Ke lāʻau lapaʻau Aterocardium: nā ʻōlelo i hoʻohana no ka hoʻohana

Loaʻa ka Aterocardium i ke ʻano o nā papa kiʻi ʻoniʻoni: pōpō, biconvex, pink, 10 mau ʻāpana i kēlā me kēia blister, i loko o ka pūlima pepa o 1 a 4 mau blisters).

Helu 1 papa:

• mea kūlohelohe: clopidogrel (i ke ʻano o ka clopidogrel hydrosulfate) - 75 mg,
• ʻO nā mea kōkua: ka magnesium stearate, povidone, lactose monohydrate, pregelatinized starch, polyethylene glycol 6000, microcrystalline cellulose,
• pāpale kiʻi: Opadry II Pink (hypromellose, triacetin, titanium dioxide, lactose monohala, polyethylene glycol, indigo carmine alumini varnish, mea hoʻonani kaila i ka hoea wīwī alumini).

Nā hōʻailona no ka hoʻohana ʻana

Hoʻohana ʻia ka Aterocardium i mea e pale ai i ka hōʻike ʻana o ka atherothrombosis ma nā ʻano ʻōlelo like ʻole o nā mea maʻi pākeke.

• nā mea maʻi i loaʻa i ka stroke ischemic (hoʻomaka ka mālama ʻana i 7 mau lā ma hope o kahi hōʻeha, akā, ʻaʻole i hala ma mua o 6 mau mahina ma hope o kona hōʻea ʻana).
• nā mea maʻi i loaʻa i ka myocardial infarction (hoʻomaka ka mālama ʻana i kekahi mau lā ma hope o ka hōʻeha ʻana o ka naʻau, akā, ʻaʻole iʻoi aku ma mua o 35 mau lā ma hope o kona hanana).
• nā mea maʻi me nā maʻi o ka aramo peripheral (vascular atherothrombosis a me ka hōʻino ʻana i nā ʻāpana o nā haʻahaʻa haʻahaʻa),
• nā mea maʻi me ka maʻi myocardial infarction a me kahi kiʻekiʻe ST kahi i ka manawa like me ASA (acetylsalicylic acid) (i nā mea maʻi e loaʻa ana i ka lāʻau lapaʻau maʻamau maʻamau e hōʻike ʻia ana no ka hana thrombolytic).
• nā mea maʻi me ka maʻi coronary syndrome me ka kahi o ka ST st elevation (myocardial infarction me ka ʻole Q Q a i ʻole ka hōʻaiʻē angina) i ka manawa like me ka acetylsalicylic acid.

Nā Hoʻohui

• uhaiki pohihihi
• ʻōpū kikī, hana ʻeha peptic a me nā kūlana ʻē aʻe me ka loaʻa ʻana o ke kao maʻi,
• lactase kakali, galactose intolerance, glucose-galactose malabsorption syndrome,
• na keiki a me na opio malalo o na makahiki 18
• hapai
• hana waiū
• hoʻonui i ka naʻau pilikino i clopidogrel a i ʻole kekahi o nā mea kōkua o ka lāʻau.

Hoʻohana (Aterocardium i hoʻohana me ka akahele):

• i nā maʻi maʻi hepatic maʻalahi
• pilikia kūlohelohe
• ʻatlelo hemorrhagic (mōʻaukala),
• interventing opi, na eha, a me na ano pathological ano me ka nui o ka ikehu o ke kahe,
• Hoʻohana me ka heparin, ASA, non-steroidal anti-inflammatory drug and glycoprotein IIb / IIIa inhibitors.

ʻLoe a me ke kākele

Lawe ʻia nā papa Aterocardium ma ke alo pono ʻole, me ka mālama ʻole o ka ʻai.

ʻO ka papa ʻōlelo i hāʻawi ʻia no nā pākeke, ʻo ia hoʻi nā mea maʻi makua, ʻo ia ka papa papa 1 i hoʻokahi manawa i ka lā.

Ma ke keokeo coronary syndrome me ka piʻi ʻana o ka hoʻāla ST ST, hoʻomaka ka mālama ʻana me ke kaʻi ʻana i ka nui o 300 mg i hoʻokahi, a hoʻomau ʻia me ka ʻano maʻamau (75 mg) hoʻokahi i ka lā i ka hui ʻana me ka acetylsalicylic acid i loko o kēlā me kēia lā o ka lā 75-325 mg. ʻO ka lawe nui i nā wai kiʻekiʻe o ka acetylsalicylic e hoʻonui i ka pohō o ke koko, no laila, ʻaʻole i manaʻo ʻia e lawe i ke ana o ka 100 mg o ka ASA i kēlā me kēia lā.

ʻAʻole i paʻa ka lōʻihi o ke ʻano o ka mālama ʻana, akā ua hōʻike ʻia nā hopena o nā noi ʻana e pono ai ʻo Aterocardium a hiki i 12 mau mahina. Loaʻa ka hopena kiʻekiʻe o ka lāʻau ma hope o 3 mau mahina o ka hoʻohana ʻana i ka lāʻau lapaʻau.

Ma ka huakaʻi myocardial infarction me ka hoʻōla ʻana o ST i ka kiʻekiʻe, hoʻomaka ka mālama ʻana me kahi pāʻina hoʻoheheʻe hoʻokahi (300 mg) hui pū me ka acetylsalicylic acid, me ka wai ʻole thrombolytic. ʻAʻole kuhikuhi ʻia nā mea maʻi ma mua o 75 mau makahiki i kahi lohi. Hoʻomaka ka mana ʻo ASA ma ke ʻano hiki i ka liʻiliʻi a he 4 mau pule.

Nā hopena hopena

• ka pānaʻi ʻana: pinepine - nā ʻeha hoʻoneʻe, ka ʻōpū o ka ʻōpū, ka ʻōpū o ka gastrointestinal, ke ʻehaʻeha, ka manawa - ka hōʻino, ka luaʻi, ka gastritis, duodenal a me nā ʻōpū o ka ʻōpū, lemulewa, constipation, ʻokoʻa - ka hoʻōki o retroperitoneal, ʻokoʻa loa - stomatitis, colitis (ma me ka pu o ka lymphocytic a i ka ulcerative paha), pancreatitis, retroperitoneal a me ka maʻi gastrointestinal me kahi hopena hōʻala.
• ʻO ka ʻōnaehana hepatobiliary: ʻehā loa - hepatitis, hoʻomaʻemaʻe ʻole o ka ate kapili ʻole, nā hoʻomaʻamaʻa hana a me nā mea maʻi ʻē aʻe
• cardiovascular system: pinepine - hematoma, luhi loa - vasculitis, hemorrhage koʻikoʻi, hypotension arterial, kahe koko mai ka hana ʻeha,
• hematopoietic system: pinepine - leukopenia, thrombocytopenia, eosinophilia, jarang - neutropenia (komo pūnuhī), ʻano kaumaha loa - anemia, agranulocytosis, granulocytopenia, thrombotic thrombocytopenic purpura, pancytopenia, thrombocytopenia koʻikoʻi,
• ʻūnaehana hanu: pinepine - nosebleeds, luhi loa - bronchospasm, hemorrhage pulmonary, hemoptysis, pneumonitis interstitial,
• kikowaena o ka nenela kikowaena: pinepine - palupalu, paresthesia, intracranial dumuka (i ka manawa hōʻeha), ʻeha, ʻehaʻeha - hoʻoweliweli i ka haunaele, hōʻeuʻeu, hilahila,
• nā ʻōhua naʻau: pinepine - ocular, conjunctival a i ʻole nā ​​ʻauamo ʻili, līkē - maʻi ʻole ma muli o ke ʻano o ke ʻano o ka pepeiao a me ka labyrinth,
• musculoskeletal ʻōnaehana: paʻakikī loa - ʻeha, myalgia, hemarthrosis, arthralgia,
• urinary system: pinepine - hematuria, loa pinepine - ke hoʻonui ʻana i ka mea hana plasma, glomerulonephritis,
• ʻili a me ka ʻili o ka subutaneus: pinepine - hemorrhage subcutaneous, pinepine - i ka hana hōʻeha, ka ʻūhā, ka hanana, ʻeha loa - urticaria, lichen planus, erythematous rash, eczema, bullous dermatitis, angioedema,
• nā maʻi kūlohelohe: hopena luhi loa - ka hopena anaphylactic, maʻi Serum,
• nā hōʻailona wana: pinepine - hoʻonui i ke koko,
• kekahi: ʻokoʻa loa - ke kuni.

