Mokhoa oa ho sebelisa lithethefatsi Lopirel?

Karolo e sebetsang ea lithethefatsi ka khetha e thibela limolek'hule ADP e nang le li-receptors tse holim'a metsi palo ea liplatelete. Kahoo, ts'ebetso ea ts'ebetso GPIIb / IIIa le pokello ea liplatelete e ba thata. Hape clopidogrel e thibela mekgwa ya ho kopanya e susumetsoang ke ba bang bahanyetsi. Liplatelete li lula li senyehile li bile li sa khone ho sebetsa ho fihlela qetellong ea bophelo ba tsona. pokello.

Kamora ho fumana sehlopha sa pele sa meriana, ts'ebetso ea antithrombotic e qala ho ba teng, boemo ba leukocytes bo thehiloe ka matsatsi a 3-7 a tsamaiso. Ka karolelano, matsatsi a 5 kamora ho khaotsa kalafo, ho bokellana ka liplatelete le nako ea ho tsoa mali e khutlele sehlopheng sa pele.

Moriana o kenella kahare ho ona Phekolo ea ka mpeng. Leha ho le joalo, mahloriso clopidogrelho plasma e tlaase haholo, ho amoheloa ke 50%. Setlhare se tlamahana le liprotheine tsa mali tsa mali.

Clopidogrel e ts'oaetsoa ka har'a sebete, hoo e ka bang 80% ea metabolites e fumanoang ka plasma ha e sebetse. Metabolite e sebetsang, e fanang ka se hlokahalang anti-kakaretso ketso, e thehiloeng ke karabelo ea oxidation, e kenyeletsang isoenzyme ea cytochrome P450 - 2B6 le 3A4. Ka potlako metabolite ka boeona e sebetsana le eona liplatelete hape ha e fumanoe ho lero la mali.

Bophelo ba halofo ke lihora tse 6 bakeng sa ntho e sebetsang le tse 8 bakeng sa metabolite ea eona e sa sebetseng. Lihlahisoa li hlahisoa haholo ka moroto le mantle.

Batho ba nang le bothata ba ho hloleha ho sebetsa hantle ba renal, ho fokotseha hoa katleho ea lithethefatsi ka 25% ha li bapisoa le batho ba phetseng hantle.

Matšoao a sebelisang Lopirel

Setlhare se sebelisetsoa ho thibela arterial thrombosis ho batho ba nang le lefu la ho hlobaela le ho hlonama ka tlhaho:

E boetse e bontšoa bakeng sa tšebeliso atherothrombotic mathata a ho bakuli ba nang le mahlomola myocardial infarction, strokena lefu le amang methapo ea methapo ea kutlo. Tabeng ena, moriana o sebelisoa e le prophylaxis.

Contraindication

Lithethefatsi ha li fanoe:

ka matla ho hloleha ha sebete,
le basali baimana le ba anyang,
ho hemorrhagic syndrome,
ho intracranial hemorrhage, seso sa ka mpenge sa tobang ulcerative colitis, maqeba a matšoafong, lefuba le hyperfibrinolysis,
bana ba ka tlase ho lilemo tse 18
ho allergy ka likarolo tsa moriana,
ka ho hloka mamello galactose.

Ho hlokahala hore u be hlokolosi ha u kopanya moriana le acetylsalicylic acid, NSAIDs, heparin, thrombolytics, ka ho se leka-lekane ha renal le hepatic, pele ho ts'ebetso ea bongaka.

Lopirel, litaelo tsa tšebeliso (mokhoa le litekanyetso)

Matlapa a nooa ka molomo, ho sa tsotelehe mofuta oa lijo.

Litaelo tsa ho sebelisoa Lopirel (75 mg)

E le molao, le myocardial infarctionischemic stroke, bakuli ba nang le maloetse a arterial ba haufi le thipa ba ngoletsoa 1 letlapeng ka nako e le ngoe ka letsatsi.

Nako ea ho amoheloa kamora lefu la pelo - ho tloha ho 1 ho isa ho 25 matsatsi, kamora stroke - Matsatsi a 7 kapa likhoeli tse 6.

Haeba mokulicoronary syndrome ntle le ho phahamisa ST kapa ea tšoaroa coronary stenting, ebe kalafo e qala ka lethal dose ea 300 mg, ebe 75 mg (Letlapa le le leng) le beoa hang ka letsatsi bakeng sa likhoeli tse 3 (thupelo e ka atolosoa ho fihlela selemo se le seng). Ho mafu a joalo, joalo ka molao, ho tlatselletsoa le ho feta empacetyl salicylic acidMotsoako o khothalelitsoeng ke 100 mg.

Sokolla foromo le sebopeho

Lopirel e fumaneha ka mokhoa oa litafole ka khetla ea filimi: pota, biconvex, pinki, e ngotsoe ka "I" lehlakoreng le leng (matlapa a 7 kapa a 10 ka paketeng e nang le lithupa: ka har'a letlapa la likarete tsa 1, 2, 4 kapa 8, matlapa a 7 kapa 1, 2, 3, 5, 6, 9 kapa 10 maleiri a matlapa a 10, ka pakete ea likarete bakeng sa sepetlele 10, 20, 30 kapa 40).

Letlapa le le leng la Lopirel le na le:

ntho e sebetsang: Clopidogrel - 75 mg,
Excipients: cellcose ea microcrystalline, lactose, talc, glyceryl dibehenate, crospovidone (mofuta A),
khetla: Opadry II 85G34669 Pink talc, joala ba polyvinyl, macrogol 3350, titanium dioxide (E171), dae oxide e khubelu (E172), lecithin (E322).

Mokhoa oa ketso

Clopidogrel ke ea sehlopha sa lihlahisoa tsa litlhare. E 'ngoe ea metabolites ea eona ke inhibitor e sebetsang ea liplatelese: e thibela ho tlama ha adenosine diphosphate (ADP) le P2Y₁₂receptor ea liplatelete e lateloang ke ts'ebetso ea methapo ea methapo ea ADP ea glycoprotein IIb / IIIa, e bakang khatello ea methapo ea mali. Sesebelisoa se tlamang se sa fetoheng se lumella liplatelese hore li se ke tsa hlola li susumetsoa ke ADP bophelo bohle ba bona (matsatsi a ka bang 7–10). Ts'ebetso e tloaelehileng ea liplatelete e khutlisoa ho latela lebelo la ho ntlafatsoa ha bona.

Setlhare se boetse se thibela ho kopana ha liplatelete tse bakoang ke lingaka tsa mafu ntle le ADP. Ho thehoa ha metabolite e sebetsang ho bakoa ke ketso ea isoenzymes ea system P₄₅₀, 'me kaha li-isoenzymes tse ling li ka fapana polymorphism kapa tsa thibeloa ke lithethefatsi tse ling, ha se mokuli e mong le e mong ea nang le thibelo ea liplatelete tse lekaneng.

Melemo ea Pharmacodynamic

Ho ja Clopidogrel letsatsi le leng le le leng ka 75 mg ho fana ka khatello e kholo ea tlatsetso ea liplatelete tsa ADP ho tloha ka letsatsi la pele la tsamaiso. Butle-butle, nakong ea matsatsi a 3-7, tekanyo ea khatello e ea eketseha, e fihla maemong a khafetsa kamora ho fihlela mmuso o lekanang. Ha u nka tekanyetso ea letsatsi le letsatsi ea 75 mg ka tekano, pokello ea liplatelese e khothalletsoa ke 40-60%. Kamora matsatsi a 5 ka mor'a ho emisa sethethefatsi, nako ea ho tsoa mali le pokello ea liplatelete butle-butle li khutlela boemong ba pele.

Ho sebetsa hantle ka bongaka / polokeho

Clopidogrel e thibela nts'etsopele ea atherothrombosis ts'ebetsong efe kapa efe ea lehae ea lesapo la methapo ea methapo (ka mohlala, ka liso tsa methapo ea methapo ea mokokotlo, mokokotlo kapa mokokotlo).

Ka liteko tsa kliniki " kuchukuliwa myocardial infarction, stroke, systemic thromboembolism kantle ho ts'ebetso ea methapo e kholo kapa lefu la methapo, haholoholo ka lebaka la ho fokotseha hoa menyetla ea ho tšoaroa ke lefu la stroke. Ho sebetsa hantle ha tšebelisano 'moho ea Clopidogrel le acetylsalicylic acid e ile ea iponahatsa e sa le pele ebile e phehella lilemo tse 5. Ho fokotseha ha menyetla ea ho ba le mathata a maholo a methapo ho bakuli ba nkang acetylsalicylic acid le clopidogrel ho fanoe ka ho fokotseha ho hoholo ha maqhubu a methapo. Nakong ea kalafo ka lithethefatsi tsena, menyetla ea ho ba le tsitsipano e itseng e fokotsehile, ho ne ho boetse ho na le tšekamelo ea ho fokotseha hoa maemo a infaration ea myocardial, empa ho ne ho se na phapang khafetsa ea thromboembolism kantle ho ts'ebetso ea methapo e kholo kapa lefu la methapo. Hammoho le sena, ho nka Clopidogrel le acetylsalicylic acid ho fokotsitse nako eohle ea ho kena sepetlele bakeng sa bakuli ba nang le mathata a tsamaiso ea methapo ea pelo.

