoʻonāukiuki myocardial infarction. ʻO ke kaila o nā maʻi koko pinepine e kūlike me ka mea i ʻike ʻia me ka hoʻohana ʻana i nā aihini thrombolytic a me ka heparin a me ASA.

ʻO nā lāʻau anti-inflammatory nonsteroidal (NSAIDs): ka hui pū ʻana o ka clopidogrel a me nā naproxen e hoʻonui i ka nalowale o ke koko mai ka gastrointestinal tract. Eia nō naʻe, ma muli o ka nele o nā haʻawina hoʻokolohua kūpono i ka launa pū me nā NSAIDs i kēia manawa, ʻaʻole ia e maopopo inā he piʻi nui loa o ke koko gastrointestinal ka ʻano o nā NSAID āpau. No laila, ʻo ka hoʻohana pinepine ʻana o NSAIDs (me ka COX-2 inhibitors) a me clopidogrel pono e mālama.

ʻO kekahi lāʻau lapaʻau hou: ʻo ka hoʻāla ʻana o ka clopidogrel i kāna metabolite ikaika e hoʻokaʻawale ana i ka CYP2C19, pono ia e hoʻohana ʻia nā lāʻau lapaʻau e ʻae ana i ka hana o kēia enzyme e kaohi ʻana i ka hōʻemi o ka lāʻau o ka metabolite ikaika o ka clopidogrel. ʻAʻole maopopo ke kumu maʻi koʻikoʻi o kēia pilina.E like me ka makaʻala, pono e hoʻokaʻawale i ka hoʻohana ʻana i nā lāʻau lapaʻau e kāohi ana i ka CYP2C19.

ʻO nā lāʻau lapaʻau e mālama ai i ka CYP2C19 e pili ana i ka omeprazole a me esomeprazole, fluvoxamine, fluoxetine, moclobemide, voriconazole, fluconazole, ticlopidine, ciprofloxacin, cimetidine, carbamazepine, oxcarbazepine a chloramphenicol.

Nā Kihi Lele ʻO Proton (PPI):

ʻO Omeprazole ma kahi o 80 mg mau manawa hoʻokahi i ka lā, i lawe pū ʻia me clopidogrel, a i ʻole he 12 mau hola ma waena o nā hopena o nā lāʻau ʻelua, e hōʻemi ana i ka ʻike o ka metabolite ikaika e 45% (lawe i ka ʻai) a me 40% (mālama i ka mālama). ʻO ka emi ʻana mai 39% (e lō ana i ka momona) a me 21% (mālama mālama ʻia) e pili ana me ka hoʻemi ʻana o ka ʻohi ʻana o ka hui platelet. ʻO Esomeprazole, i lawe pū ʻia me clopidogrel, hoʻomaka ʻia hoʻi e hōʻemi i ka ʻike o ka metabolite ikaika. E like me ka makaʻala, omeprazole a esomeprazole ʻaʻole pono e hoʻohana i ka manawa like me ka clopidogrel.

ʻO ka emi iki o ka hōʻemi i ka hoʻolaha o ka metabolite e mālama ʻia i ka hihia o ka pantoprazole a me lansoprazole.

Hoʻemi ka hōʻemi i ka plasma o ka metabolite ikaika e 20% (e hoʻouka ana i ka nui) a me 14% (mālama mālama ʻia) i ka wā e mālama ai me ka pantoprazole i loko o kahi phi o 80 mg hoʻokahi i ka lā. Hoʻohui ʻia kēia me ka emi ʻana o ka hoʻokaʻawaleʻana o nā hōʻiliʻili platelet e 15% a 11%, kēlā me kēia. Hiki i kēia ke hoʻohana i ka clopidogrel me ka pantoprazole.

ʻAʻohe mea i hōʻike i ka hoʻokaʻawale ʻana o nā wai ʻili o ka ʻōpū e like me nā mea pale kākā i loaʻa iā H2 (me ka ʻokoʻa o ka cimetidine, a he mea ia o ka CYP2C19 inhibitor) a i ʻole nā ​​antacids, hoʻopilikia i ka hana clopidogrel antiplatelet.

ʻO nā lāʻau ʻē aʻe:

ʻAʻole ʻike ʻia nā ʻike pili i ka wā lapaʻau koʻikoʻi i ka wā e lawe ana i ka clopidogrel me ka atenolol a i ʻole nifedipine a i ʻole lāua me kēia mau mea. ʻO ka hoʻohana pū ʻana o ka phenobarbital a i ka estrogen hoʻi, ʻaʻole ia e pili i ka hana pharmacodynamic o clopidogrel.

ʻAʻole loli i ka pharmacokinetics o digoxin a me theophylline me ka hoʻohana pū ʻana me ka clopidogrel.

ʻAʻole e loli nā antacids i ke kiʻekiʻe o ka hoʻopihapihaʻana o nā clopidogrel.

ʻO Phenytoin a me ka tolbutamide, kahi i hoʻoponopono ʻia me ka hoʻohana ʻana iā CYP2C9, hiki ke hoʻohana palekana me ka clopidogrel.

Nā hana no ka ʻike ʻana o ka clopidogrel me nā lāʻau lapaʻau ʻē aʻe i kuhikuhi ʻia no ka poʻe maʻi me ka atherothrombosis (me ka hoʻohui ʻia o nā lāʻau i kūkala ʻia i luna) ʻaʻole i hana. Eia nō naʻe, no nā poʻe maʻi e komo i nā hoʻokolohua lapaʻau lāʻau clopidogrel i lawe, a me clopidogrel, kahi ʻano nui o nā lāʻau lapaʻau, ʻaʻohe ʻano o nā hōʻiliʻili hewa. ʻO kēia mau lāʻau lapaʻau he mau diuretics, beta-blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors), calcium antagonists, cholesterol hoʻēmi iho i nā lāʻau, nā coronary vasodilators, nā lāʻau antidiabetic (e komo pū i ka insulin), nā lāʻau antiepileptic, a me nā mea ʻē aʻe o ka GPII IIIa nā mea hoʻokipa.

Nā ʻōlelo kikoʻī

Hōʻalo a me nā maʻi hematological

Ma muli o ke hōʻeha o ke kahe a me ka hoʻonaninani hematological i ka wā o ka mālama ʻana, inā hōʻike nā kola maʻi i ke koko, he hōʻike koko ākea a me / a i ʻole nā ​​hōʻike kūpono e hana koke. E like me nā ʻaila antiplatelet e pono, e hoʻohana ʻia ka clopidogrel me ka mālama pono ʻana i ka maʻi o nā mea maʻi e hōʻemi paha i ka huhū nui e pili ana i ka trauma, ka hoʻokele a me nā kūlana pathological ʻē aʻe, me nā mea i mālama ʻia me ASA, heparin, IIb glycoprotein inhibitors / IIIa a i ole anti-steroidal anti-inflammatory lāʻau (NSAIDs), me nā mea kākau COX-2. Pono kiaʻi ʻia nā mea maʻi no nā hōʻailona o ke koko, e komo pū ana i ka ʻālamalama okoa, ʻoiai hoʻi i nā hebedoma mua o ka mālama ʻana a / ai ʻole ma hope o nā hanana naʻau a mea ʻole paha.ʻAʻole ʻōlelo ʻia ka hoʻohana like ʻana o ka clopidogrel me nā anticoagulants waha, no ka mea, he hiki ke hoʻonui i ka pehu.

Inā hele ka mea maʻi i ka lilo ʻana o ka maʻi palekana holoʻokoʻa, a ʻoi aku ka hopena antiplatelet i kahi manawa pōkole, pono e hōʻoki ʻia ka clopidogrel i nā lā 7 ma mua o ka hoʻokō ʻana. Ma mua o kēlā me kēia lāʻau hoʻokolohua i hoʻolālā ʻia a lawe i kekahi lāʻau lapaʻau hou, pono e hoʻomanawanui ka poʻe maʻi i nā mea lapaʻau a me nā mea lapaʻau e lawe nei lākou i ka clopidogrel.

Hoʻonui ʻo Clopidogrel i ka manawa koko a pono e hoʻohana ʻia me ka akahele ʻana i ka poʻe maʻi me nā loli pathological predisposing i ke kahe koko (e pili ana i ka gastrointestinal a me ka intraocular).

Pono e hoʻomaopopo ʻia nā mea maʻi i ka wā e lawe ai iā Clopidogrel-Teva (ʻo ia wale nō a i hui pū ʻia me ASA), ʻoi aku ka lōʻihi o ke kau ʻana i ke kahe, a e haʻi iā lākou i ke kauka inā hiki iā lākou ke ʻike i kahi kuhihewa kū ʻole (e ka wahi a i ʻole manawa). . ^ E Ha yM.

Thrombocytopenic Purpura (TTP)

Kuhi iki loa, hōʻike ʻia nā hihia o ka thrombocytopenic purpura (TTP) ma hope o ka hoʻohana ʻana i ka lāʻau lapaʻau Clopidogrel-Teva, a i kekahi manawa ma hope o ka pōkole pokole. Hoʻohālikelike ia e ka thrombocytopenia a me microangiopathic hemolytic anemia, hoʻopili ʻia me nā loli neurological, kapa ʻole i ke ʻano, a i ʻole ke ʻala. ʻO TTP kahi kūlana ola e koi ai i ka mālama koke, me ka plasmapheresis.

Ua hōʻike ʻia e lawe ana i ka clopidogrel i ka hoʻomohala ʻana i ka hemophilia i loaʻa. Pono e noʻonoʻo ʻia ka hiki ʻana o ka hemophilia i loaʻa me ka hoʻonui paʻa o ka neʻe i ka manawa thromboplastin activated (APTT), me ka ʻole o ka pohihihi. ʻO ka mālama ʻana i nā mea maʻi me kahi maʻi hōʻoia i hōʻoia ʻia i ka hemophilia i hoʻopaʻa ʻia a nānā i ko lākou kūlana e pono e hoʻokō ʻia e nā poʻe loea, a pono e oki ke clopidogrel.