Nā ʻōlelo kikoʻī

Inā kānalua ka luhi, kūpono i nā hoʻokolohua kūpono a me / a i ʻole he hōʻike koko kikoʻī e hana koke.

Pono ke kāpae ʻia ʻo Aterocardium i 7 mau lā ma mua o ke kaʻina holo ʻana i ʻōlelo ʻia, ʻoiai ke hoʻonui ʻia ka lāʻau i ka lōʻihi o ke kahe koko.

Hoʻomaʻamaʻa ʻia nā mea maʻi i ka wā o ke mālama ʻana me ka clopidogrel, e lōʻihi aku ke kahe ʻana a kū a ma hope paha. Pono e hōʻike ʻia nā hihia āpau o ke koko ʻole a i ʻole localization o ke koko i kāu kauka.

ʻAʻole pili a Aterocardium a i ʻole kahi hopena liʻiliʻi no ka wikiwiki o ka hopena psychomotor a me ka hiki ke hoʻoikaika. Inā ulu ka ulu ʻana i ka wā e lawe ai i ka lāʻau lapaʻau, pono ʻoe e haʻalele i ka holo a me nā hana ʻē aʻe ʻē aʻe.

Ka hana lāʻau lapaʻau

Hoʻopili nā platelet aggregation i ʻole kahi heparin. ʻO nā waiwai Pharmacological. Hoʻopili ʻo Clopidogrel i ka paʻa ʻana o ka adenosine diphosphate (ADP) i ka ʻenemi i ka pāpaʻina o ka platelet a me ka hoʻihoʻi ʻana o ka hoʻopulapula o GPIIb / IIIa ma lalo o ka mana o ADP a, no laila, ke kāohi nei i ka hōʻiliʻili ʻana o platelet. Hoʻopaʻa ʻo Clopidogrel i ka hoʻohui platelet i hoʻoiho ʻia e nā agonists e ka ʻae ʻana i ka hoʻonui ʻana o nā hana platelet i ka hoʻokuʻu ʻia o ADP a hoʻohuli hou ʻia nā mea hou o nā platelet ADP. Nā pākula i pili i ke hoʻololi i ka clopidogrel a hiki i ka hopena o ke ola o ke ola. Hoʻihoʻi ʻia ka hana platelet maʻamau i ka uku e kūlike me ka hōʻano hou o platelet.
Mai ka lā mua o ka hoʻohana ʻana i ka helu i kēlā me kēia lā i ka 75 mg o ka lāʻau, ua ʻike ʻia kahi lohi nui i loko o ka ADP-induced platelet aggregation. Hana holomua kēia hana a paʻa i waena o 3 a 7 mau lā. Ke kūpaʻa nei, ʻo ka nui o ka pae o ka hōʻemi o ka ʻohi ʻana ma lalo o ke ʻano o ka pākahi o kēlā lā i kēia lā he 75 mg mai 40% a 60%. ʻO ka hōʻiliʻili platelet a me ka lōʻihi o ke kahe koko e hoʻi i ka papa loiloi ma ka awelika 5 mau lā ma hope o ka hoʻokuʻu ʻana o ka mālama ʻana.
Ma hope o ka lawelawe waha ma kahi wī o 75 mg, ua paʻa koke mai ka ka hanu ʻana. Ka awelika papa plasma pae haʻahaʻa o clopidogrel i loli (e pili ana i ka 2.2-2.5 ng / ml ma hope o hoʻokahi mauʻu no 75 mg orally) ua loaʻa ma kahi o 45 mau minuke ma hope o ka nānā ʻana. ʻO ka Absorption kahi liʻiliʻi o 50%, e like me ka hōʻikeʻana e nā excretion o nā metabolite clopidogrel i loko o ka urine. ʻO Clopidogrel a me ka hana nui (hana ole) ka hāmeʻe i loko o ke koko i loko o ka vitro e hoʻihoʻi i ka protein o ke kanaka (98% a me 94%, kahi). Noho a kēia kau palena i ka vitro ma luna o ke ʻano o ka nui o nā mea.
Di me vitro a ʻo i vivo he ʻelua
ʻO Clopidogrel he hoʻonui i nā ala nui o kāna kaila: hele ka mea me ke komo ʻana o nā esterases a alakaʻi i ka hydrolysis me ka hoʻokumu ʻana o kahi derivative o kahi ʻano carboxylic acid (nona ka helu o 85% o nā metabolite holoʻokoʻa i loko o ka plasma), a komo nā enzyme o ka pūnana cytochrome P450. ʻO ka mua, e hoʻololi ʻia ka clopidogrel i kahi metabolite waena o 2-oxo-clopidogrel. Ma muli o nā hana hoʻopili hou aku o 2-oxo-clopidogrel, kahi derivative thiol, kahi metabolite ikaika. Ma ka vitro, ua hōʻiliʻili ʻia kēia ala metabola e nā enzyme CYP3A4, CYP2C19, CYP1A2, CYP2B6. ʻO ka metabolite ikaika o ka clopidogrel, kahi i hoʻokaʻawale i ka vitro, wikiwiki a paʻa hou i nā mea paʻa i ka platelet receptors, pale i ka hoʻohui platelet.
ʻO 120 mau hola ma hope o ka nānā ʻana, ma kahi o 50% o ka nui i lawe ʻia ma ka urine a me 46% me nā feces. Ma hope o ka hoʻoponopono waha ʻana i hoʻokahi pākahi, ʻo ka hapalua o ke ola o ka clopidogrel e pili ana i 6 mau hola. ʻO ka hapalua o ka noho nui o ka metabolite nui (ʻaʻole ka hūnā) ka hūnā i ke koko he 8 mau hola ma hope o ke ʻano hoʻokahi a kū hou i ka lāʻau.
Ua hoʻohuli ka nui o nā enzyme polymorphic CYP450 i ka clopidogrel i kahi metabolite ikaika, hoʻāla i ka hana. Hoʻololi ʻia ʻo CYP2C19 i ka hoʻokumu ʻana i kahi metabolite ikaika a me kahi metabolite waena o 2-oxo-clopidogrel. ʻO nā pharmacokinetics o ka metabolite ikaika a me nā hopena antiplatelet, e like me ke ana o ka platelet aggregation, ʻokoʻa ʻole ia e pili ana i ka genotype CYP2C19. ʻO ka CYP2C19 * 1 allele pili i kahi metabolism holoʻokoʻa holoʻokoʻa, aʻo CYP2C19 * 2 a me CYP2C19 * 3 alleles e pili ana i kahi nāwaliwali nāwaliwali. Aia kēia mau kekelē aia no ka 85% o nā kuʻekuʻe nāwaliwali i ka hana i nā mea kuhi a me 99% nā poʻe ma ʻAsia. ʻO nā alleles ʻē aʻe e pili pū ana me ka nāwaliwali nāwaliwali nā huina CYP2C19 * 4, * 5, * 6, * 7 a me 8, akā ʻoi aku ka liʻiliʻi o ka heluna kanaka.

ʻLoe a me ke kākele

ʻO nā pākeke a me nā maʻi maʻi. I loko, 1 papa (75 mg) hoʻokahi i ka lā, me kaʻole o ka hoʻokomo i ka meaʻai.