Suction

Joalo ka monko o le mong, le lethal dose ea Clopidogrel ka lethal dose ea 75 mg ka letsatsi, ntho ena e kenella ka potlako. Ka karolelano, palo e kaholimo ea clopidogrel e sa fetoheng plasma ea mali e fihlelloa metsotso e ka bang 45 ka mor'a taolo ea molomo mme e tloha ho 2.2 ho isa ho 2,5 ng / ml. Ho amoheloa ha Clopidogrel ke liphio (ho latela tlhahlobo ea metabolites ea eona) ke bonyane 50%.

Metabolism

Sesebelisoa se sebetsang se na le metabolism e ngata sebeteng. Ho vivo le vitro, clopidogrel e tšelisoa ka mekhoa e 'meli: ka esterase e lateloang ke hydrolysis, e hlahisang sebopeho sa ts'ebetso e sa sebetseng ea carboxylic acid (85%) ho tsoa ho metabolites e potoloha tsamaisong ea systemic ka sistimi ea cytochrome P₄₅₀.

Boemong ba pele, clopidogrel e tšelisoa metabolite ea mahareng - 2-oxoclopidogrel. Metabolism ea morao-rao ea oxoclopidogrel e baka ponahalo ea metabolite e sebetsang, e leng thiol e tsoang ho clopidogrel. Tsela ena ea in vitro metabolic e etsahala ka ho nka karolo ha isoenzymes CYP2C19, CYP3A4, CYP2B6, le CYP1A2. The thiol metabolite e sebetsang e arohaneng le vitro ka mokhoa o sa fetoheng mme e tlama ka potlako ho li-receptor tsa polasetiki, e thibelang ho kopana ha tsona.

Tabeng ea tekanyetso e le 'ngoe ea Clopidogrel ka tekanyo ea 300 mg, palo e phahameng ea metabolite e sebetsang e phahame habeli ho feta ha o nka tekanyetso ea tlhokomelo ea Clopidogrel 75 mg ka matsatsi a 4. Palo e phahameng ea metabolite ea Clopidogrel e tlalehiloe ka mor'a lihora tse 0.5-1 kamora ho nka moriana.

Ho batho, kamora ho tsamaisoa ha molomo ka 14 ea li-clopidogrel tse 14 C, hoo e ka bang 46% ea radioaction e epolloa ka mala, 'me hoo e ka bang 50% ea radioaction e epolloa ka liphio. Kamora tekanyetso e le 'ngoe ea Clopidogrel ka tekanyo ea 75 mg, halofo ea bophelo ke hoo e ka bang lihora tse 6. Ka tekanyetso e le 'ngoe le tekanyetso e khutsitseng, bophelo ba halofo ea "metabolite" e tloaelehileng e sa sebetseng maling e ka nka lihora tse 8.

Pharmacogenetics

Metabolite e sebetsang ea clopidogrel le 2m oxoclopidogrel e mahareng e thehiloe ho sebelisoa eyeenzyme CYP2C19. CYP2C19 isoenzyme genotype e ama phello ea antiplatelet le pharmacokinetics ea metabolite e sebetsang nakong ea thuto ea ex vivo platelet aggregation.

Alamo ea mofuta oa CYP2C19 * 1 e tsamaisana le metabolism e sebetsang ka botlalo, 'me mefuta ea CYP2C19 * 3 le CYP2C19 * 2 ha e sebetse ebile e baka ho fokotseha ha metabolism ho baemeli ba bangata ba Mongoloid (99%) le Caucasoid (85%). Liqoso tse ling tse bakang ho fokotseha kapa ho haella ha metabolism (ho kenyelletsa empa ha ho na meeli ho li-CYP2C19 * 4, * 5, * 6, * 7, * 8) ha li sa tloaeleha. Bakuli ba nang le metabolite e fokolang ba tlameha ho ba le litlatsetso tse peli tse bonts'itsoeng tsa gene ka ho felloa ke ts'ebetso. Ho ea ka tlhaiso-leseling e phatlalalitsoeng, khafetsa ea phenotypes ea li-metabolic tsa CYP2C19 tse fokolang ho batho ba morabe oa Negroid ke 4%, lebelo la Caucasoid - 2%, le Machaena - 14%.

Ho hlahloba motsoako oa pharmacokinetics le antiplatelet ha o nka tekanyetso ea pele ea Clopidogrel 300 mg le ho ja ka nako e latelang 75 mg ka letsatsi, hammoho le ha o nka tekanyetso ea pele ea Clopidogrel 600 mg le ts'ebeliso ea eona ea morao-rao ea 150 mg ka letsatsi ka matsatsi a 5 (ho fihlela tekano e fihletsoe. ) ho ile ha etsoa lipatlisiso tse amanang le likarolo tse 40 tse amang baithaopi ba 40 lihlopheng tse 4 tsa batho ba 10 ba nang le li-subtypes tse 4 tsa CYP2C19 isoenzyme (ultrafast, e matla, e fokolang kapa e bohareng). Ka lebaka leo, ho metabolites e matla, e bohareng, le ea ultrafast, ho ne ho se na phapang e kholo ponts'ong ea metabolite e sebetsang, hammoho le litekanyetso tse tloaelehileng tsa thibelo ea liphatlalatso tsa liplatelete (indonesia ea ADP). Ho pepesetsoa ha metabolite e sebetsang ka li-metabolites tse fokolang ha ho bapisoa le li-metabolites tse matla li fokotsehile ka 63-71%. Boemong ba regimen ea 300 mg / 75 mg, phello ea antiplatelet ea metabolites e fokolang e fokotsehile ka litekanyetso tse tloaelehileng tsa polasetiki ea motsoako, e neng e le 24% (kamora lihora tse 24) le 37% (ka letsatsi la 5) ha e bapisoa le thibelo ea liplatelese tse matla ho e matla (39% - kamora lihora tse 24 le 58% - ka letsatsi la 5) le mahareng (37% - kamora lihora tse 24 le 60% - ka letsatsi la 5) Tabeng ea ho sebelisa scheme 600, CYP2C19 * 1 gene allele e fana ka metabolism e sebetsang ka botlalo ea mg / 150 mg, ho pepeseha ha metabolite e sebetsang ka metabolism e fokolang ho ne ho phahame ho feta ka morero oa 300 mg / 75 mg. Inhibition aggregation inhibition e ne e le 32% (kamora lihora tse 24) le 61% (ka letsatsi la 5), e neng e le theko e fetang tekano bakeng sa mofuta oa 300 mg / 75 mg regimen, empa e ne e tšoana le lihlopha tsa bakuli ba nang le CYP2C 19- metabolism, e fumaneng kalafo ho latela morero 300 mg / 75 mg. Ho lokela ho hopoloa hore thutong, ho nka sephetho sa bongaka bakeng sa bakuli ba sehlopha sena, regimen ea litekanyetso tsa Clopidogrel ha e e-so thehoe.

Tlhahlobo ea meta ea lithuto tse ts'eletseng, tse kenyelletsang lintlha tse tsoang ho baithaopi ba 335 ba amohetseng clopidogrel mme ba lula ba le maemong a tekano ea tekano, e bontšitse hore tlhahiso ea metabolite e sebetsang ho metabolites e fokolang e fokotsehile ka 72%, le ka li-metabolites tse bohareng - ka 28%, leha boleng bo bohareng ba thibelo ea pokello ea liplatelese e ne e le e fokotsehile ha e bapisoa le li-metabolites tse matla ka 21.4 le 5.9%, ka ho latellana.

Kamano pakeng tsa CYP2C19 genotype le sephetho sa bongaka ho bakuli ba fumanang li-clopidogrel ha li so hlahlojoe litekong tse lebelletsoeng, tse laoloang, tse sa reroang, leha ho le joalo, ho fihlela joale, ho na le litlhahlobo tse 'maloa tsa ho hlahloba. Lintlha tse phatlalalitsoeng tse tsoang liphuputsong tse 'maloa tsa cohort, hammoho le liphetho tsa genotyping lithutong tsa bongaka: CHARISMA (n = 2428), CURE (n = 2721), TRITON-TIMI 38 (n = 1477), CLARITY-TIMI 28 (n = 227), ETSE- A (n = 601).

Lithuto tse tharo tsa cohort (Giusti, Collet, Sibling) le thuto ea bongaka TRITON-TIMI 38 ho bakuli ba sehlopha se kopaneng se nang le metabolism e fokolang le e bohareng ba tlalehile liketsahalo tse ngata tsa mathata a pelo le methapo (infarction ea myocardial, stroke, lefu) kapa stent thrombosis ha e bapisoa le tse ts'oanang. ya data mabapi le metabolites e matla.

Phuputsong ea Simon cohort le thutong ea CHARISMA, ho ata ha mathata a pelo le pelo ho tlalehiloe feela ho li-metabolic tse fokolang (ha li bapisoa le ho matla).

Thutong ea Trenk cohort le CLARITY, CURE, ACTIVE-A lithuto, ho ne ho se na mokhatlo o amanang le mathata a pelo le matla a CYP2C19 metabolism

Lithuto tsa kliniki tse entsoeng ho fihlela joale li na le sampole ea boholo bo sa lekaneng ho bona phapang liphellong tsa kliniki ho bakuli ba nang le ts'ebetso e fokolang ea CYP2C19 isoenzyme.