ʻO ka wili ischemic hou

Ma muli o ka nele o nā ikepili, ʻaʻole hiki ke hāpai ʻia ka lāʻau lapaʻau i nā lā 7 i ka lā mua ma hope o kahi kui ischemic stroke.

Cytochrome P450 2C19 (CYP2C19)

Pharmacogenetics: Ma nā maʻi maʻi e hoʻolōʻihi i ka metabolizer CYP2C19, hoʻopili ka clopidogrel i nā metabolites i nā mea hou a i ke kumu i ʻōlelo ʻia ai, a he hopena liʻiliʻi ia i ka hana platelet. Aia nā hoʻokolohua e hoʻoholo ai i nā maʻi me ka CYP2C19 genotype.

Ma ka wā o ka hoʻokumu ʻana o nā metabolis ka clopidogrel ikaika, ma ka ʻāpana, me ke komo ʻana i CYP2C19, e manaʻo ʻia ana ka hoʻohana ʻana i nā lāʻau lapaʻau e hoʻoneʻe i ka hana a kēia enima. Hoʻoholo ʻia e ka ʻohana kauka o kēia kūkā. Me ka mea nui, ʻo ka hoʻohana ʻana i nā mea paʻa o ka CYP2C19 ikaika a ʻaʻole i hoʻolele ʻia i ka manawa like me kēia lāʻau.

Allergic cross-reactivity

Mai hōʻike ʻia e ka cross-reactive ka hopena o ka maʻi kūloko ma waena o thienopyridines, pono e loiloi ʻia paha he moʻolelo hypersensitivity o ka mea maʻi i nā thienopyridines ʻē aʻe, e like me ka ticlopidine a me ka prasugrel. I ka poʻe maʻi me ka mōʻaukala o ka hypersensitivity i nā thienopyridines ʻē aʻe, e nānā pono ʻia ka nānā ʻana i ka wā o ka mālama ʻana i nā hōʻailona o ka hypersensitivity i clopidogrel.

Hola paʻa kino hana

Hoʻopili ka ʻike hana Clopidogrel i nā mea maʻi me ka hana renal impaired. No laila, i ka loaʻa o nā mea maʻi, pono e hoʻohana ʻia ka lāʻau lapaʻau me ka mālama aka.

Hōʻeha ka hana ʻoluʻolu

Hoʻohana ʻia ka ʻike ma ka hoʻohana ʻana i ka lāʻau lapaʻau i nā mea maʻi me ka hana aho o ka naʻau i ʻole e hōʻemi ʻia, paʻa i ka hemorrhagic diathesis. I kēia mea, i kēia heluna, pono e hoʻohana ʻia ka lāʻau lapaʻau me ka mālama aka.

ʻŌpū a me ka lactation

Ma muli o ka hapa ʻole o nā ʻike lapaʻau e pili ana i ka hopena o ka clopidogrel i ka wā hapai, ua hoʻomaopopo ʻia e hoʻohana i ka clopidogrel i ka wā hāpai a ka mālama ʻana.

ʻAʻole i hōʻike ʻia nā haʻawina preclinical i nā hopena kūpono a kū ʻole paha i ka lāʻau lapaʻau ma ka hāpai ʻana, e hāpai ana i ka embryonic / hoʻomohala a ka wā keiki, hānau keiki a hoʻomake ʻole postnatal.

ʻAʻole i ʻike ʻia inā hoʻopili ʻia ka clopidogrel i loko o ka umauma wai kanaka. Ua hōʻike ʻia nā haʻawina preclinical ua hoʻopili ʻia ka clopidogrel i ka waiū umauma. E like me ka mea nui o ka mālama ʻana, ʻaʻole pono e hoʻomau i ka hānai manu i ka wā o ka mālama ʻana me ka clopidogrel-Teva.

ʻAʻole i hōʻike ʻia nā haʻawina preclinical e pili ana ka clopidogrel i ka ulu wai.

Nā hiʻohiʻona o ka hopena o ka lāʻau lapaʻau ma ka hiki ke hoʻokau i kahi kaʻa a lawelawe paha

Ma muli o ka hopena maʻamau o ka hauna a i ʻole nā ​​hopena maikaʻi loa, pono e hoʻohana pono ʻia ka lāʻau lapaʻau me ka mālama ʻana i ka wā e hoʻokele a me ka hana ʻana i nā mīkini.

KUPUNAKAHA LELEI

mea lāʻau lapaʻau. Hoʻopili paʻa ʻo Clopidogrel i ka hoʻopili ʻana o ka ADP i nā ʻāpana platelet a me ka hoʻōla o ka glycoprotein (GP) IIb / IIIa paʻakikī a no laila e pale i ka hōʻiliʻili ʻana o platelet. Hoʻopili pū kekahi ʻo Clopidogrel i ka hoʻohui ʻana o platelet i kumu ma nā ʻano ʻē aʻe. ʻAʻole pili ka lāʻau lapaʻau i ka hana o PDE.

Hoʻopili ʻo Clopidogrel e hoʻohuli i nā mea i pane aku i ke kōpela ADP, a no laila ke mau nei nā platelets ʻole i ka hana i ke ola holoʻokoʻa, a hoʻihoʻi ʻia ka hana maʻamau ma hope o ka hana hou ʻana o platelet (ma kahi o 7 mau lā aʻe). Ka helu koʻikoʻi a me ka hilinaʻi-hilinaʻi nui o ka platelet aggregation i ʻike ʻia i 2 mau hola ma hope o ke kaʻi ʻana o ka waha i hoʻokahi wai o clopidogrel. ʻO ke kaohi ʻana i kahi pākaukau o 75 mg e alakaʻi i kahi nui o ka hōʻiliʻili ʻana o ka platelet aggregation. Hoʻonui ka hopena i ka holomua, a loaʻa ke kūlana paʻa ma hope o 3-7 lā. Eia kekahi, ʻo ka palena o ka hōʻemi o ka hōʻiliʻili ʻana i lalo o ka mana o ka pākēnē o 75 mg he 40-60%. ʻO ka hōʻiliʻili o platelet a me ke kaila manawa e hoʻi i ka papa loiloi ma ka awelika 7 mau lā ma hope o ka pau ʻana i ka clopidogrel.

Lapaʻau lāʻau Ma hope o ka lawe ʻana i kahi momona o 75 mg, hoʻopili koke ʻia ka clopidogrel i loko o ka pānaʻi ʻana o ke kaʻahele. Eia naʻe, hiki ʻole ke nānā i kona neʻe i ka plasma koko a ma hope o 2 mau hola ma hope o ka hoʻokō ʻana, ʻaʻole i hiki i ka palena palena (0,025 25g / l).

Hoʻopili koke ʻo Clopidogrel i loko o ka ate. ʻO kāna metabolite koʻikoʻi kahi kumu neʻe o ka carboxylic acid a me nā moʻolelo no kahi o 85% o ka hoʻokomoʻana i puni i ke koko koko. C_max o kēia metabolite i loko o ke koko koko ma hope o nā pane pinepine o ka clopidogrel i kahi maʻa o 75 mg e pili ana i ka 3 mg / l a loaʻa i ka hola 1 ma hope o ka hoʻokō ʻana.

Hōʻike aku nā pharmacokinetics o ka metabolite nui i kahi pilina linear i loko o ke koena o ka clopidogrel 50-1-1 mg. ʻO Clopidogrel a me kāna metabolits koʻikoʻi e hoʻopili i ka protein plasma i ka vitro (98 a me 94%, kēlā). Ke paʻa nei kēia paʻa i ka vitro ma luna o ke ʻano o ka nui o nā mea.

Ma hope o ka lawe ʻana, ma kahi o 50% o ka nui i lawe ʻia ma ka urine a ma kahi o 46% me nā feces i nā hola 120 ma hope o ka hoʻokō ʻana. T_½ ka hanu nui loa 8 mau hola

Loaʻa ka ʻike ʻana o ka metabolite koʻikoʻi i ka plasma koko me ka ʻoi loa o nā mea maʻi (ma mua o 75 mau makahiki) i hoʻohālikelike ʻia me nā mea ʻōpio ʻōpio olakino. Eia naʻe, ʻaʻole i hoʻopili ʻia nā kaila plasma kiʻekiʻe me nā loli i ka wā platelet aggregation a me ka manawa hoʻokahe. ʻO ke kau ʻana o ka metabolite koʻikoʻi i ka plasma koko i ka wā e lawe ʻia ai ʻo 75 mg / lā he haʻahaʻa loa i nā mea maʻi me nā maʻi ʻeha kino (ʻo ka cleinine clearance (CC) 5-15 ml / min) hoʻohālikelike ʻia me nā mea maʻi me ka maʻi ʻeha maʻalahi (CC 30-60 ml / min ) a me nā olana olakino.ʻOiai ka hopena o ka inhibitory ma ka ADP-induced platelet aggregation (25%) i hoʻohālikelike ʻia me nā mea hana olakino maikaʻi, ua hoʻolōʻihi ʻia ka manawa koko i ka pae like me nā poʻe kūloko olakino i loaʻa i ka clopidogrel ma kahi kikoʻala o 75 mg / lā.

ka pale ʻana o nā hōʻike hōʻike o ka atherothrombosis i nā pākeke.