I nā mea maʻi me ka maʻi coronary syndrome (ACS) me ka piʻi o ka hoʻāla ST (kaomi ʻole o kaina a i ʻole ka myocardial infarction me ka lele Q ma ka ECG), hoʻomaka ʻia ka mālama Aterocardium me ka pākē ʻihi o 300 mg, a laila hoʻomau ʻia me kahi dosis o 75 mg i hoʻokahi lā i ka hui pū me ka acetylsalicylic acid ( ASA) ma kahi kikoʻī o 75-325 mg i kēlā me kēia 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. Hōʻike nā hopena o nā noi i ka hoʻohana ʻana o ka lāʻau lapaʻau a hiki i 12 mau mahina, a ua nānā ʻia ka hopena kiʻekiʻe ma hope o 3 mau mahina o ka mālama ʻana.

No ka poʻe maʻi me ka maʻi myocardial infarction me ka paukū ST kahi kiʻekiʻe, hoʻohālikelike ʻia ka clopidogrel i ka 75 mg i hoʻokahi lā i ka lā, e hoʻomaka ana me ka puʻu ʻana ma kahi o 300 mg i hui pū me ASA, me ka mea ʻole o nā lāʻau thrombotic. 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 hui pū ʻana o clopidogrel me ASA no hoʻokahi mau makahiki he ʻehā i aʻo ʻia i kēia maʻi.

Lapaʻau lāʻau. I nā poʻe pilikino me ka nāwaliwali nāwaliwali o CYP2C19, ua nānā ʻia kahi pane hōʻemi i ka mālama clopidogrel. ʻAʻole mau ke kūpaʻa ʻoiʻo ka pauna dosage paʻa ʻana i nā kānaka me ka nāwaliwali nāwaliwali.

ʻO Renal hiki ʻole. Loaʻa ka ʻike no ka hoʻohana ʻana i ka lāʻau lapaʻau ma nā mea maʻi me ka hala ʻole o ka honu. Pono ka lāʻau lapaʻau e hoʻohana me ka akahele (e nānā i ka ʻāpana "Nā hiʻohiʻona o ka hoʻohana").

ʻO ka hana hema ʻole. ʻO ka ʻike no ka hoʻohana ʻana i ka lāʻau lapaʻau ma nā mea maʻi me nā maʻi maʻi o ka hiki ʻana a me ka hiki ke hemorrhagic diathesis. Pono ka lāʻau lapaʻau e hoʻohana me ka akahele (e nānā i ka ʻāpana "Nā hiʻohiʻona o ka hoʻohana").

Nā hōʻailona a me ke ʻano:

Kākoʻo i nā hōʻailona atherothrombotic i nā pākeke:

I nā maʻi me ka maʻi coronary syndrome

ʻO ka poʻe i loaʻa i ka infarction myocardial (pono ia e hoʻomaka i ka hoʻomaka ʻana ma hope o kekahi mau lā, akā ʻaʻole i ʻoi aku ma mua o 35 mau lā mai ka hoʻomaka ʻana o ka hōʻeha ʻana i ka puʻuwai,) manawa kaʻi ischemic (pono e hoʻomaka i ka therapy ma hope o 7 lā, akā ʻaʻole iʻoi aku ma mua o 6 mau mahina ma hope o ka hōʻeha). nā mea maʻi me nā maʻi i hōʻike ʻia o nā arela peripheral (atherosclerosis o nā moku o nā haʻahaʻa haʻahaʻa a me ka hōʻino ʻia i nā aʻa.

I loko o nā mea maʻi me ka kahi o ka pae ST ST i kiʻekiʻe ma kahi ECG (myocardial infarction me ka Q Q poʻokela a ʻole ka angina unstable), me nā mea i kau i ka stent i ka wā o ka kaanlona palutan percutaneous, i hui pū ʻia me ka acetylsalicylic acid

I ka poʻe maʻi me ka maʻi myocardial infarction, i ka manawa e kū ai ka mahele o ST i hui pū ʻia me ka acetylsalicylic acid (i loko o nā poʻe maʻi e loaʻa ana i ka lāʻau lapaʻau maʻamau maʻamau a makemake i ka mālama thrombolytic)

Pono nā poʻeʻelemakule a me nā mea maʻi e lawe iā 1 papa (75 mg) ma ka waha i hoʻokahi lā i ka lā, me ke ʻano o ka hoʻokomo ʻana o ka meaʻai.

No nā mea maʻi me ka maʻi coronary kiʻekiʻe me ka ʻole o ka kahi ST ST i hoʻonui ʻia (myocardial infarction me ka ʻole Q Q a i ʻole ka paʻa i ʻole ka nui)

A laila e 1 papa (75 mg) ka manawa hoʻokahi i ka lā hoʻokahi, i hui pū ʻia me ka acetylsalicylic acid ma ka papa o 75-325 mg / lā.

ʻAʻole paʻa i ka lōʻihi o ke kau ʻana.

Wahi a nā hopena o nā noi ʻana, ua hoʻopaʻa ʻia ka hopena kūpono ma hope o 3 mau mahina mai ka hoʻomaka ʻana o ka hoʻōla, a ʻo ka loaʻa pono o ka hoʻohana ʻana i ka lāʻau he 12 mau mahina.

I ka poʻe maʻi me ka hala o myocardial infarction, ka mea i hoʻopaʻa ʻia i kahi kiʻekiʻe o kahi ST ma ka ECG, ua kuhikuhi ʻia ka lāʻau lapaʻau ma ka kaha o 75 mg hoʻokahi i kēlā me kēia lā.

Pono e hoʻomaka e lawe i ka Aterocardium me kahi laʻa o 300 mg e hui pū me ka acetylsalicylic acid.

Pono e mālama ʻia nā mea maʻi ʻoi aku ma mua o 75 mau makahiki me ka ʻole o ka hoʻouka ʻana. ʻO ka hui pū ʻana o ka Aterocardium a me ka acetylsalicylic acid e pono e hoʻomaka koke ma hope o ka hoʻomaka ʻana o nā hōʻailona a hoʻomau ʻia no 4 mau pule. Loaʻa ʻaʻole loaʻa nā pōmaikaʻi o kahi makemake kahi lōʻihi.

I ka poʻe maʻi me ka maʻi lohi o ka CYP 2C19, ua hōʻike ʻia kahi pane hōʻemi i ka mālama ʻana me Aterocardium.

ʻAʻole kū ʻia ka palena kau palena maʻa no nā maʻi like ʻole.

Loaʻa ka ʻike me Aterocardium i nā maʻi me ka pilikia ʻole. E kuhikuhi i ka lāʻau i kēlā mau kanaka me ka akaʻala.

Eia kekahi, me ka makaʻala, ua kuhikuhi ʻia ʻo Aterocardium i nā mea maʻi me nā maʻi o ka maʻa a me nā poʻe i hiki ke piʻi i ka hemorrhagic diathesis.

Nā hopena ʻaoʻao:

Mai ka pūnaehana hematopoietic: leukopenia, thrombocytopenia, eosinophilia, neutropenia (komo pū i ke kaumaha), thrombocytopenic purpura, pancytopenia, anemia (e komo pū ana me aplastic), thrombocytopenia, granulocytopenia, agranulocytosis.

Mai ka pūnaehana cardiovascular: hematomas, hemorrhages koʻikoʻi, hypotension arterial, vasculitis, pehu mai nā hōʻeha postoperative.

Mai ka pūnaehana ʻana: ka ʻeha, ka dyspepsia, ka ʻeha o ka ʻōpū, ka ʻōpū o ka gastrointestinal, constipation, ka nausea, ka ʻōpū o ka ʻōpū, ka luaʻi, ka gastritis, utulula. Hiki i ka maʻamau ka colitis (me ka lymphocytic a i ʻole ulcerative), pancreatitis, stomatitis, gastrointestinal a retroperitoneal koko me ka hopena momona.

Mai ka palupalu: hepatitis, hoʻomaʻemaʻe hema ʻole o ka ate, ka hoʻāʻo ʻana i ka hana naʻau hemahema.

Mai ka ʻaoʻao o ka pūnaehana nūnaehana waena: paresthesia, haki, hōʻeha, ka laʻewa Intacranial (i kekahi manawa e pau ana i ka make), ka mea ʻala, ʻono ka pīhoihoi, ka haunaele.

Mai nā naʻau sensory: retinal, ocular, conjunctivalugo, dizziness e pili ana i ka pathology o ka pepeiao a i ʻole labyrinth.