Lintlha tse ikhethang tsa Kliniki

Pharmacokinetics ea metabolite e sebetsang ea Clopidogrel ea lihlopha ka bomong ha e e-so ithutoe.

Lithutong tse kenyeletsang baithaopi ba tsofetseng (tse fetang lilemo tse 75), ha li bapisoa le data ea baithaopi ba banyenyane, ho fapana ha nako ea ho tsoa mali le pokello ea liplatelete ha lia ka tsa fumanoa. Bakeng sa kalafo ea bakuli ba tsofetseng, tokiso ea litekanyetso tsa Lopirel ha e hlokehe.

The pharmacokinetics ea clopidogrel ho bakuli ba ka tlase ho lilemo tse 18 ha e e-so ithutoe.

Ka tšenyo e mpe ea menoana (ka tumello ea creatinine ho tloha ho 5 ho isa ho 15 ml / min) ka lebaka la tšebeliso e sa khaotseng ea Clopidogrel ka lethal dose ea 75 mg ka letsatsi, tekanyo ea ho qalisoa ha karolo ea methapo ea methapo ea ADP e ne e le 25% e tlase ho feta ho baithaopi ba phetseng hantle, leha ho le joalo, nako ea ho tsoa mali e ile ea sala e tšoanang le pontšo ena bakeng sa baithaopi ba phetseng hantle ba ileng ba fumana tekanyetso ea letsatsi le letsatsi ea Clopidogrel 75 mg. Setlhare se ne se mamelletsoe hantle ke bakuli bohle.

Ka tšenyo e matla ea sebete ka lebaka la ho nka Clopidogrel ka tekanyetso ea 75 mg ka letsatsi bakeng sa matsatsi a 10, tekanyo ea thibelo ea methapo ea methapo ea methapo ea ADP e ne e tšoana le ea baithaopi ba phetseng hantle.Lihlopha tsena ka bobeli le tsona li ne li bapisoa le nako ea ho tsoa mali.

Ho ata ha li-alleles tsa mofuta oa CYP2C9 isoenzyme, tse ikarabellang bakeng sa metabolism e fokotsoang le e mahareng, li fapana pakeng tsa baemeli ba lihlopha tse fapaneng tsa morabe. Bakeng sa baemeli ba lebelo la Mongoloid, ho na le palo e nyane ea tlhaiso-leseling ea lingoliloeng e sa lumelleng tlhahlobo ea bohlokoa ba tlhahlobo ea CYP2C19 isoenzyme mabapi le nts'etsopele ea mathata a ischemic.

Ketso ea pharmacological

Karolo e sebetsang ea Lopirel ea lithethefatsi e khetha ho tlama molek'hule ea ADP ho li-receptor tse fumanehang ka holim'a liplatelete. Kahoo, ts'ebetso ea motsoako oa GPIIb / IIIa o kopantsoeng le liplatelete ha e khonehe. Clopidogrel e boetse e thibela mekhoa ea ho kopanya e hlahisoang ke bahanyetsi ba bang. Ho fihlela qetellong ea potoloho ea bophelo, liplatelete li lula li senyehile ebile li sa khone ho kopana.

Moriana o kenella ka potlako ka har'a tšilo ea lijo. Leha ho le joalo, mahloriso a Clopidogrel ho plasma a fokola haholo, ho amoheloa ke 50%. Setlhare se tlamahana le liprotheine tsa mali tsa mali.

Clopidogrel e ts'oaetsoa ka har'a sebete, hoo e ka bang 80% ea metabolites e fumanoang ka plasma ha e sebetse. Metabolite e sebetsang, e nang le phello e hlokahalang ea antiaggregatory, e thehoa ka karabelo ea oxidation, ka ho nka karolo ha cytochrome P450 isoenzyme 2B6 le 3A4. Metabolite ka boeona e kopana ka potlako le liplatelete 'me ha e bonoe ho plasma ea mali.

Bophelo ba halofo ke lihora tse 6 bakeng sa ntho e sebetsang le tse 8 bakeng sa metabolite ea eona e sa sebetseng. Lihlahisoa li hlahisoa haholo ka moroto le mantle.

Batho ba nang le bothata ba ho hloleha ho sebetsa hantle ba renal, ho fokotseha hoa katleho ea lithethefatsi ka 25% ha li bapisoa le batho ba phetseng hantle.

Litaelo tsa ho sebelisoa

Matlapa a Lopirel a lokela ho nooa ka molomo, ho sa tsotelehe lijo tse ngata.

Bakuli ba nang le lefu la ischemic / myocardial infarction kapa ba nang le lefu la ramatiki le lokela ho nka 75 mg hang ka letsatsi. Kamora ho hlaseloa ke pelo, kalafo e qala ho tloha matsatsing a pele mme e nka matsatsi a 35, mme kamora ho otloa ke stroke - ho tloha bekeng e le 'ngoe ho isa ho ea ho likhoeli tse 6.

Boteng ba lefu la ho hlobaela le ho hlohlona ntle le ho phahamisa karolo ea ST (ho kenyelletsa bakuli ba nang le khatello ea maikutlo nakong ea ho kenella hoa methapo ea methapo), kalafo e qala ka lethal dose ea 300 mg (tšebeliso e le 'ngoe), ebe ba fetohela ho 75 mg ka lihora tse 24 ka tekanyetso e le' ngoe. kaholimo ho 100 mg). Thupelo ena e fihla ho selemo se le seng.

Ka har'a acute coronary syndrome e nang le ST segmentation (hammoho le lintho tse ling tsa aspirin le thrombolytic), matlapa a beoa hanngoe ka tekanyetso ea 75 mg ka lihora tse 24 bakeng sa kopo e le ngoe le ts'ebeliso ea pele ea litekanyetso tsa ho jara (hang, ka thrombolytics le aspirin). Phekolo e qala kapele kamoo ho ka khonehang mme e ntse e tsoela pele khoeli e ngoe e le ngoe bonyane. Motsoako oa ho loants'a kamora lilemo tse 75 ha o sebelisoe.

Litlamorao

tsamaiso ea methapo ea kutlo le potoloho ea potoloho ea mali: hangata - eosinophilia, leukopenia, thrombocytopenia, ka seoelo neutropenia (ho kenyelletsa le neutropenia e matla), khaello e fokolang ea aplastic anemia, "thrombotic thrombocytopenic"
boits'ireletso ba mmele: Hoa tloaeleha haholo - liphetoho tsa anaphylactoid, bokuli ba serum, khafetsa ha li tsejoe - nts'etsopele ea maikutlo a amanang le hypersensitivity le thienopyridines (mohlala, ka ticlopidine le prasugrel),
tishu ea masculoskeletal le e sebetsang: hangata ha - ramatiki, hemarthrosis (hemorrhage tsamaisong ea masculoskeletal), myalgia, arthralgia,
tsamaiso ea methapo: hangata - ho tšoaroa ke hlooho, ho ruruha ha methapo ea methapo (tse ling tse nang le sephetho se bolaeang), ho tsekela kamehla, paresthesia, ka seoelo - litla-morao tsa tatso,
sesepa sa letlalo le subcutaneous: hangata - ho longoa, hangata - ho hlohlona, lekhopho, hangata, haholo - angioedema, mothous dermatitis (erythema multiforme, Stevens-Johnson syndrome, chefo e matla ea chefo e thibelang methapo, lefu la hypersensitivity, erythematic kapa exfoliative syrup lekhopho le matšoao a tloaelo le eosinophilia, urticaria, lichen planus, eczema,
pono: khafetsa - hemorrhages ea mahlo (litekeng tsa leihlo, conjunctiva, retina),
sebete le mokhoa oa ho ruruha: ka seoelo - hepatitis, ho hloleha ha sebete ka matla, ho hlekefetsoa hoa lithuto tsa laboratori ea boemo bo sebetsang ba sebete,
lithuto tsa lisebelisoa le tsa laboratori: khafetsa - ho fokotseha ha palo ea li-neutrophils, keketseho ea nako ea ho tsoa mali, ho fokotseha ha palo ea liplatelete,
mathata a teng sebakeng sa ente le mathata a akaretsang: khafetsa - ho tsoa mali ho tsoa sebakeng sa ho pola, ka seoelo - feberu,
ho utloa: ka seoelo - vertigo,
psyche: Ke ka seoelo - pherekano, hallucinations,
Phekolo ea ka mpeng: hangata lets'ollo, ho tsoa mali ka mpeng, ho opeloa ke mpa, bohloko ba ka mpeng, lefu la ka mpeng, ho nyekeloa, ho nyekelwa ke pelo, ho hlatsa, ho ruruha, ho ruruha, ka seoelo ho khutlisang mali, ho bolaoa ke mala ka mpeng, colitis (ho kenyeletsa le lymphocytic kapa ulcerative), pancreatitis, stomatitis,
Sistimi ea phefumoloho: khafetsa - nosebleeds, ka seoelo - bronchospasm, ho tsoa mali ho tsoa ho sistimi ea matšoafo (pulmonary hemorrhage, hemoptysis), pneumonia ea eosinophilic, pneumonitis ea ka mpeng,
liphio le pampitšana ea ho ntša metsi: hangata - hematuria, hangata - keketseho ea "choleineine" maling, glomerulonephritis,
methapo ea mali: khafetsa - hematomas, ka seoelo - ho tsoa mali ho tsoa leqebeng le sebetsang, ho tsoa mali haholo, ho fokotse khatello ea mali, vasculitis.