• i ka poʻe maʻi ma hope o ka infarction myocardial (ka hoʻomaka o ka mālama ʻana - i ka lā mau lā ma hope iho, akā, ʻaʻole i hala ma mua o 35 mau lā ma hope o ka hoʻomaka), kūhā ischemic (ʻo ka hoʻomaka ʻana o ka mālama ʻana - 7 mau lā, ʻaʻole ia he mau ma mua o 6 mau mahina ma hope o ka hoʻomaka) a i ʻole me kahi maʻi maʻi peripheral i hōʻike ʻia. nā ʻalala (hōʻino i nā keʻa a me ka atherothrombosis o nā moku o nā lalo haʻahaʻa).
• i nā mea maʻi me ka maʻi coronary syndrome (ACS):
• me ACS me ka hānai ʻole ʻana i ka māhele S - T (kaina pectoris stabil ole a me ka myocardial infarction me ka Q wave), me nā poʻe maʻi e hoʻomāloʻi ana i ka shunting i ka wā o ka angioplasty corutanary, me ka hui pū me ka acetylsalicylic acid,
• me ka wahī myocardial infarction me kahi kiʻekiʻe o ka māhele S - T, i hui pū me ka acetylsalicylic acid (i nā maʻi nā maʻi e loaʻa ana i ka lāʻau lapaʻau maʻamau a e hōʻike ʻia ana me ka lāʻau thrombolytic).

Hōʻalo ʻia nā hanana atherothrombotic a me ka thromboembolic me ka hoʻāla ʻana me ka atalal: clopidogrel i hui pū ʻia me ka acetylsalicylic acid e hōʻike ʻia ana no nā maʻi pākeke me ka maʻi o ka atrial, ka mea nona ka liʻiliʻi me kahi mea e hiki ai i nā hanana vascular, contraindications e hoʻomaʻamaʻa me ke koko K antagonist, a me ka hoʻohaʻahaʻa haʻahaʻa o prophylaxis me nā kahe koko a me ka hoʻokahe koko. a me nā hanana thromboembolic, e pili pū me ka hahau ʻana.

APIKIPUI

makua, ʻo ia hoʻi nā mea maʻi maʻi. Kuhi ʻia nā clopidogrel he 75 mg 1 mau manawa i kēlā me kēia lā, ʻaʻohe o ka meaʻai o ka meaʻai.

Hoʻomaka ka hana Clopidogrel o nā poʻe maʻi me ka ACS me ka ʻole o ka hoʻāla ʻana i ka māhele S - T (kaina pectoris unstable a i ʻole myocardial infarction me ka neʻe ʻana o ka Q ma ka ECG) e hoʻomaka me hoʻokahi pāʻai ʻana he 300 mg, a laila hoʻomau ʻia ma kahi maʻi o 75 mg hoʻokahi i hoʻokahi lā (me ka acetylsalicylic acid ma kahi make o 75- 325 mg / lā). Ma muli o ka hoʻohana nui ʻana o nā dosis kiʻekiʻe o ka acetylsalicylic acid e hoʻonui ai i ka hōʻemi o ka hoʻokahe ʻana, e manaʻo ʻia ʻaʻole e hoʻonui i ka pā o 100 mg. ʻAʻole paʻa i ka lōʻihi o ka mālama ʻana. Loaʻa nā pono o ka hoʻohana ʻana i ka lāʻau a hiki i ka 12 mau mahina, a ua loaʻa ka hopena ʻoi loa ma hope o 3 mau mahina o ka mālama ʻana.

No ka poʻe maʻi me ka infarction myocardial acute me ka kiʻekiʻe o ka māhele S - T, ua kuhikuhi ʻia ka clopidogrel e 75 mg i hoʻokahi lā i ka lā, e hoʻomaka ana me kahi pākēnē o ka nui o 300 mg i hui pū me ka acetylsalicylic acid, me ka mea ʻole o nā lāʻau thrombolytic. Hoʻomaka ka mālama ʻana o nā mea maʻi ma luna o nā makahiki 75 he hapa ʻole o ka ʻauamo ʻana o ka clopidogrel. Pono e hoʻomaka ʻia ka lāʻau hoʻohui ʻana ma hope o ka hoʻomaka ʻana o nā hōʻailona a hoʻomau mau no ka liʻiliʻi o 4 mau hebedoma. Loaʻa nā pōmaikaʻi o ka hoʻohana ʻana i ka hui pū ʻana o clopidogrel me ka acetylsalicylic acid no nā mea he 4 mau pule ʻaʻole i aʻo ʻia i kēia maʻi.

I ka poʻe maʻi me ka fibrillation atrial, hoʻohana ʻia ka clopidogrel i loko o kahi pākahi o 75 mg. Me ka clopidogrel, pono e hoʻomaka ka hoʻohana ʻana i ka waikawa acetylsalicylic a hoʻomau ʻia (ma ke ʻano o 75-100 mg / lā).

Ma ka hihia o ka nalo ana:

• inā ua emi iki ma mua o 12 mau hola mai ka manawa pono ke lawe i ka hopena hou aʻe, e lawe koke ka mea maʻi i ka hala i hala, a lawe ʻia ka hopena hou aʻe i ka manawa maʻamau.
• inā he 12 mau hola i hala, pono e lawe ka mea maʻi i ka hopena hou aʻe ma mua o ka manawa maʻamau, akā ʻaʻole hoʻi e pāpālua i ka nui o ka pauku e uku ai no ka pōʻaiʻai i hala.

ʻO Renal hiki ʻole. Hoʻolaha ka ʻike ka hopena therapeutic no ka hoʻohana ʻana i ka lāʻau lapaʻau i nā mea maʻi me ka pilikia ʻole.

ʻO ka hana hema ʻole. Hoʻohana ka ʻike i ka lāʻau lapaʻau me ka hoʻohana ʻana i ka lāʻau lapaʻau i nā mea maʻi me nā maʻi maʻi palupalu a i kaupalena ʻia ka hemorrhagic diathesis.

NA KAHOA HALE

ua hōʻike ʻia ka huhū he hopena maʻamau maʻamau a loaʻa pinepine i ka malama mua o ka mālama ʻana.

Hoʻokaʻawale ʻia nā hopena ʻino ma waena o nā ʻōpū, ua wehewehe ʻia ka lōʻihi o ko lākou hanana ʻana ma lalo nei: ma pinepine (mai ≥1 / 100 a me ≤1 / 10), pinepine (mai ≥1 / 1000 a ≤1 / 100), iki ʻole (mai ≥1 / 10,000 a i ʻole ≤ 1/1000), lino loa (mai nā lōkō a me ka lymphatic: jarang - thrombocytopenia, leukopenia, eosinophilia, neutropenia, komo pū me ka nui o ka neutropenia, aneane ʻole - thrombotic thrombocytopenic purpura, aplastic anemia, pancytopenia, agranulocytosis, ikaika thrombocytop . ^ E Ha yM.

Ma ka ʻāpana o ka ʻōnaehana pale: ākea loa - maʻi serum, hoʻonanui anaphylactoid, ʻike ʻole - cross-hypersensitivity ma waena o thienopyridines (e like me ticlopidine, prasugrel) (e nānā i KAʻAHU PILI ANA).

Mai ka psyche: aneʻane loa - ahulau, nā haunaele.

Mai ka ʻōnaehana o ka poloka: līkuhi - ke komo koko intracranial (i kekahi mau hihia, mea hōʻeha), ʻehaʻeha, paresthesia, hānai, ʻokoʻa loa - ke hoʻololi ʻana i ka ʻai.

Mai ka ʻaoʻao o ka io o ka hihiʻo: pinepine - kahe koko ma ka maka o ka maka (conjunctival, ocular, retinal).

Ma ka ʻāpana o ka organ hoʻolohe.

Mai nā moku: pinepine - he hematoma, aneane ʻole - nui hemorrhage, kahe koko mai ka ʻeha hōʻemi, vasculitis, hypotension arterial.

Mai ka papa hana hanu: pinepine - nosebleeds, aneane loa - ke koko o ka ʻōpū o ka ʻōpū (hemoptysis, hemorrhage pulmonary), bronchospasm, pyroneitis interstitial, pneumonia eosinophilic.

Mai ka pūnaehana ʻana: pinepine - ka huhui o ka gastrointestinal, ʻeha, ka ʻeha o ka ʻōpū, ka dyspepsia, ka pinepine - ʻōpū o ka ʻōpū a me ka ulia duodenal, gastritis, luaʻi, kaʻaila, constipation, flatulence, ʻokoʻa - hōʻea i ka wā e hoʻoneʻe ana i ka ʻeha o ka ʻōpū, ʻeha. nā ʻūhā retroperitoneal fatal, pancreatitis, colitis (kūikawā ulcerative a i ʻole lymphocytic), stomatitis.

Mai ka ʻōnaehana hepatobiliary: ʻineki loa ʻole - nā hemahema o ka ate, ka hepatitis, nā hopena maʻamau o nā hōʻailona pili o ka ate.

Ma ka ʻāpana o ka ʻili a me ka kiko subcutaneous: pinepine - ka hemorrhage subcutaneous, jarang - holo wulu, ʻeha, introrrmalage hemorrhage (purpura), ʻano liʻiliʻi loa - bullmat dermatitis (poʻokika necrolysis epidermal, sindrom Stevens-Johnson, erythema multiforme), angioedema, cutaneous a exfoliative , urticaria, ʻ hyplelo hypersensitivity syndrome, nā hopohopo me ka eosinophilia a me nā ʻōnaehana systemic (DRESS syndrome), eczema, lichen planus.

Mai ka ʻōnaehana musculoskeletal: piliona loa - hemorrhage musculoskeletal (hemarthrosis), arthritis, arthralgia, myalgia.