Mai ka ʻili a me ka kiko o ke kūlohelohe: hemorrhage subcutaneous, gohu, purpura, rash skin, erythematous rash, angioedema, bullous dermatitis (Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis), lichen planus, eczema, urticaria.

Mai ka pūnaehana hanu: nosebleeds, ka huhū o ka hanu (hemorrhage pulmonary, hemoptysis), perstonitis interstitial, bronchospasm.

Mai ka papa musculoskeletal: arthritis, hemarthrosis, myalgia, arthralgia.

Mai ka urinary system: hematuria, hoʻonui i nā kiʻekiʻe o ka hana i loko o ke koko, glomerulonephritis.

Nā hua maʻi hypersensitivity: pane anaphylactic, maʻi Serum.

ʻO nā hoʻololi i nā kekona laboratorium: kahi hōʻemi i nā pae platelet a me neutrophil, he hoʻonui i ka manawa koko.

ʻO nā hopena ʻē aʻe: ke kala, ke koko i ke kahua ʻoi ʻana.

Hoʻopili pū kekahi me nā lāʻau lapaʻau a me ka waiʻona:

Nā Palena Protein IIb / IIIa. Pono ka lāʻau e hoʻokaʻawale me ka makaʻala i nā poʻe maʻi ma ka hiki ke koko o ka hoʻokahe ʻia ma muli o nā hōʻemi, nā trauma a me nā kūlana pathological e pono ai ka hoʻohana ʻana i nā mea pale o ka protein IIb / IIIa.

ASKL. ʻAʻole pili ʻo ASA i ka hopena o ka hopena o ke clopidogrel i ka ADP-hoʻohuihui ʻia o ka platelet, akā, ʻo ka clopidogrel e hoʻonui ai i ka hopena o ASA ma ka hui platelet i lalo o ka hana o ka collagen.

ʻO ka ka manawa like o 500 mg o ASA ʻelua i ka lā no ka lā hoʻokahi, ʻaʻole i alakaʻi i ka hoʻololi nui ʻana i ke kahe koko. Hoʻohana pinepine ka hoʻohana ʻana i ka Aterocardium a me ASA, no ka mea aia kahi pilikia o ka kahe koko.

Anticoagulants oral. Ma muli o ke koʻikoʻi nui o ke koko, ʻaʻole i ʻōlelo ʻia ʻia ka hoʻohana ʻana o ka anticoagulants waha a me ka atherocardia.

Heparin. Hōʻike nā haʻawina i ka hoʻohana ʻana o ka clopidogrel i ka hopena o ka heparin a ʻaʻole pono ia i ka hoʻoponopono hoʻoponopono o nā mea hope loa. ʻAʻole i hoʻopilikia ke komo ʻana o ka heparin i ka hopena o ka clopidogrel. Akā ma muli o ka hoʻonui nui o ka kahe, ka ʻōlelo a ka hoʻohana pinepine ʻana i kēia mau lāʻau.

Nā mea uila thrombolytic. ʻO ka palekana o ka hoʻokele ʻana o ka Aterocardium, ʻo fibrin-spibrin a ʻo fibrin-spibrin-spins agents a me heparin i aʻo ʻia i nā mea maʻi me ka maʻi myocardial infarction. ʻO ka like aʻe o ka hoʻomohala ʻana i ka ʻaihue ua like pū me ka hoʻohana pū ʻana o nā hana thrombolytic a me ka heparin me ASA.

Nā NSAID. ʻO ka hoʻohana like ʻana o ka Aterocardium a me ka naproxen e hoʻonui i ka hōʻeha o ke akekala gastrointestinal. ʻAʻohe ʻikepili e pili ana i ka hoʻopili ʻana o ka clopidogrel me nā lāʻau lapaʻau anti-inflammatory a pau ʻole.

E hui pū me nā lāʻau lapaʻau ʻē aʻe. No ka mea i hoʻokumu ʻia ai ka metabolite ikaika o ka clopidogrel ma lalo o ka hana a CYP 2C19, ʻo ka hoʻohana ʻana i nā lāʻau lapaʻau e hōʻemi ana i ka hana o kēia enzyme e alakaʻi ana i kahi kaohi o ke kaohi o ka metabolite hoʻoikaika, a no laila, i ka hoʻoemi ʻana i ka hopena lapaʻau o Aterocardium. No laila, pono e pale i ka hoʻomohala ʻana i ka hui o Aterocardium a me nā lāʻau hōʻona e pili ana i ka hana o CYP 2C19. Kēia mau lāʻau like: esomeprazole, omeprazole, fluoxetine, fluvoxamine, moclobemide, voriconazole, ticlopidine, fluconazole, ciprofloxacin, carbamazepine, cimetidine, chloramphenicol a me oxcarbazepine.

Nā pale huna Proton.

Ua hōʻoia ʻia ʻaʻole ia i like ka like o ka pale ʻana o ka kō CYP 2C19 ma lalo o ka hana a nā lāʻau lapaʻau mai ka pūʻulu o nā mea pale proton pump. Hōʻike nā hōʻike i kēia hiki ke pili i ka pilina ma waena o Aterocardium a me kekahi o nā lāʻau lapaʻau i kēia hui. ʻAʻohe mea hōʻoiaʻiʻo ʻokoʻa ʻē aʻe o nā lāʻau e hoʻemi ana i ka hana o ka waikila hydrochloric (antacids, H2 blockers) e pili ana i ka hopena antiplatelet o Aterocardium.

ʻO ka hoʻohana pū ʻana o Aterocardium me ka atenolol a me ka nifedipine i loli ʻole i ka hoʻohana pono ʻana o nā lāʻau lapaʻau. Eia kekahi, ʻaʻole i loli nā huahana pharmacodynamic o clopidogrel i ka wā e hoʻohana ʻia me ka cimetidine, digoxin, theophylline, estrogen, a me phenobarbital.

ʻAʻole pili ka hopena i nā kūmoku i ka lawe ʻana o ka clopidogrel.

Hōʻike nā noiʻi e hiki i nā hua o nā carbonyl nā clopidogrel ke pale i ka hana o ka cytochrome P450 2C9. Hiki, hiki i kēia ke hana i ka piʻi ʻana o ka hoʻololi ʻana o ka plasma o NSAIDs, tolbutamide a me ka phenytoin, ka metabolism o nā mea e kū ana ma lalo o ka mana o ka cytochrome P450 2C9. Akā ke hōʻike nei nā hopena noiʻi e hiki ke palekana me ka tolbutamide a me ka phenytoin i lawe ʻia me ka atherocard.

ʻAʻole i loaʻa ka launa nui o nā maʻi ma waena o nā lāʻau Aterocardium a me nā beta-adrenergic blockers, diuretics, blockers channel kalapona, ʻāmaʻomaʻo ACE, antacids, antidiabetic, antiepileptic, antiepileptic, anti-cholesterol-lowing drug, and hormone replacement therapy III antagonists.

ʻO ke ʻano a me nā waiwai:

Pākaukau 1 papa:

Clopidogrel 75 mg

ʻO nā mea kōkua: microcrystalline cellulose, magnesium stearate, lactose monohala, pregelatinized starch, polyethylene glycol 6000, povidone K 25, red iron oxide (E 172)

ʻO ka mea hana nui - clopidogrel - selly pale i ke kaohi ʻana o ka ADP i nā poʻe ʻaee ma luna o ka platelets a me ka hoʻāla hou ʻana o nā mea paʻakikī GPIIb / IIIa ma lalo o ka mana o ADP, ka hopena o ka hoʻoweliweli ʻana o ka platelet aggregation.

Ke wehe nei i ka platelet aggregation i hoʻoiho ʻia e nā agonist e loaʻa pū ma ka kāohi ʻana i ka hoʻonui ʻana o nā hana platelet i ka hoʻokuʻu ʻia o ADP a me nā mea hoʻohuli hōkeke i nā platelet ADP.