Litaelo tse khethehileng

Ho se sebetse ha sebete: ho isa tekanyong e lekanyelitsoeng - ka tlhokomeliso, ho matla - ho hanoa.

Mofuta o mongata o tšoauoa ka ho eketseha ha nako ea ho tsoa mali. Boemong bona, kalafo e kenyelletsa ho tšeloa mali ka bongata, hobane ha ho na litlhare.

Ho tlalehiloe ka maemo a phallo e matla ea mali nakong ea tšebeliso e tšoanang le Lopirel acetylsalicylic acid, hammoho le heparin.
Ho hloleha ha liphio: kalafo e etsoa ka masene ka tekanyo e itseng ea lefu.
Tlhokomeliso e bohlokoa ho bakuli ba kotsing ea ho tsoa mali ka mabaka a fapaneng kapa ba sebelisang meriana e itseng.
Ts'ebetsong ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea bongaka, ha ts'ebetso ea antiplatelet e sa ratehe, thupelo e emisoa beke e le 1 pele ho letsatsi la ho buuoa.
Bakuli ba lokela ho lula ba beiloe leihlo ho bona ho tsoa mali.
Lisebelisoa tsa ho tsamaisa le lisebelisoa tse thata: ha li amehe.
Clopidogrel e na le bokhoni ba ho thibela ts'ebetso ea CYP2C9 isoenzyme, kahoo ho na le monyetla oa keketseho ea khatello ea mali ea tolbutamide le phenytoin. Tsamaiso e tšoanang ea li-agents tsena le Lopirel e bolokehile.
Mokuli o lokela ho tseba hore nako ea ts'ebetso ea ho tsoa mali e eketseha haholo, kahoo ngaka efe kapa efe e lokela ho tseba kalafo.
Ho otla ka matla ke ischemic, sethethefatsi ha se khothalletsoe hore se sebelisoe (ka tlase ho beke ea 1).
Ka tlasa lilemo tse 18, moriana o thibetsoe.
Phekolo ea bakuli ba nang le infarction e mpe ea myocardial (le keketseho ea karolo ea ST), kalafo ha e qale matsatsing a 'maloa a qalang kamora lefutso la myocardial.

Maemong a tsoang mali, ts'ebetso ea mali le ea sebete e hlahlojoe.

Ho sebelisana le lithethefatsi

Moriana o ka kopantsoe le atenolol, phenobarbital, estrogens, cimetidine kapa nifedipine.

Ho pakoa hore tšebeliso ea letsatsi le letsatsi ea acetylsalicylic acid (ho fihlela ho 1000 mg ka letsatsi) le Clopidogrel ha e ame thepa ea motsoako. Leha ho le joalo, nako ea tšebelisano 'moho ea lithethefatsi tsena ha ea lokela ho feta selemo se le seng (tlhokomelo e lokela ho nkuoa).

Ha e kopantsoe le li-anticoagulants tsa molomo, haholo-holo warfarin, menyetla ea ho hlaha le nako ea ho tsoa madi e ka eketseha.
Ho kopantsoe ha sethethefatsi le thrombolytics ha ho khothaletsoe hape, kaha polokeho ea motsoako o joalo ha e thehwe ka nepo.
Leha ho na le litholoana tse ntle tsa lithuto tsa kliniki tsa ho sebelisana ha moriana le heparin, tlhokomeliso e lokela ho ba teng ha u li sebelisa ka nako e le ngoe.
Bathong ba leng kotsing e kholo ea ho tsoa mali le ho nka Lopirel, ha ho kgothaletsoe ho kenyelletsa le ho nka glycoprotein IIb / IIaa inhibitors.
Mohlomong motsoako oa sethethefatsi le digoxin, theophylline, antacids.

Lithethefatsi li thibela metabolism ea lithethefatsi tseo litekanyetso tsa pharmacokinetic li itšetlehileng ka CYP2C9 isoenzyme. Ka ho khetheha, moriana o ka eketsa khatello ea plasma ea phenytoin le tolbutamide. Tlhokomelo e tlameha ho nkuoa.

Ho pakoa hore ho kopana ha clopidogrel - naproxen ho eketsa menyetla ea ho tsoa mali ka mpeng. Leha ho le joalo, maemong a NSAIDs tse ling, mokhoa o joalo ha o so ka o netefatsoa. Ntlheng ena, ka motsoako oa lithethefatsi tsena o lokela ho ba hlokolosi.

Analogs of the drug Lopirel

Sebopeho se etsa qeto ea li-analogues:

Plavix,
Aggregal
Sylt,
Fluder,
Fagot,
Troken
Deplatt 75,
Thabeleng,
Detrombe
Plaglir,
Cardutol,
Targetek
Klopile,
Clapitax
Clopidogrel,
Lirta
Lethathamo la 75,
Egithromb,
Cardogrel
Lopirel
Plogrel,
Klopirel.

Sehlopha sa li-antiplatelet agents li kenyelletsa li-analogane:

E khoneha
Aggregal
Pentilin
Agrenox
Ayferol
Thabeleng,
Clopidogrel,
Clapitax
Cardutol,
Parcedil
Kopanya
Lirta
Agrilin,
Lopirel,
Tiklo
Aklotin,
Curantil
Troken
Pentomere
Persantine
Methylethylpyridinol,
Klopile,
TS'ELISO
Radomin
Brilinta
Fluder,
Targetek
Cardiomagnyl
Thamarkhotson,
Cardioxypine
Eifitol
Acetylsalicylic acid
Trental
Coplavix,
Vixipin
Agapurin
Doksilek,
Akonol,
E sebetsang
Emoxibel
Klopirel,
Alprostan,
Khaello
Ginkio
Aspinat
Colpharite
Ginos
Emoxipin
Ibustrin
Tiklid,
Mikristin
Fagot,
Pentoxifylline
Tagren
Plavix,
Cilostazol
Lethathamo la 75,
Monafram
Ka bomalimabe
Musiamo
Laspal
Ticagrelor,
Xanthinol Nicotinate,
Pentamon
Ralofect,
Cardogrel
Thrombital
Ventavis.

Bongata

Ka ho sebelisa lithethefatsi tse ngata, ho eketsoa ha nako ea ho tsoa mali le ho mpefala hoa boemo ho ka etsahala.

Phekolo - ho latela matšoao.

E khethehileng antidote moriana ha o na. Maemong a fetisisang, ho felisoa ha lithethefatsi ka ho tšela mokuli ho ka khoneha. boima.

Tšebelisano

Ha e kopantsoe le anticoagulants ea molomohaholoholo warfarin, monyetla oa ketsahalo le nako ea ho tsoa mali e ka eketseha.

Bathong ba nang le kotsi ea ho tsoa mali mme ba nka Lopirel, ha ho kgothaletswe ho eketsa glycoprotein IIb / IIІa inhibitors.

Motsoako o netefalitsoeng clopidogrel – naproxen e eketsa menyetla ea ho tsoa mali ka mpeng. Leha ho le joalo, molemong oa ba bang NSAIDs mokhoa o joalo ha o so ka o netefatsoa. Ntlheng ena, ka motsoako oa lithethefatsi tsena o lokela ho ba hlokolosi.

Ntle le litholoana tse ntle tsa lithuto tsa kliniki tsa ho sebelisana le lithethefatsi le heparin, nakong ea kamohelo ea bona ka nako e ts'oanang ho hlokahala hore ba be hlokolosi.

Motsoako oa lithethefatsi le thrombolytics, kaha polokeho ea motsoako o joalo ha e thehiloe hantle.

E tekanyetso ea ho ja letsatsi le letsatsi acetylsalicylic acid(ho fihlela ho 1000 mg ka letsatsi) le clopidogrel ha e ame tlatsetsa thepa ea lithethefatsi. Leha ho le joalo, nako ea tšebelisano 'moho ea lithethefatsi tsena ha ea lokela ho feta selemo se le seng (tlhokomelo e lokela ho nkuoa).

Lithethefatsi li thibela metabolism ea lithethefatsi, Raphaoping matšoao a itšetlehileng ka isoenzyme CYP2C9. Ka ho khetheha, moriana o ka eketsa mahloriso a plasma phenytoin le tolbutamide. Tlhokomelo e tlameha ho nkuoa.

Mohlomong motsoako oa lisebelisoa ka digoxin, theophylline, antacids.

Analogs Lopirela

Likhatiso tsa lithethefatsi: Clopidogrel, Avix, Atrogrel, Deplat, Zilt, Karum Sanovel, Clopidale, Klopikor, Lopigrol, Orogrel, Plavigrel, Plagril, Reodar, Tessiron, Trombone, Flamogrel 75, Aterocardium, Gridoklein, Deplatt, Hrendrendrendrendrendrendravrendravrendravrendravrendravrendravrendravrendravrevrendiavrevrendra Neo, Plavix, Platogril, Reomax, Trombeks.