Mai nā pūpū a me ka ʻōnaehana urinary: pinepine pinepine - hematuria, aneane loa - glomerulonephritis, hoʻonui i hana ma loko o ke koko.

ʻO ke ʻano ākea a me nā hopena ma ka wahi i hōʻike ʻia: pinepine - kahe koko i ka wahi i ʻōlelo ʻia, ʻaʻole liʻiliʻi loa - ka ʻā.

Nā haʻawina ʻo Laboratory: loaʻa pinepine - i ka manawa hoʻokahe manawa lōʻihi, kahi hōʻemi o ka nui o nā neutrophils a me nā platelets.

Koho KAHIKOLA

pehu a me nā kūlana patological e pili ana i ka maʻi hematological. Inā ʻike ʻia nā hōʻailona o ke koko i ka wā o ka hoʻohana ʻana i ka lāʻau lapaʻau, hiki i kahi hoʻāʻo ʻia o ke koko nui a me / a i ʻole nā ​​hana kūpono e hoʻomaʻamaʻa koke. E like me nā ʻaina antiplatelet e pono, e hoʻohana pono ka clopidogrel i nā poʻe maʻi me ka nui o ka ikehu i ka hoʻokaʻeha ʻana ma muli o ka trauma, ka hōʻola ʻana a me nā kūlana pathological ʻē aʻe, a me ka hihia o ka poʻe maʻi e hoʻohana ana i ka acetylsalicylic acid, heparin, IIb / IIIa glycoprotein inhibitors a NSAIDs, ma nā hanana COX-inhibitors. 2 a i ʻole nā ​​selotonin reuptake inhibitors (SSRIs). Pono e nānā pono a ʻike i nā hōʻike o nā maʻi koko i loko o nā mea maʻi, me ka hoʻokaʻawale ʻana o ke koko huna, ʻoiai hoʻi i nā hebedoma mua o ka mālama ʻana a / a i ʻole ma hope o nā hanana invasive ma ka puʻuwai a me nā hana hōʻiliʻili.ʻAʻole ʻōlelo ʻia ka hoʻohana like ʻana o ka clopidogrel me nā anticoagulants waha, no ka mea, hiki ke hoʻonui i ka nui o ke kahe.

Ma ka hihia o kahi wawaʻi i hoʻolālā ʻia, i manawa iki ʻole e koi aku i ka hoʻohana ʻana i nā ʻaina antiplatelet, e hoʻolako ʻia ka mālama ʻana me ka clopidogrel i nā lā 7 ma mua o ka hoʻomaʻemaʻe ʻana. Pono ka poʻe maʻi e hoʻomaopopo i nā kauka, me nā mea lapaʻau, ke lawe nei lākou i ka clopidogrel, ma mua o ke kuhikuhi ʻana i kekahi lāʻau e hoʻohana iā lākou i mua o ka hoʻohana ʻana i kahi lāʻau hou. Hoʻonui ʻo Clopidogrel i ka lōʻihi o ke kahe ʻana, no laila e hoʻohana pono ʻia i ka poʻe maʻi me ka nui o ka puehu o ke kahe (e pili ana i ka gastrointestinal a me ka intraocular).

Hoʻomaʻamaʻa ʻia nā mea maʻi i ka wā o ka mālama ʻana me ka clopidogrel (kahi i ʻole a i hui pū ʻia me ka acetylsalicylic acid), hiki ke hoʻopau ʻia ke kaila ma hope o ka maʻamau, a pono lākou e hoʻomaopopo i ke kauka e pili ana i kēlā me kēia hihia o ka ʻano maʻamau (ma kahi a i ʻole ka manawa) i ka ʻaʻa.

ʻO ka forura thrombotic. ʻO nā hihia o ka thrombocytopenic purpura (TTP) i ʻike pinepine ʻia i hope o ka hoʻohana ʻana i ka clopidogrel, i kekahi manawa ma hope o kona hoʻohana pōkole ʻana. Hōʻike ʻia ka TTP ma ka thrombocytopenia a me ka microangiopathic hemolytic anemia me nā neurological manifestations, renal dysfunction, a i ʻole maʻi. Hiki paha i TTP kahi maʻi hiki ke hōʻeha, a no laila e koi aku i ka mālama ʻana, me ka plasmapheresis.

Loaʻa ka hemophilia. ʻO ka hoʻomohala ʻia o ka hemophilia i loaʻa ma hope o ka hoʻohana ʻana i clopidogrel i hōʻike ʻia. Ke hōʻoia nei i ka lōʻihi o ka manawa thromboplastin partial i hoʻoneʻe ʻia (APTT) me ka ʻole ʻole o ke kahe, ke ʻilo nei ka hoʻomohala ʻia o ka hemophilia i loaʻa. Pono nā mea maʻi e hoʻokuʻu i ka hoʻohana ʻana i clopidogrel a e ʻōlelo aku i ka mea loea e loaʻa pono ai ke ʻano.

ʻO ka manawa hou ua loaʻa i ka ischemic stroke. Ma muli o ka lawa ʻole o ka ʻike, ʻaʻohe mea e noʻonoʻo pono ai e kuhikuhi i ke clopidogrel i nā lā 7 i ka lā mua ma hope o kahi maʻi ischemic koʻikoʻi.

Cytochrome P450 2C19 (CYP 2C19). Lapaʻau lāʻau. I ka poʻe maʻi me ka hana hoʻonaninani genetically i hōʻemi ʻia i ka CYP 2C19, kahi i hoʻohaʻahaʻa ʻia o ka metabolite ikaika o ka clopidogrel i loko o ke koko koko a me ka hopena antiplatelet i liʻiliʻi ʻia. Loaʻa i nā hoʻokolohua kahi hiki ke hoʻomaopopo i ka genotype CYP 2C19 i kahi maʻi.

Ma muli o ka hoʻololi ʻia ʻana o ka clopidogrel i ka metabolite hoʻoneʻe hapa ma o ka hana a CYP 2C19, hiki i ka hoʻohana ʻana i nā lāʻau lapaʻau e hōʻemi i ka hana ʻana o kēia enzyme e pili ana i ka emi ʻana o ke kaohi o ka metabolite ikaika o clopidogrel i loko o ke kaila koko. Eia nō naʻe, ʻaʻole i hōʻike ʻia ka manaʻo koʻikoʻi o ka maʻi i kēia manawa. No laila, hoʻohana pono ʻole i ka hoʻohana ʻana i ka pale o CYP 2C19 ikaika a i ʻole e pale ʻia (ʻike hoʻi INTERACTIONS).

Hoʻopili i ke hoʻopili kūwaho o ke alaloa. Pono e nānā ʻia nā mea maʻi no ka mōʻaukala o ka hypersensitivity i nā thienopyridines ʻē aʻe (e like me ka ticlopidine, prasugrel), ʻoiai ua loaʻa nā lono o ka alaka silang ma waena o thienopyridines (e nānā i ADVERSE EFFECTS).

Hiki i nā Thienopyridines ke hōʻemi i ka hopena maʻi i nā maʻi allergy, e like me ka angioedema, rash, hematological cross-reaction (thrombocytopenia, neutropenia).

ʻO ka poʻe maʻi me ka maʻi kūlohelohe a me / a hematologic paha i ka wā e hoʻohana ai i ka lāʻau lapaʻau mai ka pūʻulu thienopyridine i nui ka piʻi o ka hopena like ma ka hoʻohana ʻana i nā thienopyridines. No laila, pono e nānā pono ia nā mea maʻi.

Nā hui ahonui kūikawā. Hoʻololi ka ʻike i ka lāʻau lapaʻau me ka clopidogrel i nā maʻi me ka pilikia ʻole, no laila, e kau ʻia nā mea maʻi like i ka lāʻau me ka akaʻala (e nānāAPAKAHI).

ʻO ka ʻike no ka hoʻohana ʻana i ka lāʻau lapaʻau ma nā mea maʻi me nā maʻi maʻi palupalu a me ka hiki ʻana o ka diathesis hemorrhagic e palena. No laila, pono ke kuhikuhi i nā clopidogrel i nā mea maʻi me ka mālama (e hoʻohālikelike i ka APPLICATION).

Nā mea kūʻai. ʻO ka Clopidogrel-Teva ka lactose. ʻO nā mea maʻi me nā maʻi hoʻoili lohi ʻole e like me ka galactose intolerance, Lapp lactase deficiency or impaired glucose-galactose malabsorption ʻaʻole pono e lawe i kēia lāʻau lapaʻau.

Pākuʻi kūikawā. ʻO nā koina lāʻau i hoʻohana ʻole ʻia a kīnā ʻole e hoʻolale ʻia e like me nā hoʻoponopono kūloko.

Hoʻohana i ka wā hāpai a me ka lactation. Ma muli o ka hapa ʻole o nā data lapaʻau, ʻo ka hoʻohana ʻana o ka clopidogrel i ka wā hāpai ʻana he mea pono ʻole no nā wahine hāpai.

ʻAʻole i hōʻike ʻia nā haʻawina holoholona i kahi hopena a i ʻole a i ʻole a i ʻole ke kūpaʻa ʻana i ka wā hāpai, embryo / hoʻomohala i ka hanana, hānau ʻana a hānau ʻia a postnatal.

ʻAʻole i ʻike ʻia a excreted i ke clopidogrel ma ka umauma umauma. Ua hōʻike ʻia nā haʻawina holoholona me ka hoʻopili ʻana o ka clopidogrel i ka waiū umauma, no laila, pono ka hana ʻana i ka umauma i ka wā o ka mālama ʻana me clopidogrel.

Pūnaewele. ʻAʻole i hōʻike i nā hoʻokolohua holoholona holoholona i kahi hopena maikaʻi o ka clopidogrel ma ka hānai.