ʻO nā platelets i hoʻopili me ka clopidogrel e hoʻololi i ka loli a hiki i ka hopena o ke ola o ke ola.

Hoʻi hou ka hana platelet i ka manawa ma hope o ka manawa e koi ai no ka hoʻōla maoli ʻana o kēia mau mea koko.

Mai ka lā mua o ka hoʻohana ʻana i ka hōʻilio pinepine o 75 mg o ka lāʻau, ua hoʻopaʻa ʻia ka nui o ke koʻikoʻi o ADP-induced platelet aggregation.

Hoʻonui holomua kēia hopena, paʻa i ka waena ma waena o nā lā 3 a me 7th o ka mālama ʻana.

ʻO ka pae awelika o ka hōʻemi ʻana o ka ʻōpū ma lalo o nā hana a kahi maʻa o 75 mg ma kahi kūlana paʻa he 40-60%.

ʻO ka lōʻihi o ke kahe a me ka piʻi o ka platelet aggregation e hoʻi i ka baseline ma ka awelika 5 mau lā ma hope o ka pau ʻana o ka lapaʻau.

Ma hope o ka hoʻoponopono waha ʻana i ka lāʻau i loko o kahi kaomi o 75 mg, hoʻopaʻa ʻia ka wikiwiki i ka pānaʻi ʻana. Loaʻa nā kikowaena plasma kiʻekiʻe kiʻekiʻe i ka clopidogrel i loli (ma ka nui o ka 2.2-2.5 ng / ml ma hope o ke ʻano waha hoʻokahi o 75 mg o ka lāʻau) ua loaʻa i 45 mau minuke ma hope o ka lawe ʻana iā Aterocardium.

Hōʻike ka hoʻoliʻi ʻana o clopidogrel me ka urine i ka kahe ʻana o ka hana ikaika ma kahi o 50%.

I loko o nā hoʻokolohua vitro, hoʻopili clopidogrel a me kāna hana kūlohelohe i ka plasma koko e hoʻihoʻi i ka protein, ke hoʻomau nei kēia pili i kona saturation ma luna o kahi hoʻomohala ākea.

Hoʻopau ka hana kūlohelohe o clopidogrel i loko o ka palupalu. Ke vivo a me ka vitro aia ʻelua mau ala o ka metabolism.

ʻO ka mea mua i hele pū me ke komo ʻana o nā esterases, ke alakaʻi nei i ka hydrolysis me ka hoʻokumu ʻana o kahi kumumea a me ke ʻano o ka carboxylic acid.

Hoʻopili ʻia ke ala metabolic lua me ka komo ʻana o ka ʻōnaehana pū ka cytochrome P450.

ʻO ka mea mua, he hua waena o ka metabolite 2-oxo-clopidogrel i hoʻokumu ʻia mai ka clopidogrel, a laila huli ʻia i kahi metabolite ikaika (thiol derivative). Hoʻokomo ka metabolite hoʻoikaika i ka vitro wikiwiki a hiki i ka launa pū me ka platelet receptor apparatus, ka mea e hoʻonāukiuki i ka hoʻohui platelet.

Ma kahi o 50% o ka nui o ka waiʻai i hoʻoponopono ʻia i loko o ka pāʻai a ma kahi o 46% me nā feces ma hope o 120 mau hola. ʻO ka hapalua ola o kahi pākahi hoʻokahi 6 mau hola.

ʻO ka hapalua ola o ka metabolite ʻoi ʻole he 8 mau hola (ma hope o hoʻokahi helu a ma hope o ka hoʻokele hou ʻana).

Nā Papa Hoʻopiʻi 75 mg Helu 10, 40.

Ma ke ana o ka lōʻihi, ʻaʻole iʻoi aku ma kahi o 25 tikelika Celsius i ka ʻupena mua.

ʻO nā waiwai Pharmacological

Hoʻopili ʻo Clopidogrel i ka pili ʻana o ka adenosine diphosphate (ADP) i kahi mea hōʻeha ma kahi papa platelet a me ka hoʻihoʻi o muri mai o ka hoʻopulapula o GPIIb / IIIa e ADP a no laila ke kāohi nei i ka hoʻohui o platelet. Hoʻopaʻa ʻo Clopidogrel i ka hōʻiliʻili o ka platelet i hoʻolako ʻia e nā agonist e nā mea ʻē aʻe, ma ke kāohi ʻana i ka hoʻonui ʻana o ka hana platelet i hoʻokuʻu ʻia i ka ADP, e hoʻohuli hou ʻia ana i ka papa inoa o nā ADP platelet. Nā pākula i pili i ke hoʻololi i ka clopidogrel a hiki i ka hopena o ke ola o ke ola. Hoʻihoʻi ʻia ka hana platelet maʻamau i ka uku e kūlike ana i ka hōʻano hou o ka platelet.

Mai ka lā mua o ke keʻena ʻana i ka helu i kēlā me kēia lā o 75 mg, kahi lohi nui o ka hōʻuluʻulu ʻana o ka platelet ADP-induced. Hana holomua kēia hana a paʻa i waena o 3 a 7 mau lā. Ke kūpaʻa nei, ʻo ka nui o ka pae o ka hōʻemi o ka ʻohi ʻana ma lalo o ke ʻano o ka hopena o kekahi lā ma kahi o 75 mg o 40% a 60%. ʻO ka hōʻiliʻili platelet a me ke koko hoʻi ka lōʻihi e hoʻi i ka papa loiloi ma ka awelika 5 mau lā ma hope o ka hoʻokuʻu ʻana o ka mālama ʻana.

Ma hope o ka lawelawe waha ma kahi wī o 75 mg, ua paʻa koke mai ka ka hanu ʻana.

ʻO ka lōʻihi o ka plasma kiʻekiʻe o ka clopidogrel i hoʻololi ʻia (ma kahi o 2.2-2.5 ng / ml ma hope o hoʻokahi mauʻu no ka 75 mg orally) ua loaʻa ma kahi o 45 mau minuke ma hope o ka noi. ʻO ka Absorption kahi liʻiliʻi o 50%, e like me ka hōʻikeʻana e nā excretion o nā metabolite clopidogrel i loko o ka urine. ʻO Clopidogrel a me ka hana nui (hana ole) ka hāmeʻe i loko o ke koko i loko o ka vitro e hoʻihoʻi i ka protein o ke kanaka (98% a me 94%, kahi).

Noho a kēia kau palena i ka vitro ma luna o ke ʻano o ka nui o nā mea.

Hoʻopili nui ka Clopidogrel i loko o ka ate. In vitro and in vivo, ʻelua mau ala nui o kāna kaila metabol: ka mea e hui pū me ka komo ʻana o nā esterases a alakaʻi i ka hydrolysis me ka hoʻokumu ʻana o kahi derivative o kahi ʻano kāmao kūlohelohe (kahi e pili ana i ka 85% o nā metabolites holoʻokoʻa i ka plasma koko), a ua komo nā enzyme o ka pūhui cytochrome P450 . ^ E Ha yM.

ʻO ka mua, e hoʻololi ʻia ka clopidogrel i kahi metabolite waena o 2-oxo-clopidogrel. Ma muli o nā hana hoʻopili hou aku o 2-oxo-clopidogrel, kahi derivative thiol, kahi metabolite ikaika. Ma ka vitro, hui ʻia kēia kipa metabola e nā enzyme CYP3A4, CYP2C19, CYP1A2, a me CYP2B6. ʻO ka metabolite ikaika o ka clopidogrel, ka mea i hoʻokaʻawale i ka vitro, wikiwiki a paʻa ʻole i ka hoʻopaʻa ʻia i nā ʻāpana platelet, a laila ʻae me ka hoʻohui ʻana i ka platelet.

ʻO 120 mau hola ma hope o ka nānā ʻana, ma kahi o 50% o ka nui o ka nui e hoʻopau ʻia i loko o ka urine a me 46% me nā feces. Ma hope o ka hoʻoponopono waha ʻana i hoʻokahi pākahi, ʻo ka hapalua o ke ola o ka clopidogrel e pili ana i 6:00. ʻO ka hapalua o ka noho nui o ka metabolite (hele ʻole) a hūnā i loko o ke koko he 8:00 ma hope o ka helu hoʻokahi a hoʻohana hou ʻia ka lāʻau.