Tekanyetso le tsamaiso

Bakeng sa thibelo ea mathata a ischemic ho bakuli kamora lefu la myocardial infarction, ischemic stroke le lefu le fumanehang le sa tsoa fumanoa, batho ba baholo (ho kenyeletsa le bakuli ba tsofetseng) ba fuoe 75 mg 1 nako / letsatsi, ho sa tsotelehe ho ja lijo. Phekolo e lokela ho qala ka nako ho tloha matsatsing a 'maloa ho isa matsatsing a 35 kamora ho ts'oaroa ke myocardial ka ho theha leqhubu la pathological Q le ho tloha matsatsing a 7 ho isa ho likhoeli tse 6 ka mor'a ho otloa ke ischemic.

Sebelisa ho batho ba baholo le bakuli ba tsofetseng ba nang le ts'ebetso e tloaelehileng ea CYP2C19 isoenzyme

Ka myocardial infarction, ischemic stroke, le lefu la pherekano ea methapo ea methapo, 75 mg ea Lopirel e beoa hanngoe ka letsatsi.

A a hlobaetsang le coronary syndrome ntle le karolo ea ST karolo ea (myocardial infarction ntle le Q wave, e sa tsitsang angina), kalafo e lokela ho qala ka tekanyo e le 'ngoe ea ho jarisa (300 mg), kamora 75 mg e beeloe hanngoe ka letsatsi (mmoho le tekanyetso ea letsatsi le letsatsi ea 75-25 mg acetylsalicylic acid ) Kaha tšebeliso ea lipalo tse phahameng tsa acetylsalicylic acid e eketsa menyetla ea ho tsoa mali, lethal dose ea acetylsalicylic acid e khothalletsoang ponts'o ena ha ea lokela ho feta 100 mg. Nako e nepahetseng ea kalafo ha e e-so fumanoe ka semmuso. Ho latela lithuto tsa tliliniki, moriana o lokela ho nooa ho fihlela selemo sa 1. Phello e ntle haholo ea melemo e bonoa ke likhoeli tse 3 tsa kalafo.

Ka acute coronary syndrome e nang le ST-segment elevation (acute myocardial infarction e tšoauoa ka ST-segment elevation), lethal dose ea 300 mg e beuoe hanngoe, e lateloe ke 75 mg hang ka letsatsi e kopane le acetylsalicylic acid (e kopantsoeng kapa e se nang thrombolytics). Phekolong ea bakuli ba lilemo li 75 le ho feta, kalafo ea Lopirel e lokela ho etsoa ntle le ho nka tekanyo ea ho jarolla. Phekolo ea ho kopanya e qala hang kamora ho qala matšoao ebe e nka libeke tse 4. Ho sebetsa hantle ha ho kopantsoe acetylsalicylic acid le clopidogrel le lipontšo tsena ho feta libeke tse 4 ha ho so ithutoe.

Ka fibrillation ea atrial (fibrillation ea atria), 75 mg ea Lopirel e beoa hanngoe ka letsatsi. Hammoho le clopidogrel, ts'ebeliso ea acetylsalicylic acid e lokela ho qala le ho tsoela pele (tekanyetso ea letsatsi le letsatsi ea 75-100 mg).

Haeba u fetoa ke tekanyetso e latelang ea Lopirel, u lokela ho latela likhothaletso tse latelang.

Haeba ho se ho fetile lihora tse 12 ka mor'a ho tlola lethal dose, o lokela ho nka tekanyetso ea Lopirel hang hang, 'me u noe litlhare tse latelang.
Haeba ho se ho fetile lihora tse 12 kamora ho tlola tekanyetso, tekanyetso e latelang ea Lopirel e lokela ho nkuoa ka mokhoa o tloaelehileng.

Likarolo tsa ts'ebeliso

Teko ea mali e lokela ho etsoa bekeng ea pele ea kalafo maemong a kopaneng a clopidogrel le acetylsalicylic acid, NSAIDs, heparin, IIb / IIIa glycoprotein inhibitors kapa fibrinolytics, hammoho le ho bakuli ba nang le kotsi e eketsehileng ea ho tsoa mali (likotsi, ho kenella ka tšebetso ea ho buuoa kapa maemo a mang a methapo ea methapo).

Ka lebaka la kotsi ea ho tsoa mali le litla-morao tsa hematological, haeba matšoao a kliniki a fanang ka tlhahiso ea sena a hlaha nakong ea kalafo, tlhahlobo ea mali (APTT, palo ea liplatele, liteko tsa tšebetso ea mosebetsi oa liplatelete) le ts'ebetso ea ts'ebetso ea sebete e lokela ho etsoa hang-hang.

Maemong a ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso, haeba phello ea anti-aggregation e sa lakatse, Clopidogrel e lokela ho khaoloa matsatsi a 7 pele ho buuoa.

Clopidogrel e lokela ho sebelisoa ka hloko ho bakuli ba nang le kotsi ea ho tsoa mali (haholo-holo gastrointestinal le intraocular).

Bakuli ba lokela ho lemosoa hore ba lokela ho tsebisa ngaka ka bothata bo bong le bo bong ba ho tsoa mali.

Ka lebaka la data e sa lekaneng, Clopidogrel ha ea lokela ho beoa nakong ea khatello ea methapo ea ischemic (matsatsing a 7 a pele).

Litlhokahalo tsa polokeho

E laetsoe ka hloko ho bakuli ba nang le monyetla oa ho tsoa mali (likotsi, ho kenella ka tšebetso ea ho buuoa, joalo-joalo) le ts'ebetso e matla ea mokokotlo oa mokokotlo le oa hepatic (hemorrhagic diathesis e ka hlaha).

Ts'ireletso le ho sebetsa hantle ho bakuli ba ka tlase ho lilemo tse 18 ha li e-so theoe.

Lithethefatsi li na le lactose, ka hona ha ea lokela ho nkuoa ke batho ba nang le lefutso la lactose.

Clopidogrel ke setlhare se fetolang phetoho ea metabolic e amang li-enzyme tse ngata tsa sebete. Ts'ebetso e ts'oanang ea lithethefatsi tse sitisang ts'ebetso ea enzyme ea sebete ea CYP2C19 e ka lebisa phetohong ea sebopeho sa metabolite e sebetsang, ka hona, ho fokotseha ha phello ea kalafo. Ho amoheloa ha li-clopidogrel le proton pump blockers ka linako tse fapaneng tsa letsatsi ha ho ame ntlafatso ea karabelo ea ts'ebelisano.

Tsamaiso e ts'oanang ea li-clopidogrel tse nang le li-blocker pump blockers li lokela ho laoloa, tseo ho nang le bopaki ba bokhoni ba tsona ba ho fokolisa ts'ebetso ea phekolo ea Clopidogrel, mohlala, omeprazole.

Haeba mokuli a hloka ho nka proton pump blockers ha a ntse a nka clopidogrel, lithethefatsi tsa sehlopha sena tse nang le bokhoni bo nyane ba ho bua li lokela ho beoa. E 'ngoe ea lithethefatsi tsena ke pantoprazole.

Lokolla liforomo le sebopeho

Setlhare se fumaneha litafoleng tse nang le karolo e le 'ngoe e sebetsang (clopidogrel hydrosulfate) le li-excipients tse se nang phello ea antiplatelet. Kakaretso ea motsoako oa mantlha ke 97.87 mg. Chelete ena e tšoana le 75 mg ea Clopidogrel. Matlapa a na le khetla e khethehileng, ka lebaka leo phello ea lithethefatsi e leng bonolo. Tabeng ena, ntho e sebetsang e lokolloa butle-butle, ho kenngoa hoa hlaha ka mpeng. Likarolo tse nyane:

crospovidone
lactose
phospholle cellulose,
glyceryl dibehenate
Opadry II 85 G34669 pinki,
talcum phofo.

Sephutheloana sena se na le matlapa a 14, 28 kapa 100.

Setlhare se fumaneha litafoleng tse nang le motsoako o le 1 o sebetsang.

Mofumahali

Moriana o qala ho nka bohato hang hang lebaleng la tsamaiso - kamora lihora tse peli ho na le phokotseho ea matla a ho kopana ha liplatelete. Ha tekanyetso e kholo e ntlafala. Ha matšoao a hlobaetsang a lefu lena a felisoa, tekanyo ea lithethefatsi ea fokotseha. Ka lebaka leo, kamora ho nka tekanyetso ea Lopirel ea tlhokomelo bakeng sa matsatsi a 4-7, tlhoriso e phahameng ea sethethefatsi sena e fihlelloa. Matla a fumanoang a bolokoa nako ea bophelo ea lisele tsa mali (matsatsi a 5-7).

Ho koaloa ha Clopidogrel ho potlakile, ha liprotheine tsa plasma li le holimo haholo (98%). Ho fetoha hoa ntho ena ho etsahala sebeteng. E bonoa ka mekhoa e 'meli: ka litekanyetso le tokollo e eketsehileng ea carboxylic acid (ha e bonts'e ts'ebetso), ka ho nka karolo ha cytochrome P450. Ts'ebetso ea ho tlama ho li-receptor tsa platelet e etsahala tlas'a tšusumetso ea metabolites.

Ho lokela ho hopoloa hore ho nka moriana ka tekanyetso e kholo (300 mg hang) ho lebisa keketseho e kholo ea khatello ea maikutlo. Boleng ba letšoao lena bo phahame habeli ho feta tekanyo e phahameng ea mahloriso maemong a ha litekanyetso tsa tlhokomelo li nkuoa matsatsi a 4.