E na keiki. ʻAʻohe Clopidogrel-Teva ʻaʻole i kuhikuhi ʻia no nā keiki.

ʻO ka hiki ke alakaʻi i ka hopena i ka wā e lawe ana i nā kaʻa a i ʻole nā ​​hana ʻē aʻe. ʻAʻole pili a Clopidogrel a i ʻole he hopena iki no ka hiki ke alakaʻi i nā kaʻa a i ʻole nā ​​mea hana ʻē aʻe.

KohoAHU

anticoagulants waha. ʻAʻole ʻōlelo ʻia ka hoʻohana like ʻana o ka clopidogrel me nā anticoagulants waha, no ka mea, e hiki i kēlā hui ke hoʻonui i ka nui o ke koko. ʻOiai ka hoʻohana ʻana o ka clopidogrel ma kahi maʻa o 75 mg / lā ʻaʻole e loli i ka ʻōlelo lapaʻau pharmacokinetic o S-warfarin a i ʻole ka internationalization normal ratio (INR) i nā poʻe maʻi i mālama ʻia me warfarin i nā manawa lōʻihi, ka manawa like o ka clopidogrel a me warfarin e hoʻonui i ka hopena o ke kahe koko no ka kū kūʻokoʻa nā hopena i ka hemostasis.

Nā mea paʻa o Glycoprotein IIb / IIIa. Hoʻohana pono ʻo Clopidogrel me ka makaʻala i nā mea maʻi me ka nui o ke kahe o ke koko ma muli o ka trauma, ka hana a me nā mea pathological ʻē aʻe e hoʻohana ʻia ai nā mea hoʻopaʻa aku o IIb / IIIa glycoprotein inhibitor.

Ka waikawa Acetylsalicylic. ʻAʻole ka hoʻololi o ka acetylsalicylic acid i ka hopena o ka pale o ke clopidogrel i ka ADP-induced platelet aggregation, akā hoʻonui ka clopidogrel i ka hopena o ka acetylsalicylic acid ma ka platelet agregation i hoʻoiho ʻia e collagen. Eia nō naʻe, ʻo ka hoʻohana like ʻana o 500 mg o ka acetylsalicylic acid 2 mau manawa i kahi lā no 1 lā ʻaʻole i hoʻoulu i ka nui o ka manawa i ka pehu, noho lōʻihi ma ka clopidogrel. No ka mea hiki ke launa ʻo ka pharmacodynamic ma waena o clopidogrel a me ka acetylsalicylic acid me ka nui o ka piʻi nui o ke kahe, ka manawa like i kēia mau lāʻau e pono ai ka mālama. ʻOiai ʻo kēia, aia ka ʻike e lawe ana i ka clopidogrel a me ka acetylsalicylic acid e hui pū a hiki i hoʻokahi makahiki.

Heparin. Ua hōʻike ʻia ʻaʻole koi ka clopidogrel i ka hoʻoponopono hoʻoponopono ʻana i ka heparin a ʻaʻole i hoʻopilikia i ka hopena o ka heparin ma ka coagulation. ʻO ka hoʻohana like ʻana o ka heparin i loli ʻole i ka hopena o ka pale o ke clopidogrel ma ka platelet aggregation. Mai ka hiki ke launa pū ʻana ma waena o ka clopidogrel a me ka heparin me ka nui o ka piʻi ʻana o ke kahe, e hoʻokaʻawale ka hoʻohana ʻana i kēia mau lāʻau.

Nā mea uila thrombolytic.ʻO ka palekana o ka hoʻohana pinepine ʻana o ka clopidogrel, fibrin-spibrine a me fibrin-sp thrinoly thrombolytic a me ka heparin i aʻo ʻia i nā mea maʻi me ka maʻi myocardial infarction. Ua like ke kū o nā maʻi koko nui me ka hoʻohana pinepine ʻana i nā lāʻau thrombolytic a me ka heparin me ka acetylsalicylic acid.

Nā NSAID. ʻO ka hoʻohana kūpono ʻana o ka clopidogrel a me ka naproxen, ua hōʻike ʻia e hoʻonui i ka nui o ke koko gastrointestinal. Eia nō naʻe, ma muli o ka nele o nā haʻawina e pili ana i ka hoʻopili ʻana i ka lāʻau lapaʻau me nā NSAIDs ʻē aʻe, ʻaʻole i hoʻoholo iki inā paha e piʻi nui ka hopena o ke koko gastrointestinal i ka wā e hoʻohana ʻia me nā NSAID āpau. No laila, koi ʻia ka mālama ʻana i ka wā e hoʻohana ai i nā NSAID, i nā mea ākea COX-2, me clopidogrel.

Nā Selotonin Reuptake Inhibitors (SSRIs). Kuhi i ka manaʻo o ka SSRI e hoʻopilikia i ka platelet activation a hoʻonui i ka nui o ka pohō, ʻo ka hoʻohana pinepine ʻana o SSRI me clopidogrel e pono ai ka makaʻala.

E hui pū me nā lāʻau lapaʻau ʻē aʻe. Ma muli o ka hoʻololi ʻia ʻana o ka clopidogrel i ka metabolite hoʻoneʻe hapa ma o ka hana a CYP 2C19, hiki i ka hoʻohana ʻana i nā lāʻau lapaʻau e hōʻemi i ka hana ʻana o kēia enzyme e hiki ai i ke kaohi i ke kaohi o ka metabolite ikaika o clopidogrel i loko o ke kaila koko. ʻAʻole i hoʻonui ʻia ka manaʻo koʻikoʻi o kēia noi. No laila, me he mea pale ʻana, pono e hoʻohana pono i ka hoʻohana ʻana i nā mea paʻa a me ka hōʻemi CYP 2C19.

ʻO nā lāʻau lae e pale i ka hana o CYP 2C19 e pili ana i ka omeprazole, esomeprazole, fluvoxamine, fluoxetine, moclobemide, voriconazole, fluconazole, ticlopidine, ciprofloxacin, cimetidine, carbamazepine, oxacarbazepine a me chloramphenic.

Nā pale huna Proton. ʻO ka hoʻoneʻe ʻana o ka metabolite ikaika i loko o ke koko i emi iho me ka hoʻohana like ʻana a i ʻole he 12 mau hola o ka wā ma waena o nā kūmole o clopidogrel a me omeprazole i loko o kahi waihona o 80 mg. Ua mālama pū ʻia kēia hāʻule me ka emi o kaohi ʻana o ka hōʻoluʻolu platelet. Hoʻomoe ʻia ʻo Esomeprazole e komo i loko o kahi pilina like me clopidogrel.

ʻO ka hōʻemi iki me ka hoʻohaʻahaʻa ʻia o ka metabolite i loko o ke koko ka mea i hoʻomaopopo ʻia me ka pantoprazole a i nā lansoprazole.

ʻO nā hōʻiliʻili lāʻau lapaʻau nui koʻikoʻi me ka hoʻohana ʻana i clopidogrel i ka manawa like me ka atenolol, nifedipine, a i ʻole me nā lāʻau ʻelua ke ʻike ʻia. Eia kekahi, ʻaʻole i loli iki ka hana o ka pharmacodynamic o clopidogrel i ka wā e hoʻohana ana i ka phenobarbital a me ka estrogen.

ʻAʻole i loli nā hopena o ka digoxin a i ʻole theophylline i ka wā e hoʻohana ai ka clopidogrel.

ʻAʻole i pili i nā antacids i ke kiʻekiʻe o ka komo ʻana o ka clopidogrel.

ʻO ka hoʻohanaʻana o ka hana antithrombotic o ka clopidogrel hiki ke hoʻemi ʻia e ka hapa kokoke i ka wā i hui pū ʻia ai me ka pale o nā papa pale. I kēia hihia, ʻaʻole ka hopena o ka ʻeha i ka hoʻokele ʻana i ka hopena o ka hoʻokō ʻana o clopidogrel. ʻAʻole i aʻo ʻia ka hui ʻana o ka clopidogrel me nā pale ākea proton.

Hiki i nā metabolite clboxidic clopidogrel ke pale i ka hana a ka cytochrome P450 2C9. Hiki i kēia ke hoʻonui i nā pae plasma o nā lāʻau lapaʻau e like me ka phenytoin a me ka tolbutamide, a me nā mea ʻē aʻe a me ka metropized e hoʻohana ana i ka hoʻohana ʻana i ka cytochrome P450 2C9. ʻOiai ke kū nei o nā hopena o kahi hōʻike noiʻi e hiki ke hoʻohana ʻia ka phenytoin a me ka tolbutamide i ka manawa like me ka clopidogrel.

Me ka ʻike ʻole ʻia o ka ʻike ma luna o nā lāʻau lapaʻau i hāʻawi ʻia i luna, nā loiloi e pili ana i ka hoʻopili ʻana o ka clopidogrel me nā lāʻau lapaʻau e hōʻike pinepine ʻia ana i nā mea maʻi me ka atherothrombosis ʻaʻole i mālama ʻia.Eia nō naʻe, nā poʻe maʻi i komo i loko o nā haʻawina ʻo klopidogrel i hoʻohana i nā lāʻau lapaʻau ʻē aʻe i ka manawa like, me ka diuretics, block-adrenoreceptor blockers, ACE inhibitors, calcium antagonists, cholesterol lowing agents, coronary vasodilators, antidiabetic drugs (me ka insulin), antiepileptic drug, hormones ʻo ka hopena a me nā GPIIb / IIIa antagonist, me ka hōʻike ʻole o nā hopena koʻikoʻi e pili ana i ka maʻi.