Lapaʻau lāʻau. Ua hoʻohuli ka nui o nā enzyme polymorphic CYP450 i ka clopidogrel i kahi metabolite ikaika, hoʻāla i ka hana. Hoʻololi ʻia ʻo CYP2C19 i ka hoʻokumu ʻana i kahi metabolite ikaika a me kahi metabolite waena o 2-oxo-clopidogrel. ʻO nā pharmacokinetics o ka metabolite ikaika a me nā hopena antiplatelet, e like me ke ana o ka platelet aggregation, ʻokoʻa ʻole ia e pili ana i ka genotype CYP2C19. ʻO ka CYP2C19 * 1 allele pili i kahi metabolism holoʻokoʻa holoʻokoʻa, aʻo CYP2C19 * 2 a me CYP2C19 * 3 alleles e pili ana i kahi nāwaliwali nāwaliwali. Ke kuleana nei kēia mau pelekala no ka 85% o nā aleline, nāwaliwali i ka hana ma ke keʻokeʻo a ʻo 99% i nā poʻe ʻAmelia. ʻO nā alleles ʻē aʻe e pili pū ana me ka nāwaliwali nāwaliwali nā huina CYP2C19 * 4, * 5, * 6, * 7 a me 8, akā ʻoi aku ka liʻiliʻi o ka heluna kanaka.

Kākoʻo 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 manawa, akā, ʻaʻole i hala ma mua o 35 mau lā ma hope o ka hoʻomaka) ʻana, hōʻeha ischemic (ka hoʻomaka ʻana o ka mālama ʻana - 7 mau lā, ʻaʻole ia ma mua o 6 mau mahina ma hope o ka hoʻomaka) a i ʻole ka mea i hōʻike ʻia e ka maʻi peripheral arteri (hōʻino i nā aʻa a me ka atherothrombosis o nā moku o nā lalo haʻahaʻa),
• i nā maʻi me ka maʻi coronary syndrome:

̶ me ka mahele coronary syndrome me ka kahi o ka ST st elevation (unstable angina a me myocardial infarction me Q wave), me nā poʻe maʻi i loaʻa i kahi stent i waiho ʻia i ka wā ʻo ka coriopio percutaneous coroliary, i hui pū me ka acetylsalicylic acid (ASA)

̶ me ka maʻi myocardial infarction me ka piʻi o ka mahele ST i hui pū ʻia me ka acetylsalicylic acid (i nā mea maʻi e loaʻa ana i ka lāʻau lapaʻau maʻamau a e hōʻike ʻia ana me ka lāʻau thrombolytic).

Kāohi i nā hanana atherothrombotic a me ka thromboembolic ma ka atrial fibrillation. Hoʻohui ʻo Clopidogrel me kahi ASA no nā maʻi pākeke me ka fibrillation atrial, nona ka mea i liʻiliʻi he keu no ka hanana ʻana o nā hanana vascular, aia nō nā contraindications no ka mālama ʻana me nā vitamin K antagonist (AVK) a loaʻa iā ia kahi haʻahaʻa o ke koko, no ka pale ʻana i nā hanana atherothrombotic a me ka thromboembolic. e komo pū me ka uha. E nānā pū i ka ʻāpana "Nā huahana Pharmacological".

Hoʻohui nūhou

ʻAʻole ia e hui pū i ka hui ʻana i ka ʻoihana Aterocardium me anticoagulants waha ma muli o ka hoʻoweliweli ʻana o ka piʻi o ka huhū.

Hiki i nā pilina ke lilo me ka hoʻohana pū ʻana o ka clopidogrel me nā lāʻau lapaʻau ʻē aʻe / hoʻomākaukau:

• Non-steroidal anti-inflammatory drugs (komo pū kekahi COX-2 inhibitors), ASA, protein IIb / IIIa inhibitors, thrombolytic drug, heparin: aia kahi hewa o ka maʻi (hoʻohana clopidogrel me ka mālama ʻana me kēia hoʻopili).
• fluconazole, fluoxetine, omeprazole, moclobemide, esomeprazole, voriconazole, carbamazepine, ticlopidine, chloramphenicol, ciprofloxacin, fluvoxamine, oxcarbazepine, cimetidine (nā lāʻau e hoʻōla ana i ka hana o ka hana iā CYP2C19)
• proton pump inhibitors: hiki i nā mea pili ke hoʻopili, no laila, ʻaʻole i ʻōlelo ʻia kēia mau hui, ke ʻole ke koʻikoʻi.
• nā lāʻau e hoʻōla nei me ka hoʻohana ʻana i ka cytochrome P450 2C9: hiki ke hoʻonui i ke kiʻekiʻe o kēia mau lāʻau i ka plasma (me ka ʻokoʻa o ka tolbutamide a me ka phenytoin, kahi e palekana pono ai me ka Aterocardium).
• atenolol, nifedipine, estrogen, cimetidine, fenobarbital, theophylline, antacids, digoxin, diuretics, ACE inhibitors (angiotensin-converting enzyme), beta-blockers, calcium blockers channel, antiepileptic, hypocholesterolemic and other drug. ka hoʻonui ʻana i nā moku coronary, nā GPIIb / IIIa antagonist, nā loli hou ʻana o nā lāʻau lapaʻau.

ʻO nā hui o Aterocardium nā: Clopidogrel, Plavix, Aspirin Cardio, Dipyridamole.

Loaʻa ka hopena

hematoma, luhi loa

ka mea maʻamau - ka maʻi hemorrhage, ka huhū mai ka ʻā ʻana o ka hana, vasculitis, hypotension arterial,

mai ka papa hana ʻana: maʻamau - ʻeha o ka ʻōpū, ka maʻi ʻeha, ka dyspepsia, ka ʻeha o ka gastrointestinal, pinepine ʻole - ka ʻōpū, constipation, ʻeha a me ka uluu duodenal, gastritis, luaʻi, flatulence, ʻokoʻa pinepine - ka hoʻōla o retroperitoneal, ʻokoʻa pinepine - ka pancreatitis, colitis (komo i ka ulcerative a i ʻole lymphocytic), fatal gastrointestinal a me ka hoʻihoʻi retroperitoneal, stomatitis,

mai ka ʻōnaehana hepatobiliary: loaʻa pinepine loa - ka wī o ka hoʻopiʻi o ka ate, hepatitis, nā hoʻomaʻamaʻa hana o ke akea

mai ka pūnaehana nūnaehana kikowaena: maʻamau-maʻamau - kaʻeha, ka paresthesia, dizziness, ka pīpī intracranial (i kekahi mau hihia, mea momona), ʻano maʻamau loa - ka hilahila, ka ʻola ʻana, ka hoʻowalewale,

mai nā naʻau sensory: ʻaʻole maʻamau - polū o ka maka

(conjunctival, ocular, retinal), maʻamau maʻamau - dizziness (pathology o ka pepeiao a me ka labyrinth),

ma ka ʻāpana o ka ʻili a me ka kiko subutan: maʻamau - subcutaneous hemorrhage, maʻamau-maʻamau - ʻāʻī ka ʻula, ʻeha, purpura, ʻokoʻa ke ʻano - angioedema, erythematous rash, bullous dermatitis (toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, kraemia), lichen planus

mai ka papa hana hanu: maʻamau - nosebleeds, pinepine loa maʻamau - ka huhū hanu (hemoptysis, hemorrhage pulmonary), bronchospasm, pneumonitis interstitial,

mai ka musculoskeletal system: maʻamau loa maʻamau - hemarthrosis, arthritis, arthralgia, myalgia,

mai ka urinary system: ʻaʻole-maʻamau - hematuria, maʻamau loa maʻamau - glomerulonephritis, hoʻonui i hana i loko o ke koko.