Lintho tse hlahisoang ke motsoako oa lithethefatsi li hlaha ka liphio.

The excretion ea dintho tse fumanehang ka sebopeho sa moriana li etsahala ka liphio le mala (ka tekanyo e lekanang). Ts'ebetso ena ea lieha. Ho tlosoa ka botlalo ha lintho tse sebetsang hangata ho hlaha ka letsatsi la 5 kamora ho nka tekanyetso ea ho qetela ea Lopirel.

Ka tlhokomelo

Haeba ho etsoa opereishene, moriana ha o khethoe ka lebaka la kotsi ea ho tsoa mali. Maemo a mang a pathological a kenyelelitsoeng sehlopheng sa li-contraindication tse amanang:

maloetse ao menyetla ea ho tsoa mali e leng holimo haholo, mohlala, le ts'enyo ea litho tsa pono kapa seteraeke sa mpa,
nalane ea allergy ho thienopyridine.

Bakeng sa hemorrhage ea mokokotlo, ho nka Lopirel ho kopantsoe.
Lopirel e thibetsoe ho mpefatsa leqeba la peptic.
Ka tšenyo ea tšilo ea lijo, Lopirel e lokela ho nkuoa ka hloko.

Mokhoa oa ho nka Lopirel

Maemong a mangata, 0,075 g e behiloe hanngoe ka letsatsi. Litaelo tsa ho sebelisa lithethefatsi maemong a mang:

syndrome ea coronary e tsamaeang le ho phahama ha ST: ho 0,075 g ka letsatsi ho tloha ka letsatsi la bobeli, tekanyetso ea pele ke 0,3 g hang, nako ea kalafo ha e telele ho feta libeke tse 4, ts'ebetso ea bongaka ea kalafo e telele ha e so theoe,
coronary syndrome ntle le matšoao a ho phahamisoa ha ST: mohlala oa tšoana, empa nako ea thupelo e ka ba telele (ho fihlela likhoeli tse 12),
Fibrillation ea Atrial: 0,075 g, ka letsatsi.

Sebakeng ka seng, ts'ebeliso ea ASA e khothalletsoa. Leha ho le joalo, ho na le meeli: ha ho na ho feta 0,5 mg ka letsatsi.

Ho nka moriana oa lefu la tsoekere

Hoa amoheleha ho sebelisa pheko bakeng sa lefu le joalo, empa tlhokomeliso e lokela ho sebelisoa ka lebaka la lactose eo e leng karolo ea eona. Ntle le moo, khahlano le semelo sa lefu la tsoekere, menyetla ea ho tšoaroa ke lefu la stroke, myocardial infarction ea eketseha. Phekolo ea antiplatelet ke mohato oa bohlokoa kalafong ea lefu lena, ke feela moriana o ikemiselitsoeng ka bonngoe, o tsotella boemo ba 'mele.

Ho lumelletsoe ho sebelisa lithethefatsi bakeng sa lefu la tsoekere, empa u lokela ho ba hlokolosi ha u li sebelisa.

Phekolo ea ka mpeng

Ho tsitsa, bohloko bo ka mpeng, liphetoho sebopeng sa setulo se bonahala hangata, ho nyekeloa ke pelo. Hangata, nts'etsopele ea khoholeho ea ka mpeng e bonoa, ts'ebetso ea "stool" e thata, ho etsoa ha khase ho ea pele. Ka linako tse ling ho fumanoa leqeba, ho hlatsa hoa hlaha. Colitis le pancreatitis le tsona ha li sa tloaeleha.

Tsamaiso ea methapo e bohareng

Ho tsekela, ho opa hlooho, ho khathatsoa ke tatso, tahlehelo ea eona e felletseng. Ho ka hlaha lipono. Ho ferekana hoa letsoalo hoa tsebahala.

Nakong ea kalafo le Lopirel, ho nyekeloa le pelo le ho hlatsa li ka hlaha.
Ho kizungubetsa ke litlamorao ke lithethefatsi Lopirel.
Lopirel e ka baka hlooho.
Ha u ntse u nka Lopirel, bohloko ka mpeng bo ka hlaha.
Litlamorao tse ling tsa Lopirel ea lithethefatsi ke ponahalo ea hepatitis.
Letlalo la ho hlohlona ke litla-morao tsa Lopirel.
Hoaba ho ka hlaha nakong ea kalafo le Lopirel.

Lintho tse fapaneng tse tla etsahala

Ho latela litaelo, Lopirel 75 mg e na le lithibelo tse itseng mabapi le ho nka:

Eosinophilia (lefu leo ho lona ho nang le keketseho ea palo ea eosinophils).
Leukopenia (ho fokotseha ha palo ea lisele tse tšoeu tsa mali maling).
Thrombocytopenia (boemo bo khetholloang ka ho fokotseha ha palo ea liplatelete ka tlase ho tloaelehileng, e tsamaeang le ho tsoa mali le mathata a ho emisa ho tsoa mali).
Neutropenia (boemo bo fokotsehileng ba li-granulocytes tsa neutrophilic maling).
Herederal kapa e fumanoeng ea methapo ea mali ka lebaka la ts'enyo ea lisele tsa 'moko oa masapo.
Thrombotic thrombocytopenic purpura (lefu le kotsi le tsebahalang ka anemia ea microangiopathic hemolytic).
Tsietsing
Granulocytopenia (palo e tlaase ea lisele tse tšoeu tsa mali).
Boloetse
Intracranial hemorrhage.
Hemophilia e fumanoeng (lefu le sa tloaelehang la lefutso le amanang le ho ruruha ha tlhaho).
Karabelo ea Anaphylactoid.
Pherekano.
Khotso.
Migraine
Paresthesia (bothata ba ho hloka kutloelo-bohloko, bo tšoauoang ka ho itlhahisa ka mokhoa o itlhahelang feela oa ho hlaka le ho chesa hoa likhama).
Tlokotsi ea tatso.
Hemorrhage ea mahlo.
Hematomas.
Ho tsoa mali haholo.
Ho theola khatello ea mali.
Vasculitis (sehlopha sa maloetse a ipapisitseng le ts'oaetso ea methapo ea methapo ea mmele).
Epistaxis.
Bronchospasm (pathology e hlahang ha mesifa e boreleli ea bronchi e kenella mme lumen ea eona e fokotsehile).
Pulmonary hemorrhage.

Ho ea ka litaelo ho Lopirel, hoa tsebahala hore, ntle le litlamorao tse hlalositsoeng ka holimo, moriana o ka tsosa maikutlo a latelang a fosahetseng:

Pneumonia ea Eosinophilic (lefu leo ho lona li-eosinophils li bokellanang ka har'a pulmonary alveoli).
Letšollo (boemo ba kelello ba motho bo lahlela metsi kapele, athe setofo se fetoha metsi).
Interstitial pneumonitis (tšenyo ea matšoafo, eo ts'oaetso ea ho ruruha e amang interstitium).
Seso sa duodenal (seso se bakoang ke ketso ea acid le pepsin ho mucous membrane ea mucous ea duodenum ho batho ba nang le acidity e ngata).
Bloating.
Gastritis (lefu le sa feleng le khetholloang ka liphetoho tsa dystrophic le ho ruruha ho mucosa ea ka mpeng, le tsoa ka tlolo ea bocha).
Tšitiso ea kahare.
Ho khutlisa mali ho khutlisa.
Lefu la ho ruruha la colon mucosa.
Pancreatitis (e leng lefu leo ho lona ho ruruha makhopho a sefahleho).
Angioedema (boemo bo hlobaetsang bo khetholloang ke nts'etsopele e potlakileng ea edema ea lehae ea mucous, hammoho le lisele tsa subcutaneous le letlalo ka bolona).
Maqhubu a Nettle.
Ramatiki (lefu la manonyeletso, le tsamaeang le ho ruruha).
Hemarthrosis (hemorrhage e kopaneng ea patsi).
Arthralgia (bohloko bo kopaneng).
Hematuria (ho ba teng ha madi ka har'a moroto).
Glomerulonephritis (lefu la liphio le tšoauoang ke lesion ea glomeruli).

A na nka sebelisa lithethefatsi nakong ea kemolo?

Ho latela litlhahlobo tsa Lopirel, hoa tsebahala hore Clopidogrel ha e so ka e bonts'oa e na le litlamorao tse mpe ho ima le ho beleha, empa ka lebaka la tlhaiso ea tlhaiso-leseling ea bongaka, ho fana ka taelo ea hore lithethefatsi tsena li hatelloa ho basali ba baimana.

Nakong ea lithuto, ho ile ha fumaneha hore ntho e sebetsang le metabolites ea eona li fetela lebeseng la matsoele, ka hona, ho nyekeloa ho lokela ho emisoe nakong ea kalafo le moriana. Ha ho na tlhaiso-leseling mabapi le ho aroloa ha clopidogrel ka lebese la mme. "Lopirel" e kopantsoe le bana ba ka tlase ho lilemo tse leshome le metso e robeli.

Lopirel o na le lithethefatsi tse ling tse nkelang sebaka:

"Plagril."
Egithromb.
Plavix.
"Deplatt 75".
Detrombe.
Clapitax.
"Lenane la 75".
Zeke.
Avix.
"Orogrel".
Brilinta.
"Platogril."
Reomax.
"Medogrel".
Cardogrel.
Tessiron.
"Clorelo."
Klopikor.
Claridol
Gridoklein.