KAOLELO

me ka nui o ka clopidogrel, he hiki ke hoʻonui ʻia i ka manawa hoʻokahe me nā hoʻopiʻi ʻana aʻe. I ka hihia o ke kahe, ke kauoha ʻia ka hana hōʻailona.

ʻAʻole maopopo ka lāʻau Clopidogrel. Inā kūpono ka hoʻoponopono ʻana i ka manawa koko lōʻihi, hiki ke hoʻopau ʻia ka hopena o ka clopidogrel ma o ka lawe ʻana o ka pā platelet.

Nā ʻōkuhi no ka hoʻohana clopidogrel-teva

Nā Papa - 1 papa:

Nā mea waiwai: clopidogrel - 75 mg,

7 a 10 mau pcs. - blisters (2, 4, 8, 9, 12) - nā ʻeke pepa.

Ma hope o ka lawelawe waha ma kahi maʻa o 75 mg, ua kiʻi koke ʻia ka clopidogrel mai ka papaleka. Eia nō naʻe, ke hoʻonui iki nei ka ʻike i ka plasma koko a ma hope o 2 mau hola ma hope o ka hoʻokele ʻana, ʻaʻole i hiki i ka pae e hiki ke hoʻoholo ʻia (0.025 g / L)

Hoʻopiliʻia nā huhū i ka ate. ʻO ka metabolite nui ka mea e hana ʻole ai i ka waikawa carboxylic a hoʻomākaʻi ʻia ma kahi o 85% o nā mea hoʻomaka e kahe ana i ka plasma. ʻO Cmax o kēia metabolite i loko o ke koko koko ma hope o nā pane pinepine o ka clopidogrel e pili ana i ka 3 mg / l a nānā i kahi ma kahi o 1 hola ma hope o ka hoʻokele ʻana.

Hōʻike ʻia ka pharmacokinetics o ka metabolite nui e ka pilina laina ma ka pakanō o clopidogrel 50-150 mg.

ʻO Clopidogrel a me ka metabolits nui e pani paʻa i nā protein plasma i ka vitro (98% a me 94%, kēlā me kēia). Hoʻopau paʻa kēia pilina i ka vitro ma luna o ke ʻano o ka nui o ka manaʻo.

Ma hope o ka helu ʻana i ka clopidogrel hōʻailona ʻia me 14C, ma kahi o 50% o ka nui i lawe ʻia ma ka urine a ma kahi o 46% me nā kīʻaha no nā hola 120. T1 / 2 o ka metabolite nui he 8 hola.

Hoʻohālikelike ʻia me nā mea ʻōpio ʻōpio olakino, ʻoi aku ka nui o ke kaila o ka metabolite nui i nā maʻi makua (75 mau makahiki a ʻoi aku ka nui), ʻaʻohe o nā loli o ka platelet aggregation a me ka manawa hoʻokahe.

I nā maʻi ʻehaʻeha koʻikoʻi (CC 5-15 ml / min), ʻo ke kiko o ka metabolite nui i loko o ke koko koko he haʻahaʻa ma lalo o nā maʻi pēpē maʻalahi (CC 30-60 ml / min) a i nā mea hana olakino olakino. ʻOiai ka hopena o ka inhibitory ma ka ADP-induced platelet aggregation i hoʻohālikelike ʻia me nā mea hana olakino olakino, ua hoʻonui ʻia ka manawa koko i ka like me nā poʻe kūloko olakino.

Hōʻikeʻike Platelet Aggregation. Hoʻopili paʻa mau ia i ka paʻa ʻana o ka adenosine diphosphate (ADP) i nā ʻāpana platelet a me ka hoʻōla o ka puʻupuʻu GPIIb / IIIa, no laila e ʻoki ana i ka hoʻohui platelet. Mālama i ka hoʻohui platelet i hoʻoiho ʻia e nā agonist e ala i ka pale ʻana i ka hana platelet i hoʻonui ʻia e ka ADP. ʻAʻole pili i ka hana PDE.

Hoʻololi ʻo Clopidogrel i ka hoʻololi ʻana i nā ADP i nā platelets, no laila ke hoʻomau nei nā platelets i ka hana ʻana i ko lākou "ola", a hoʻihoʻi ʻia ka hana maʻamau me ko lākou hou ʻana (ma hope o 7 mau lā).

Nā hōʻailona no ka hoʻohana ʻana o clopidogrel-teva

ʻO ka paleʻana i nā hoʻopiʻi thrombotic i nā maʻi me ka myocardial infarction, ischemic stroke, a i ʻole peripheral artery occlusion. I ka hui pū me ka acetylsalicylic acid no ka pale ʻana i nā hoʻopiʻi thrombotic ma ke aʻa coronary syndrome: me ka paukū st me ka hiki ʻana o ka terapi thrombolytic, me ka piʻi ʻana o ka pāʻina stina ststable, ka pakanui myocardial ʻole Q me ka moho).i ka poʻe maʻi ma lalo o ka hoʻomau ʻana.

ʻO ka pale ʻana o nā hoʻopiʻi thrombotic a me ka thromboembolic, me ka maʻa, a me ka fibrillation atrial (atrial fibrillation) i mua o ka liʻiliʻi o kahi mea e hoʻopilikia ai i nā hoʻopiʻi vascular, ka hiki ʻole ke lawe i nā anticoagulants kūlike a me ka hoʻemi haʻahaʻa o ke koko (i hui pū me ka acetylsalicylic acid).

ʻO Clopidogrel-teva Hoʻohana i ka wā hāpai a me nā keiki

ʻO ka lawa ʻana a me ke aʻo ʻana i nā haʻawina maʻi ʻoiaʻiʻo e pili ana i ka palekana o ka clopidogrel i ka wā hāpai ʻana ʻaʻole i mālama ʻia. Hiki ke noi ʻia i nā hihia pōpilikia.

ʻAʻole i ʻike ʻia a hoʻopili ʻia nā clopidogrel me ka umauma waiū i nā kānaka. Inā pono, hoʻohana i ka wā lactation e hoʻoholo i ka hoʻopau ʻana o ka umauma.

I nā hoʻokolohua holoholona hoʻokolohua me ka hoʻohana ʻana i ka clopidogrel ma loko o nā papa o 300-500 mg / kg / lā, ʻaʻole i ʻike ʻia nā hopena teratogenic a me nā hopena maikaʻi ʻole i ka hānai a me ka hoʻomohala ʻana o ka maʻi hānau. Ua hoʻokumu ʻia e hoʻopili ʻia ka clopidogrel a me kāna metabolites i loko o ka waiū umauma.

Clopidogrel Teva Dosage

Lawe ʻia ma kahi 1 manawa / lā.

ʻO ka helu mua a me ka mālama mālamaʻana he 75 mg / lā. ʻO ka ukana ka ukana ʻo 300 mg / lā.

Hoʻokumu ka regimen noi i nā hōʻike a me ke kūlana olakino.

Hoʻohana ʻia ka Clopidogrel me ka akahele me ka nui o ka hoʻoneʻe ʻana o ka nahu ma muli o ka trauma, ka hōʻoki kino ʻana, a me nā pilikia o ka ʻōnaehana hemostasis. Me nā mea hōʻiliʻili hoʻolālā i hoʻolālā ʻia (inā ʻaʻole ʻoi aku ka hopena antiplatelet), pono e hoʻopale ʻia ka clopidogrel i nā lā 7 ma mua o ka hoʻomaʻemaʻe ʻana.

Hoʻohana ʻia ka Clopidogrel me ka akahele i nā mea maʻi me ka maʻi hepatic koʻikoʻi, kahi paha e hele ai ka hemorrhagic diathesis.

Ke hōʻike ʻia nei nā hōʻike o ke kahe nui (koko kūmole, menorrhagia, hematuria), ke hōʻike ʻia ʻana o ka ʻōnaehana hemostatic (ka manawa aʻokiʻina, ka helu platelet, nā hana hoʻoliʻina hana platelet) nā hōʻike. Hoʻomaopopo pinepine ʻia ka mākaʻikaʻi ʻana o nā wahi hōʻike o ka hana hana maʻa.

Hoʻohana me ka akahele me ka wā like i ka warfarin, heparin, NSAIDs, no kahi lōʻihi - me ka acetylsalicylic acid, no ka mea I kēia manawa, ʻaʻohe paʻa o ka palekana o ia noi.

Ma nā hoʻokolohua hoʻokolohua, ʻaʻole i ʻike ʻia nā hopena carcinogenic a me genotoxic.

Hoʻokomo i ka hiki ke lawe i nā kaʻa a kāohi i nā mīkini

ʻAʻole paʻa i ka hopena o ka clopidogrel ma ka hiki ke lawe i nā kaʻa a me nā hana hoʻokele.

Ke keu

Me ka nui o ka clopidogrel, hiki ke nānā ʻia ka nui o ke kahe me ka hoʻopiʻi ma hope. I ka hihia o ke kahe, ke kauoha ʻia ka hana hōʻailona.

ʻAʻole maopopo ka antidote o ka hana o ka clopidogrel. Inā hiki iā ʻoe ke hoʻoponopono koke i ka manawa koko ākea, hiki ke hoʻokuʻu ʻia ka hopena o ke clopidogrel e ka lawe ʻana o ka pā platelet.

Hoʻohana i ka wā hāpai a lactation

Ma muli o ka hapa ʻole o nā ʻike lapaʻau e pili ana i ka hoʻohana ʻana i ka clopidogrel i ka wā hāpai ʻana, pono pono e kuhikuhi i nā wahine hāpai.

ʻAʻole i hōʻike ʻia nā haʻawina holoholona i kahi hopena a i ʻole a i ʻole a i ʻole ke kūpaʻa ʻana i ka wā hāpai, embryo / hoʻomohala i ka hanana, hānau ʻana a hānau ʻia a postnatal.