Ua nānā ʻia nā ʻano maʻi hypersensitivity, ʻokoʻa pinepine - ka maʻi serum, nā hopena anaphylactic,

nā hōʻailona o ka laboratorium: ʻaʻole maʻamau - ka lōʻihi o ka hoʻonui ʻana i ka manawa koko, hoʻemi i ka pae o nā neutrophils a me nā platelets,

nā mea ʻē aʻe: maʻamau - kaheʻe ʻana ma ka pūnaewele injection, ʻokoʻa loa maʻamau - ka ʻeha.

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

Anticoagulants oral. ʻAʻole kōkua ʻia ka hoʻohana ʻana me ka clopidogrel, no ka mea he pilikia ka piʻi o ka nui o ke koko.

Nā mea hōʻike i ke glycoprotein IIb, / IIIA. Pono e hoʻohana pū ʻia ka Aterocardium me ka makaʻala i nā mea maʻi me ka piʻi nui o ka kahe koko ma muli o ka trauma, o ka hōʻola ʻana a i nā kūlana pathological paha i hoʻohana ʻia nā glycoprotein IIb, IIAa inhibitors.

ʻO ka acetylsalicylic acid (ASA). ʻAʻole hoʻololi ʻo ASA i ka hopena pale o ka clopidogrel i ka ADP-hoʻohuihui ia o ka platelet aggregation, akā hoʻonui ka clopidogrel i ka hopena o ASA i ka collelet-induced platelet aggregation. Eia nō naʻe, ʻo ka hoʻohana like ʻana o 500 mg o ASA 2 mau manawa i ka lā no 1 lā ʻaʻole i hoʻoulu i ka nui o ke kahe koko, i hoʻonui ʻia ma muli o ka hoʻohana ʻana o clopidogrel. No ka hiki ke hoʻopili ʻia ka pilina ma waena o ka clopidogrel a me ka acetylsalicylic acid me ka nui o ka piʻi ʻana o ke kahe, ke koi ʻia ka hoʻohana ʻana i kēia mau lāʻau. ʻOiai ʻo kēia, ua hoʻohana ʻia nā clopidogrel a me ASA no ka 1 makahiki.

Heparin. Wahi a ke aʻo ʻana, ʻaʻole pono ʻo clopidogrel i kahi hoʻoponopono hoʻoponopono no ka heparin a ʻaʻole i hoʻololi 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 i ka pilina ma waena o ke clopidogrel a me ka heparin e hiki ke piʻi me ka nui o ka ʻeha o ke koko, e hoʻohana pono ka hoʻohana ʻana i ka makaʻala.

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 pū ʻana o ka clopidogrel a me nā naproxen hiki ke hoʻonui i ka nui o ke koko gastrointestinal. Eia nō naʻe, ʻaʻohe ʻikepili ma ka pili o ka hopena o ka lāʻau me nā NSAIDs ʻē aʻe, ʻaʻole maopopo ia a i ʻole ka hopena o ke koko 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.

E hui pū me nā lāʻau lapaʻau ʻē aʻe.

Mai ka lilo ʻana i ka clopidogrel i ka metabolite neʻe i ka hapa ma lalo o ka mana o CYP2C19, ʻo ka hoʻohana ʻana i nā lāʻau lapaʻau e hōʻemi ana i ka hana a kēia enme hiki ke hana i ka emi ʻana o ke kaohi o ka metabolite hoʻoikaika o clopidogrel i loko o ke koko koko, a me ka hoʻemi ʻana i ka hopena lapaʻau. ʻO ka hoʻohana pū ʻana i nā lāʻau lapaʻau e pale i ka hana o CYP2C19 e pono e pale ʻia.

ʻO nā lāʻau lae e pale i ka hana o CYP2C19 e pili ana i ka omeprazole, esomeprazole, fluvoxamine, fluoxetine, moclobemide, voriconazole, fluconazole, ticlopidine, ciprofloxacin, cimetidine, carbamazepine, oxcarbazepine a me chloramphenic.

Nā pale huna Proton. ʻOiai ke hōʻike nei nā hōʻike hōʻike, ʻaʻole i like ka like o ka pale o ka hana ʻana o ka hana CYP2C19 ma lalo o ka hana a nā ʻano lāʻau like ʻole i ka papa o nā proton pump inhibitor, ʻaʻole i like like ʻole, aia ka hōʻike e hōʻike nei i ka hiki ke pili ʻana i ka pili o nā lāʻau āpau o kēia papa. No laila, pono e pale ʻia ka hoʻohana ʻana o nā pale me nā pale proton, ke ʻole pono maoli. ʻAʻohe mea iʻike i nā lāʻau ʻē aʻe e hōʻemi ana i ka hoʻoneʻe ʻana i ka wai i loko o ka ʻōpū, e like me, no ka laʻana, H 2 blockers (me ka manaʻo ʻole o cimetidine, he mea mālama i ka CYP2C9) a i nā antacids, pili i ka hana antiplatelet o clopidogrel.

Ma muli o nā haʻawina, ʻaʻohe hōʻike nui o nā lapaʻau i hōʻike ʻia me ka hoʻohana ʻana i ka clopidogrel i ka manawa like me ka atenolol, nifedipine, a i ʻole nā ​​lāʻau ʻelua. Eia kekahi, ʻaʻole i loli iki ka hana o ka pharmacodynamic o clopidogrel i ka wā e hoʻohana pū ana me ka phenobarbital a me ka estrogen.

ʻAʻole loli i nā huahana pharmacokinetic o digoxin a i ʻole theophylline i ka wā e hoʻohana ai ka clopidogrel. ʻAʻole pili ka hopena i nā kūmoku i ka lawe ʻana o ka clopidogrel.

Ua hōʻike ʻia nā ʻikepili noiʻi e hiki ke hoʻokaʻawale nā ​​carboxyl metabolites o clopidogrel i ka hana o ka cytochrome P450 2C9. Hiki i kēia ke hoʻonui i nā pae plasma o ka phenytoin, tolbutamide a me nā NSAIDs, i hoʻohālikelike ʻia e ka cytochrome P450 2C9. ʻOiai ke ʻano nei, hōʻike ʻia nā hopena o nā noi i hiki ke hoʻohana ʻia ka phenytoin a me ka tolbutamide i ka manawa like me ka clopidogrel.

ʻAʻohe hui lapaʻau koʻikoʻi i nā lapaʻau me nā diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, agents that dilate the coronary vessel, antacids, hypoglycemic (including insulin), hypocholesterolemic, antiepileptic drug, GPIIb / IIIa antagonists, and antagonists of GPIIb / IIIa.

Nā hiʻohiʻona noi

Hōʻalo a me nā maʻi hematological. Ma muli o ka hopena o ke kahe a me ka hopena hematological, ʻo ka hōʻike kiko ʻana i ke koko a me / a i ʻole nā ​​hoʻokolohua kūpono paha e hoʻokō koke ʻia inā ʻike ʻia nā hōʻailona o ke koko i ka wā o ka hōʻino (ʻike

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 hoʻomaopopo i ke kauka (me ka wahine hoʻi) ke hoʻohana nei lākou i ka clopidogrel, ma mua o ke ʻano ʻana o kekahi maʻa, a i ʻole ma mua o ka hoʻohana ʻana 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 (ʻoiai a i ʻole hui pū ʻana me ASA), hiki ke hoʻokaʻalo paha ka hope ma mua o ka maʻamau, a ʻo ia ke hoʻomaopopo i ke kauka e pili ana i kēlā me kēia hihia o ka maʻi (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. ʻO ka TTP kahi kūlana pōpilikia hiki ke laka, a no laila e koi aku i ka mālama koke, me ka plasmapheresis.

Loaʻa ka hemophilia. ʻO nā hihia o ka hoʻolālā ʻana i loaʻa hemophilia ma hope o ka hoʻohana ʻana i clopidogrel. I nā hihia i hōʻoia ʻia i ka hoʻonui ʻia ʻana o APTT (hoʻāla i ka manawa tromboplastin), i hui pū ʻia a ʻaʻole ʻole i hui pū ʻia me ka uha, e pono ka noʻonoʻo ʻia o ka nīnau no ka loaʻa ʻana o ka hemophilia i loaʻa. ʻO nā mea maʻi me ka maʻi hōʻoia i hōʻoia ʻia i ka hemophilia i loaʻa ma lalo o ka nānā o kahi kauka a loaʻa i ka mālama ʻana, pono e hoʻohana ʻia ka hoʻohana ʻana o ka clopidogrel.