Pele o fetola ea mantlha ka analogue, etela setsebi sa bongaka.

Setlhare se fumaneha ka mokhoa oa matlapa, a koahetsoeng ka koae ea filimi. Li na le sebopeho se harelaneng, se biconvex, 'mala o pinki. Matlapa a kenngoe ka har'a lithutsoana tsa likotoana tse leshome. "Plagril" analogue of "Lopirel".

Lihora tse peli kamora ho nka tekanyetso ea pele - li-milligram tse makholo a mane - thibelo ea pokello ea liplatelete e bonoa. Phello e phahameng e fihlella kamora matsatsi a supileng, ka ts'ebeliso ea kamehla ea lithethefatsi ka tekanyetso ea li-milligram tse mashome a mahlano ho isa ho tse lekholo ka letsatsi.

Ho latela litaelo tsa tšebeliso le analogue ea Lopirel 75 mg, hoa tsebahala hore phello ea lithethefatsi e phela matsatsi a leshome. Kamora ho khaotsa ho phekoloa ka "Plagril" bakeng sa matsatsi a 5, nako ea ho tsoa mali le ho kopana ha liplatelete li khutlela boemong ba tsona ba pele. Moriba o thibela ponahalo ea atherothrombosis ho batho ba nang le lefu la vasheritis ea methapo.

Phekolo ea lithethefatsi e lokela ho khaotsa matsatsi a supileng pele ho ts'ebetso ea bongaka, eo ho eona antipatelet e sa sebetseng. Maemong ana, motho eo o lokela ho tsebisa ngaka ea litsebi ka bothata bofe kapa bofe ba ho tsoa mali nakong ea tšebeliso ea Plagril. Ntle le moo, haeba motho a lokela ho buuoa kapa ho fuoa moriana o mong, mokuli o boetse o lokela ho bolella ngaka ka tšebeliso ea Plagril. Nakong ea phekolo, ho hlokahala hore ho hlahlojoe ho sebetsa ha sebete.

Moriana o thusa ho fokotsa pente ea "platelet", e ts'oaroang ke lingaka tse ling tse thibelang ts'ebetso ea hae ka "adenosine diphosphate" e sebetsang.

Ho latela litaelo, analogue ea Lopirel e sebelisetsoa merero ea prophylactic ho thibela ho hlaha ha atherothrombosis:

Ho batho ba nang le bothata ba myocardial infarction, le ischemic stroke ka lesapo le fumanoeng la methapo ea methapo.
Bathong ba nang le lefu la ho hlobaela ka pelong,
Ho bakuli ba neng ba lula ba thothomela nakong ea mokokotlo oa coronary angioplasty.

Ho feta moo, Klopikor e khothalletsoa merero ea prophylactic ea thromboembolic, liketsahalo tsa atherothrombotic tse nang le fibrillation ea atria.

Ha u sebelisa moriana o noang ka li-milligram tse mashome a supileng a metso e mehlano ka letsatsi, thibelo ea bohlokoa ea liplatelese e etsoa ho tloha ka letsatsi la pele la kalafo. Matsatsing a supileng a tlang, ketso ena ea eketseha.

Khatello ea sebopeho sa liplatele ka ho lekana e atile liperesente tse mashome a mane ho isa ho tse mashome a tšeletseng (ha o sebelisa moriana ona ka bongata ba limiligrama tse mashome a supileng a metso e mehlano ka letsatsi). Kamora ho khaotsa ho tsoa mali, boemo ba liplatelete bo ile ba khutlela mehatong ea pele ea matsatsi a mahlano.

Ho latela maikutlo, analogue ea Lopirel 75 mg - Zilt e thusa ho thibela ho hlaha ha lefu la pelo kapa setorouku ho bakuli ba nang le lefu la methapo ea methapo.

Ntho e sebetsang e kenella ka potlako ka mor'a taolo ea molomo. Likahare tsa Clopidogrel li ajoa habeli ka makhetlo a 2,2,5,5 ka li-millilita (kamora ho kenella li-milligram tse mashome a supileng a metso e mehlano tsa moriana). Nako ea ho fihlela khatello e phahameng e ka ba metsotso e mashome a mane a metso e mehlano. Tekanyo ea ho amoheloa ha motsoako o sebetsang, ho latela tlhahisoleseling ea lihlahisoa tsa "metabolic" tsa sehlahisoa ke liphio, ke liperesente tse mashome a mahlano.

Ha ho kgothaletswe ho fana ka moriana o fuoang batho ba nang le lefu la sethoathoa haholo le khatello ea meriana e ka tlasa beke e le 'ngoe. "Zilt" e eketsa nako ea ho tsoa mali, sena se lokela ho tsotelloa ha se sebelisoa ka nako e le ngoe le "Aspirin", lithethefatsi tse seng khahlanong le ts'oaetso tsa "cell", Heparin "le" Warfarin ". Bakuli ba joalo ba lokela ho hlahlojoa bakeng sa kutloisiso e eketsehileng ea kutlo ea manane ho ticlopidine, prazogrel le thienopyridine e ngoe, hobane tšebeliso ea kutlo e eketsehileng pakeng tsa meriana ea sehlopha sena e ka khonahala.

Ha a supa nalaneng ea bongaka ea mokuli mabapi le kutloelo-bohloko e eketsehileng ho thienopyridine, o lokela ho shejoa ka hloko nakong ea kalafo ho khetholla matšoao a hypersensitivity ho karolo e sebetsang. Ha u lokisetsa mokuli bakeng sa ts'ebetso e reriloeng, tšebeliso ea lithethefatsi e lokela ho emisoa ka matsatsi a mahlano ho isa ho a supileng.

Motho o lokela ho lemosoa ka monyetla oa ho tsoa mali ka nako e telele nakong ea kalafo le ka tlhoko ea ho tsebisa setsebi sa bongaka ka nyeoe e 'ngoe le e' ngoe ea ho tsoa mali. Ha o buisana le lingaka tse ling, o lokela ho tlaleha ts'ebeliso ea "Zilt" kamehla, tlhaiso-leseling ena e bohlokoa ha o fana ka litlhare tse ncha le ha u etela ngaka ea meno.

Sena ke setlhare sa antithrombotic se sitisang mokgatlo wa liplatelete, se thibelang tšebetso ea ho hokahanya adenosine diphosphate le li-receptors tse ka har'a membrane ea platelet, hape e kenya tšebetsong li-glycoprotein receptors. "Reomax" e thusa ho fokotsa pokello ea liplatelete, e halefisoang ke agonists tse ling, e thibelang ts'ebetso ea bona ka adenosine diphosphate.

Sesebelisoa se sebetsang (clopidogrel) ka mokhoa o ikhethileng se tlama adenosine diphosphate le li-receptor tsa polasetiki, se sitisa mokgatlo oa tsona. Ho hokahana ka tsela e sa fetoheng le methapo ena ea methapo, ho etsa hore lisele tsa mali li sebetse ka linako tsohle tsa "bophelo" ba bona. Egithromb ke analogue ea matlapa a Lopirel.

Khatello ea mokhatlo e tsejoa kamora lihora tse peli, mme phello e kholo e shejoa kamora matsatsi a mahlano ho isa ho a supileng. Ha e ame tšebetso ea sehlopha sa li-enzyme tse fanang ka hydrolyze ea phosphodiester bond.

Boteng ba maloetse a boko a sa foleng, moo cholesterol le mafura a mang a behiloeng leboteng le kahare la methapo ka methapo le lipalo, mme mabota ka bo ona a fetoha a bobebe mme a lahleheloa ke matla a lona, moriana o thusa ho thibela thrombosis.

Setlhare se emela sehlopha sa lithethefatsi - li-antiplatelet agents. E sebelisoa ho thibela mathata a atherothrombotic lits'ebetsong tse fapaneng tsa pathological tsa lefu la pelo.

Motsoako o sebetsang oa matlapeng a Plavix ke clopidogrel. E thibela ts'ebetso ea liplatelete tsa gluing. Matla ana a tlhaho a hlaha ka lebaka la khatello ea mokokotlo ea ente ea adenosine diphosphoric acid ho lipheletso tse amanang le methapo ea methapo le ts'ebetso e latelang ea ts'ebetso ea tsona. Tšusumetso ena e etsahala bophelong bohle ba sethala (matsatsi a supileng ho isa ho a leshome), ka hona monyetla oa ho qalella hape ho kopana o hlaha feela kamora hore sele e nchafale.

Phello ea pharmacological ea Plavix e etsahala kamora phapanyetsano ea clopidogrel ka hara sebete, 'me ho hlahisoa sehlahisoa se sebetsang sa metabolic, se sitisang ts'ebetso ea ho khomarela liplatelete. Kamora ho qala ho sebelisa Plavix, ts'ebetso ea ts'ebetso ea anti-aggregation e etsoa matsatsi a mabeli ho isa ho a mararo ebe e fihla maemong a sa khaotseng.

Kamora ho khaotsa kalafo ea Plavix, ts'ebetso ea liplatelete e tsoela pele ka matsatsi a mahlano ho isa ho a supileng. Ho sebelisa moriana ho fokotsa haholo menyetla ea ho ba le ischemia ea "cerebral ischemia", le ho kenella ka har'a myocardial infraction ea methapo e fapaneng ea pelo le methapo ea mali, ho kenyelletsa le keketseho ea likonteraka tsa lefutso, tse eketsang menyetla ea likhahla tsa mali methapong ea tsona.