ʻAʻole i maopopo ka excreted i ke clopidogrel ma ka umauma umauma. Ua hōʻike ʻia nā noiʻi holoholona me ke hoʻopili ʻia nā clopidogrel i ka waiū umauma, no laila, pono e hōʻoki ʻia nā umauma i ka wā e mālama ai me ka clopidogrel.

ʻAʻole i hōʻike i nā hoʻokolohua holoholona holoholona i kahi hopena maikaʻi o ka clopidogrel ma ka hānai.

ʻAʻohe Clopidogrel-Teva ʻaʻole i kuhikuhi ʻia no nā keiki.

Nā hiʻohiʻona noi

Pipi a me nā kūlana pili i pili i nā pilikia hematological.

Inā ma ka hoʻohana ʻana i ka lāʻau lapaʻau aia nā hōʻailona e hōʻike ana i ka hiki ʻana o ke kahe, ke hōʻike nui ʻana i ke koko ākea a me / a i ʻole nā ​​hana kūpono e hoʻomaʻamaʻa koke. E like me nā ʻaila antiplatelet e pono, e hoʻohana ʻia ka clopidogrel me ka mālama i ka poʻe maʻi me ka nui o ka nui o ke kahe koko no ka trauma, ka hōʻola ʻana a i nā kūlana pathological ʻē aʻe, penei i nā mea maʻi e hoʻohana ana i kahi ASA, heparin, IIb / IIa glycoprotein inhibitors a i ʻole nā ​​lāʻau lapaʻau anti-inflammatory, i loko o nā COX-inhibitors. 2 a i ʻole nā ​​selotonin koho koho hou (SSRIs) a i nā mea ola ʻē aʻe e hoʻonui i ka hōʻeha ke kahe (e.g., pentox ifillin). Pono e nānā pono a ʻike i nā hōʻike o nā maʻi koko i loko o nā mea maʻi, me ka hoʻokaʻawale ʻana o ke koko huna, ʻoiai hoʻi i nā hebedoma mua o ka mālama ʻana a / a i ʻole ma hope o nā hanana invasive ma ka puʻuwai a me nā hana hōʻiliʻili. ʻAʻole ʻōlelo ʻia ka hoʻohana like ʻana o ka clopidogrel me nā anticoagulants waha, no ka mea, hiki ke hoʻonui i ka nui o ke kahe.

Ma ka hihia o ka wawaʻi ʻana i hoʻolālā ʻia, ʻoluʻolu ka manawa o ka hoʻohana ʻana i nā ʻaina antiplatelet, e hoʻolako ʻia me ka clopidogrel i nā lā 7 ma mua o ka hoʻomaʻemaʻe ʻana. Pono ka poʻe maʻi e hōʻike i nā kauka, ʻo ia hoʻi dentist e lawe ana lākou i ka clopidogrel, ma mua o ke kuhikuhi ʻana i kekahi mea e hoʻokuʻi ʻia iā lākou a i ʻole e hoʻohana ʻia i kahi lāʻau hou. Hoʻopau ka Clopidogrel i ka lōʻihi o ke kahe, no laila e hoʻohana pono me ka akahele ʻana i nā mea maʻi me ka nui o ka puehu o ke kahe (e pili ana i ka gastrointestinal a me ka intraocular).

Hoʻomaʻamaʻa ʻia nā mea maʻi i ka wā o ka mālama ʻana me ka clopidogrel (kahi i ʻole a i hui pū ʻia me ASA), hiki ke hoʻokaʻalo paha ka hope ma mua o ka maʻamau, a pono lākou e hoʻomaopopo i ke kauka e pili ana i kēlā me kēia hihia o ka ʻano maʻamau (ma kahi a i ʻole ka lōʻihi) i ke koko.

ʻO ka forura thrombocytopenic purpura (TTP).

ʻO nā hihia o ka thrombocytopenic purpura (TTP) i nānā pinepine ʻia ma hope o ka hoʻokele clopidogrel, i kekahi manawa ma hope o kona hoʻohana pōkole ʻana. Hōʻike ʻia ka TTP ma ka thrombocytopenia a me ka microangiopathic hemolytic anemia me nā neurological manifestations, renal dysfunction, a i ʻole maʻi. Hiki paha i TTP kahi maʻi hiki ke hōʻeha, a no laila e koi aku i ka mālama ʻana, me ka plasmapheresis.

ʻO ka hoʻomohala ʻia o ka hemophilia i loaʻa ma hope o ka hoʻohana ʻana i clopidogrel i hōʻike ʻia. Ke hōʻoia nei i ka lōʻihi o ka manawa thromboplastin partial i hoʻoneʻe ʻia (APTT) me ka ʻole ʻole o ke kahe, ke ʻilo nei ka hoʻomohala ʻia o ka hemophilia i loaʻa. Pono nā mea maʻi e hoʻokuʻu i ka hoʻohana ʻana i clopidogrel a e ʻōlelo aku i kekahi loea i loaʻa pono i ke ʻano kūpono.

ʻO ka manawa hou ua loaʻa i ka ischemic stroke.

Ma muli o ka lawa ʻole o ka ʻike, ʻaʻohe mea e noʻonoʻo pono ai e kuhikuhi i ke clopidogrel i nā lā 7 i ka lā mua ma hope o kahi maʻi ischemic koʻikoʻi.

Cytochrome P450 2C19 (CYP2C19).

Lapaʻau lāʻau. I ka poʻe maʻi me ka hana hoʻonaninani genetically i hōʻemi ʻia i CYP2C19, kahi i hoʻohaʻahaʻa ʻia o ka metabolite ikaika o clopidogrel i loko o ka plasma a me kahi hopena antiplatelet i ʻōlelo ʻia. Aia nā hoʻokolohua e ʻike ai i ka genotype CYP2C19 i kahi maʻi.

Ma ka lilo ʻana o ka clopidogrel i ka metabolite hoʻoneʻe hapa ma lalo o ka mana o CYP2C19, hiki i ka hoʻohana ʻana i nā lāʻau lapaʻau e hōʻemi ana i ka hana a kēia enzyme e hiki ai i ke kaohi i ke kaohi o ka metabolite ikaika o clopidogrel i ka plasma. Eia nō naʻe, ʻaʻole i hōʻike ʻia ka manaʻo koʻikoʻi o ka maʻi i kēia manawa. No laila, me he mea pale ʻana, pono e kāohi i ka hoʻohana ʻana i ka mea paʻa ikaika a me ka CYP2C19 inhibitors (ʻike.Pauku "Hoʻohui ʻana me nā huahana lapaʻau a me nā ʻano ʻē aʻe o kekahi ʻano".

Pono e hoʻohana ʻo Clopidogrel me ka makaʻala i nā maʻi i ka manawa like i lawe i nā huahana i kahi substrate no ka cytochrome CYP2C8.

Hoʻopili i ke hoʻopili kūwaho o ke alaloa.

Pono e nānā ʻia nā mea maʻi no ka mōʻaukala o ka hypersensitivity i nā thienopyridines ʻē aʻe (e like me ka ticlopidine, prasugrel), no ka mea aia nā lono o ka cross-allergy ma waena o thienopyridines (e nānā i ka ʻāpana "Hōʻino i ka wā".

Hiki i nā Thienopyridines ke hōʻemi i ka hopena maʻi i nā maʻi allergy, e like me ka angioedema, rash, hematological cross-reaction (thrombocytopenia, neutropenia).

ʻO nā mea maʻi i loaʻa i ka mōʻaukala o nā hopena alaka a me / a he hematological paha ke hoʻohana ʻana i ka lāʻau lapaʻau mai ka pūʻulu thienopyridine i nui ka piʻi o nā hopena like ma ka hoʻohana ʻana i nā thienopyridines. No laila, no nā mea maʻi e pono e mālama pono.

Nā hui ahonui kūikawā.

Loaʻa ka hana Therapeutic me ka clopidogrel i nā maʻi me nā pilikia kūlohelohe kaupalena ʻia, nolaila, e kuhikuhi ʻia nā mea maʻi i ka lāʻau lapaʻau me ka makaʻala (e ʻike i ka Māhele "Dosage a me ka Management").

ʻO ka ʻike no ka hoʻohana ʻana i ka lāʻau lapaʻau me nā mea nā maʻi ate hōʻemi ʻia ka ʻōpū a me ka hiki ʻana o ka diathesis hemorrhagic i palena. No laila, pono ke kuhikuhi i ka clopidogrel i nā poʻe maʻi me ka mālama ʻana (e ʻike i ka Māhele "Dosage a me ka Management").

ʻO ka Clopidogrel-Teva ka lactose. ʻO nā mea maʻi me nā maʻi hoʻoili maʻamau e like me ka galolose galactose, ka nele o Lapp lactase a i ʻole he mea hoʻomakei glucose-galactose e lawe pono i kēia lāʻau.

Pākuʻi kūikawā e pili ana i ka haʻalele

ʻO nā koina lāʻau i hoʻohana ʻole ʻia a hoʻopau ʻole ʻia paha e hoʻokaʻawale ʻia e like me nā kānāwai kūloko.

Hoʻopili me nā lāʻau lapaʻau a me nā ʻano ʻē aʻe ʻē aʻe

Hiki i nā lāʻau ke hoʻonui i ka hopena o ke kahe

Aia ke hoʻonui hoʻonui koko o ka pehu ma muli o potentiation o nā hopena o nā lāʻau lapaʻau. E hoʻohana me ke akahele o nā lāʻau ʻē aʻe e hoʻonui i ka hopena o ke kahe.