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 2 C19 (CYP2C19). Pharmacogenetics Ma nā mea maʻi me ka hana hoʻonaninani me ka genetically hōʻemi o CYP2C19, aia ke koena haʻahaʻa o ka metabolite ikaika o ka clopidogrel i loko o ke koko koko a me ka hopena antiplatelet i haʻi ʻia. I kēia manawa aia nā hoʻokolohua e ʻike ai i ka genotype CYP2C19 i kahi maʻi.

Ma ka lilo ʻana o ka clopidogrel i ka metabolite hoʻoikaika ʻokoʻa 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 alakaʻi ai 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, ʻo ke ana i ka wehe ʻana i ka hoʻohana like ʻana o nā mea paʻa o ka CYP2C19 ikaika a me ke ʻano (ʻike

Cross-reactivity ma waena o thienopyridines. ʻO ka moʻolelo o ka mea maʻi i ka hypersensitivity i nā thienopyridines ʻē aʻe (e like me ka ticlopidine, prasugrel) e nānā pono ʻia no ka mea ua loaʻa nā hōʻike no ka cross-allergy ma waena o thienopyridines (e nānā i ka ʻāpana "Hōʻino i ka hopena"). ʻO ka hoʻohana ʻana o ka thienopyridines hiki ke alakaʻi i ka hopena kūlohelohe o ka maʻi i ka hōʻeha nui, e like me ka pāheʻe ʻana, ka pā o Quincke, a i ʻole hematological hopena e like me thrombocytopenia a me neutropenia. ʻO nā mea maʻi i loaʻa i ka mōʻaukala o nā hopena alaka a me / a he hematological paha i hoʻokahi thienopyridine i nui ka piʻi o ka ulu ʻana i like ʻole a i ʻole nā ​​ʻano like ʻole ʻē aʻe i kekahi thienopyridine. Kuhi ʻia ka nānā ʻana o cross-reactivity.

Hola paʻa kino hana. Hoʻololi ka ʻike i ka lāʻau lapaʻau e hoʻohana ai i ka clopidogrel i nā mea maʻi me ka pilikia ʻole, no laila, e kau ʻia nā mea maʻi like i ka lāʻau me ka akaʻala (e ʻike i ka Māhele "Dosage and Administration").

Hōʻeha ka naʻau ʻili. ʻO ka ʻike no ka hoʻohana ʻana i ka lāʻau lapaʻau ma nā maʻi me nā maʻi maʻi palupalu a me ka hiki ʻana o ka diathesis hemorrhagic i palena ʻia, no laila, e kuhikuhi ʻia nā mea maʻi iā clopidogrel me ka makaʻala (e ʻike i ka Māhele "Dosage and Administration").

Nā mea kūʻai. ʻO ka Aterocardium ka lactose. ʻO nā mea maʻi me nā maʻi hoʻohemo maʻamau e like me ka galolose galactose, ka nele o Lapp lactase a i ʻole impaired glucose-galactose malabsorption e hoʻohana i kēia lāʻau.

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, ʻaʻole pono ke kuhikuhi ʻia ka lāʻau lapaʻau i nā wahine hāpai (ma ke ʻano he laoa). ʻAʻole i hōʻike i nā hoʻokolohua holoholona me ka hopena maikaʻi o ka clopidogrel i ka wā hāpai, ka embryo / hoʻomohala i ka hanana, hānau keiki a me ka hoʻomohala postnatal.

ʻAʻole i maopopo ka excreted i ke clopidogrel ma ka umauma umauma. Ua hōʻike ʻia nā haʻawina holoholona me ka excreted i loko o ka umauma waiū, no laila ʻo ka hoʻoulu ʻana i ka umauma e pono e haʻalele i ka wā o ka mālama ʻana me ka lāʻau lapaʻau.

Pūnaewele. I ka wā noiʻi ʻana i nā holoholona laboratorium, ʻaʻole i ʻike ʻia nā hopena ʻino o ka clopidogrel e pili ana i ka momona.

Ke keu

Nā hōʻailona: ka lōʻihi o ke koko me nā hoʻopiʻi ʻana.

Hoʻomaʻamaʻa ka hoʻomaʻamaʻa. Inā pono, ʻo kahi hoʻoponopono wikiwiki i ka manawa koko lōʻihi, hiki ke hoʻoneʻe ʻia ka hopena o ka lāʻau ma ke kahe ʻana o ka pā platelet. ʻAʻole maopopo ka antidote o ka hana pharmacological o clopidogrel.

ʻO nā hopena ʻino

Ma ka ʻāpana o ke koko a me nā pūnaehana lymphatic: thrombocytopenia, leukopenia, eosinophilia, neutropenia, komo me ka neutropenia koʻikoʻi, thrombotic thrombocytopenic purpura (TTP) (e nānā i ka ʻāpana "Peculiarities o ka hoʻohana"), aplastic anemia, pancytopenia, agranulocytyen, grabe granulocytopenia, anemia.

Mai ka ʻaoʻao o ka pahuhopu: ka maʻi serum, ka hopena anaphylactoid, cross-hypersensitivity ma waena o thienopyridines (e like me ticlopidine, prasugrel) (e nānā

Mai ka pūnaehana nūhou: ke koko neʻe (intracranial) (i kekahi mau hihia - hōʻeha), ka ʻeha, ka paresthesia, ka maʻi hakahaka, hoʻololi i ka ʻono ʻono.

Mai ka ʻaoʻao o ka io o ka hihiʻo: ke kahe ana o ka maka o ka maka (conjunctiva, spectacle, retinal).

Ma ka ʻāpana o nā kino o ka lohe a me ke kaulike: huki.

Mai ka pūnaehana vascular: hematoma, hemorrhage koʻikoʻi, ka huhū mai ka ʻeha hōʻemi, vasculitis, hypotension arterial.

Mai ka ʻeha gastrointestinal: ka huhui o ka gastrointestinal, ʻeha, ka ʻeha o ka ʻōpū, ka dyspepsia o ka ʻōpū ʻoka a me ka ʻōpio duodenal, gastritis, pukawa, ke kaʻaʻi, constipation, flatulence, hemorrhage retroperitoneal, gastrointestinal a retroperitoneal hemorrhage, colastalitis, pancreatitis (ma ka kiko, ulcerative a lymphocytic), stomatitis.

Mai ka papa hana o ka hana kūwaho: nā maʻi hōʻoki o ke akeʻai, hepatitis, nā hopena maʻamau o nā māka hana o ka ate.

Ma ka ʻāpana o ka ʻili a me ka kiko subcutaneous: subcutaneous hemorrhage, rash, pruritus, intradermal hemorrhage (purpura), bullous dermatitis (toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme), eda angioneurotic, erythematous rash, ʻōpala, urticaria, lapaʻau me nā eosinophilia a me nā ʻōnaehana systemic (DRESS syndrome), eczema, lichen planus.

Ma ka ʻāpana o ka ʻōnaehana o ka iwi-iwi, nā mea pili a me ka aʻa: musculoskeletal hemorrhage (hemarthrosis), arthritis, arthralgia, myalgia.

Mai nā pūpū a me ka ʻōnaehana urinary: hematuria glomerulonephritis, hoʻonui i hana nui i loko o ke koko.

Nā maʻi maʻi psychiatric: hallucitions, confing.

ʻO ka hanu, thoracic a me mediastinal disorders: nosebleeds, respiratory tract coup (hemoptysis, pulmonary hemorrhage), bronchospasm, interstitial pneumonitis, eosinophilic pneumonia.

Nā maʻi maʻamau: ke kuni.

Nā noiʻi Laboratory: lōʻihi ka manawa o ke koko, kahi hoʻohaʻahaʻa i ka nui o nā neutrophils a me nā platelets.