Anticoagulants oral. ʻAʻole ʻōlelo ʻia ka hoʻohana like ʻana o ka clopidogrel me nā anticoagulants waha, no ka mea, e hiki i kēlā hui ke hoʻonui i ka nui o ke koko. ʻOiai ka mea o ka hoʻohana ʻana o clopidogrel ma kahi o ka 75 mg i kēlā me kēia lā, ʻaʻole e hoʻololi i ka kōmike pharmacokinetic o S-warfarin a i ʻole ka internationalization normalized ratio (INR) i nā poʻe maʻi i mālama ʻia me warfarin no ka manawa lōʻihi, ka manawa like o ka clopidogrel a me warfarin e hoʻonui i ka hōʻeha o ka hoʻokahe ma muli o ka nā hopena kūʻokoʻa i ka hemostasis.

Nā Kiʻi Glycoprotein IIb, / IIIA . ^ E Ha yM. Hoʻohana pono ʻo Clopidogrel me ka makaʻala i nā mea maʻi me ka nui o ke kahe o ke koko ma muli o ka trauma, ka hana ʻana a me nā kūlana pathological ʻē aʻe kahi glycoprotein IIb, / IIIA inhibitor i ka wā like.

ʻO ka acetylsalicylic acid (ASA). ʻAʻole ka hoʻololi o ka acetylsalicylic i ka hopena o ka pale o ka clopidogrel i ka ADP-induced platelet aggregation, akā hoʻonui ka clopidogrel i ka hopena o ASA i ka collelet-induced platelet agregation. Eia nō naʻe, ʻo ka hoʻohana like ʻana o 500 mg o ASA 2 mau manawa i ka lā no kahi lā ʻaʻole i lilo ka ulu nui o ka kahe koko, e lōʻihi ana ma muli o ka clopidogrel. No ka mea hiki ke launa ʻo ka pharmacodynamic ma waena o clopidogrel a me ka acetylsalicylic acid me ka nui o ka piʻi nui o ke kahe, ka manawa like i kēia mau lāʻau e pono ai ka mālama.ʻOiai ʻo kēia, aia ka ʻike i ka lawe ʻana i clopidogrel a me ASA i hoʻokahi a hiki i hoʻokahi makahiki.

Heparin. Ua hōʻike ʻia ʻaʻole koi ka clopidogrel i ka hoʻoponopono hoʻoponopono ʻana i ka heparin a ʻaʻole i hoʻopilikia i ka hopena o ka heparin ma ka coagulation. ʻO ka hoʻohana like ʻana o ka heparin i loli ʻole i ka hopena o ka pale o ke clopidogrel ma ka platelet aggregation. Mai ka hiki ke launa pū ʻana ma waena o ka clopidogrel a me ka heparin me ka nui o ka piʻi ʻana o ke kahe, e hoʻokaʻawale ka hoʻohana ʻana i kēia mau lāʻau.

Nā mea uila thrombolytic. ʻO ka palekana o ka hoʻohana pinepine ʻana o ka clopidogrel, fibrin-spibrin a ʻo fibrin-espesal thrombolytic agents a me ka heparin i hōʻike ʻia i loko o nā mea maʻi me ka maʻi myocardial infarction. ʻO ke alapine o ke koko puhoi nui e like me ka nānā ʻana me ka hoʻohana like ʻana o nā lāʻau thrombolytic a me ka heparin me ASA.

ʻO nā lāʻau anti-inflammatory nonsteroidal (NSAIDs). ʻO ka hoʻohana kūpono ʻana o ka clopidogrel a me ka naproxen, ua hōʻike ʻia e hoʻonui i ka nui o ke koko gastrointestinal. Eia nō naʻe, ma muli o ka nele o nā haʻawina e pili ana i ka hoʻopili ʻana i ka lāʻau lapaʻau me nā NSAID ʻē aʻe, no laila maopopo ʻole ia, ka piʻi ʻana o ka nahu kuʻuna o ke gastrointestinal i ka wā e hoʻohana ʻia me nā NSAID āpau. No laila, pono ke mālama pono i ka wā e hoʻohana ai i nā NSAID, i nā lā inhibitor COX-2, me clopidogrel.

Nā Selotonin Reuptake Inhibitors (SSRIs). Hāʻawi ka SSRI e pili ana i ka hoʻāla o platelet a hoʻonui i ka nui o ka kahe, ke hoʻohana pinepine ʻia nā SSRI me ka clopidogrel e makaʻala.

Nā Kihi Inoa nā proton Pump (PPIs).

ʻO ka hoʻoneʻe ʻana o ka metabolite ikaika i loko o ke koko i emi iho me ka hoʻohana like ʻana a i ʻole he 12 mau hola o ka wā ma waena o nā kūmole o clopidogrel a me omeprazole i loko o kahi waihona o 80 mg. Ua mālama pū ʻia kēia hāʻule me ka emi o kaohi ʻana o ka hōʻoluʻolu platelet. Hoʻomoe ʻia ʻo Esomeprazole e komo i loko o kahi pilina like me clopidogrel.

Ua hōʻike ʻia nā ʻike kūloko e pili ana i ka hoʻopili ʻana i ka maʻi pharmacodynamic / pharmacokinetic a me ka pilikia cardiovascular. I kēia mea, pono ke hoʻopili ʻia ka clopidogrel me omeprazole a esomeprazole me ka akahele.

ʻO ka liʻiliʻi o ka hoʻohaʻahaʻa ʻana i ka neʻe o ka metabolite i loko o ke koko i nānā ʻia me ka pantoprazole a i ʻo lansoprazole. Hiki ke hoʻohana ʻo Clopidogrel me ka pantoprazole.

ʻAʻohe mea iʻike i nā lāʻau lapaʻau e hoʻohaʻahaʻa i ka wai, e like me nā mea pale palaka proton a i ʻole nā ​​antacids e hoʻopilikia i ka hana antiplatelet o clopidogrel

ʻAʻole pili i nā anacid ke kiʻekiʻe o ka lawe ʻana o ka clopidogrel.

E hui pū me nā lāʻau lapaʻau ʻē aʻe. Ma ka lilo ʻana o ka clopidogrel i ka metabolite hoʻoneʻe hapa ma lalo o ka mana o CYP2C19, hiki i ka hoʻohana ʻana i nā lāʻau lapaʻau e hōʻemi ana i ka hana a kēia enzyme e hiki ai i ke kaohi i ke kaohi o ka metabolite ikaika o clopidogrel i ka plasma. ʻAʻole i hoʻonui ʻia ka manaʻo koʻikoʻi o kēia noi. No laila, me he mea pale ʻana, pono e hoʻohana pono i ka hoʻohana ʻana i nā mea paʻa a me ka moder CYP2C19.

ʻO ka hoʻomākaukau e hōʻalo a i ʻole hōʻino ʻia o ka hana CYP2C19 e pili ana i ka omeprazole, esomeprazole, fluvoxamine, fluoxetine, moclobemide, voriconazole, fluconazole, ticlopidine, carbamazepine a me efavirenz.

Hoʻololi i ka launa lāʻau lapaʻau i ka wā e hoʻohana ai i ka clopidogrel i ka manawa like atenolol, nifedipine a i ʻole me nā lāʻau ʻelua ua ʻike ʻia ʻole. Eia kekahi, ʻaʻole i loli iki ka hana o ka pharmacodynamic o clopidogrel i ka wā e hoʻohana nei fenobarbital a me ka estrogen .

ʻO nā hiʻohiʻona Pharmacokinetic Digoxin a theophylline ʻaʻole i loli me ka hoʻohana like me ka clopidogrel.

Hiki i nā metabolite clboxidic clopidogrel ke pale i ka hana a ka cytochrome P450 2C9.Hiki i kēia ke hoʻonui i nā pae plasma o nā lāʻau lapaʻau e like ʻo ka ʻaoʻao puhnyinin a me nā mea ʻē aʻe e hoʻohana ʻia ana me ka hoʻohana ʻana i ka cytochrome P450 2C9. ʻOiai ke loaʻa nei nā hopena o kahi hōʻike noiʻi i kēlā phenytoin a me tolbutamide Hiki ke hoʻohana palekana me ka clopidogrel.

Nā lāʻau lapaʻau e hoʻohālikelike i ka cytochrome CYP2C8

Ua hōʻike ʻia ʻo Clopidogrel e hoʻonui i ka hoʻolaha repaglinide i nā mea hana olakino olakino. ʻO ka hoʻohana pū ʻana o ka clopidogrel a me nā lāʻau lapaʻau e hōʻiliʻili nui ʻia e ka cytochrome CYP2C8 (e.g. repaglinide, paclitaxel) e hana pono me ka akahele, me ka ʻike mau i ka hoʻonui ʻana o ko lākou manaʻo i ka plasma koko.

Me ka ʻike ʻole ʻia o ka ʻike ma luna o nā lāʻau lapaʻau i hāʻawi ʻia i luna, nā loiloi e pili ana i ka hoʻopili ʻana o ka clopidogrel me nā lāʻau lapaʻau e hōʻike pinepine ʻia ana i nā mea maʻi me ka atherothrombosis ʻaʻole i mālama ʻia. Eia nō naʻe, nā mea maʻi i komo i nā haʻawina ʻo clopidogrel i hoʻohana i nā lāʻau lapaʻau ʻē aʻe i ka manawa like, me ka diuretics, beta-blockers, ACE inhibitors, calcium antagonists, kolepa hoʻokaʻawale i nā lāʻau, nā vasodilators coronary, nā lāʻau lapaʻau antidiabetic (me ka insulin), nā lāʻau antiepileptic, nā hana hoʻokolohua hormone. a me nā hoʻohālikelike GPIIb / IIIa, me ka hōʻike ʻole ʻana i nā hopena koʻikoʻi e pili ana i ka maʻi.