Lithethefatsi ke tsa sehlopha sa phekolo ea lithethefatsi - li-antiplatelet agents le li-anticoagulants. Brilinta e sebelisoa kalafong e rarahaneng ea maloetse a pelo, moo ho nang le kotsi e eketsehileng ea likhahla tsa mali kahare ho li-capillaries, tse ka lebisang ho otloa ke lefu la sethoathoa kapa lefu la myocardial.

Kamora ho sebelisa moriana, motsoako o sebelisang 'mele oa motsoako o kenella maling ho tsoa ka mpeng e nyane. Litaba tsa pharmacological maling li fihlella metsotso e mashome a mabeli ho isa ho e mashome a mararo kamora ts'ebeliso ea moriana, khatello e kholo e fihlelloa kamora hora e le 'ngoe le halofo.

Karolo e sebetsang e hasana ka kotloloho linthong tsohle tsa 'mele, e fetela ka har'a moko oa lithane tsa bokong le ho kenella kahara popelong ea "popelo" le kenang ka popelong le lebeseng. Ntho e sebetsang (ticagrelor) e fapanyetsana lisele tsa sebete, lihlahisoa tsa eona tse bolileng li pepesoa bile. Bophelo ba halofo ke lihora tse ka bang tse supileng.

Sebelisa ho bakuli ba nang le ketsahalo e fokotsehileng ea liphatsa tsa lefutso ea CYP2C19 isoenzyme

Ka ts'ebetso e tlase ea CYP2C19 isoenzyme, phello ea antiplatelet ea clopidogrel ea fokotseha. Ha u sebelisa litekanyetso tse phahameng (lethal dose ea 600 mg, mme joale ka 150 mg ka letsatsi letsatsi le letsatsi), phello ea antiplatelet ea clopidogrel ea eketseha. Ha re nahana ka liphetho tsa tlhahlobo ea lipatlisiso, ho ne ho sa khonehe ho theha mofuta o nepahetseng oa litekanyetso bakeng sa bakuli ba nang le metabolism e fokotsehileng ka lebaka la ts'ebetso e tlase ea CYP2C19 isoenzyme.

Sebelisa ho bakuli ba merabe e fapaneng

Bakeng sa baemeli ba merabe e fapaneng, ho ata ha li-gene tsa CYP2C19 isoenzyme, tse ikarabellang bakeng sa metabolism e fokotsitsoeng le e bohareng ea Clopidogrel ho metabolite e sebetsang, e fapana. Ho na le leseli le fokolang feela ka baemeli ba morabe oa Mongoloid mabapi le tlhahlobo ea kamano pakeng tsa CYP2C19 isoenzyme genotype le liphetho tsa kliniki.

Sebelisa ho banna le basali

Boithuto bo nyane bo bapisa likarolo tsa pharmacodynamic tsa Lopirel ka bong ka bobeli li bontsitse tekanyo e tlase ea thibelo ea tlatsetso ea methapo ea methapo ea ADP ho basali, empa ho ne ho sena phapang ea nako ea ho tsoa mali. Phuputsong e kholo e laoloang ea CAPRIE (motsoako oa clopidogrel le acetylsalicylic acid ho bakuli ba nang le menyetla ea ho eketseha ha mathata a ischemic) ho basali le banna, khafetsa liphetho tsa kliniki, liphapang tsa kliniki le tsa laboratori ho tloha ho tloaelehileng, le litlamorao tse ling li ne li tšoana.

Litlamorao

Ho ile ha etsoa thuto ea polokeho e amang bakuli ba fetang 44,000, ho kenyeletsoa bakuli ba fetang 12,000 ba neng ba phekotsoe bonyane selemo se le seng. Ho mamella ka kakaretso Clopidogrel ho tšoana le mamello ea acetylsalicylic acid, ho sa natse morabe, bong le lilemo tsa bakuli. Lithuto tse ngata tsa kliniki (CURE, CAPRIE, COMMIT, CLARITY, ACTIVE A) li hlahisitse litla-morao tse bohlokoa tse boletsoeng ka tlase.

Tekong ea CAPRIE, mamello ea clopidogrel (lethal dose ea letsatsi le letsatsi ea 75 mg) e tsamaisana le seo bakeng sa acetylsalicylic acid (lethal dose la letsatsi le letsatsi la 325 mg). Melaetsa e iketsahallang e na le tlhahisoleseling mabapi le karabelo e mpe.

Litekong tsa bongaka le ts'ebeliso ea morao tjena ea Clopidogrel, linyeoe tse atileng haholo tsa ho tsoa mali (haholoholo khoeling ea pele ea kalafo) li tlalehiloe.

Teko ea bongaka ea CAPRIE, tekanyo eohle ea ho tsoa mali ka ts'ebeliso e fapaneng ea Clopidogrel kapa acetylsalicylic acid e ne e le 9,3%. Ho tsoa madi ho hoholo ka clopidogrel ho ne ho tlalehiloe ka maqhubu a tšoanang le acetylsalicylic acid.

Litekong tsa bongaka tsa CURE tse sebelisang acetylsalicylic acid le clopidogrel matsatsi a 7 kamora hore methapo ea methapo ea methapo ea methapo e kenelle ka ho ikatisa ho bakuli ba emeng kalafo matsatsi a fetang a 5 pele ho ts'ebetso ea bongaka, keketseho ea khafetsa ea ho tsoa mali haholo ha ea ka ea bonoa. Ho bakuli ba ileng ba tsoela pele ho nka motsoako oa lithethefatsi tsena ka matsatsi a 5 pele ho qala ho kenella ka mokokotlong, ho lutla ho matla ho ile ha bonoa ka makhetlo a 9,6% (bakeng sa ho kopantsoe ha acetylsalicylic acid + clopidogrel) le 6.3% (bakeng sa ho kopantsoe ha acetylsalicylic acid + placebo).

Teko ea bongaka ea CLARITY e bontsitse keketseho e akaretsang ea tekanyo ea ho tsoa mali bakeng sa sehlopha sa acetylsalicylic acid + Clopidogrel ha se bapisoa le sehlopha sa acetylsalicylic acid + placebo. Ka lihlopha tsena ka bobeli, khafetsa ho tsoa mali haholo ho ne ho tšoana ebile ho batla ho ikemetse ka mofuta oa kalafo ea heparin kapa fibrinolytic le litšobotsi tsa pele tsa bakuli.

Teko ea bongaka ea COMMIT, liketsahalo tsohle tse amanang le ho ruruha ha methapo ea methapo ea pelo kapa hemorrhage e se nang kankere e ne e le tlase ebile li sa fapana ka lihlopha tsena ka bobeli.

Ka teko ea bongaka ea ACTIVE-A, monyetla oa ho tsoa mali haholo o ne o phahame ho sehlopha sa acetylsalicylic acid + Clopidogrel ho feta sehlopha sa acetylsalicylic acid + placebo (6.7% le 4.3%, ka ho latellana). Ha e le hantle, ho tsoa mali ho hoholo lihlopheng tsena ka bobeli e ne e le extracranial (5.3% le 3.5%, ka ho latellana), hangata ho tsoa mali ho ile ha ntlafala (3.5% le 1.8%, ka ho latellana). Sehlopheng sa acetylsalicylic acid + clopidogrel, li-hemorrhages tsa intracranial li ne li atile haholo ha li bapisoa le sehlopha sa acetylsalicylic acid + placebo (1.4% le 0.8%, ka ho latellana). Ho boetse ho ne ho se na phapang e kholo ea lipalo bakeng sa lihlopha tsena maemong a lefu la hemorrhagic (0.8% le 0.6%, ka ho latellana) le ho tsoa mali ho bolaeang (1.1% le 0.7%, ka ho latellana).

Lithutong tsa bongaka le ka litlaleho tse iphetotseng, ho tlalehiloe karabelo tse latelang tse bohloko:

tsamaiso ea methapo ea kutlo le potoloho ea potoloho ea mali: hangata - eosinophilia, leukopenia, thrombocytopenia, ka seoelo neutropenia (ho kenyelletsa le neutropenia e matla), khaello e fokolang ea aplastic anemia, "thrombotic thrombocytopenic"
boits'ireletso ba mmele: Hoa tloaeleha haholo - liphetoho tsa anaphylactoid, bokuli ba serum, khafetsa ha li tsejoe - nts'etsopele ea maikutlo a amanang le hypersensitivity le thienopyridines (mohlala, ka ticlopidine le prasugrel),
psyche: Ke ka seoelo - pherekano, hallucinations,
tsamaiso ea methapo: hangata - ho tšoaroa ke hlooho, ho ruruha ha methapo ea methapo (tse ling tse nang le sephetho se bolaeang), ho tsekela kamehla, paresthesia, ka seoelo - litla-morao tsa tatso,
pono: khafetsa - hemorrhages ea mahlo (litekeng tsa leihlo, conjunctiva, retina),
ho utloa: ka seoelo - vertigo,
methapo ea mali: khafetsa - hematomas, ka seoelo - mali a tsoang leqebeng le sebetsang, ho tsoa mali haholo, ho fokotse khatello ea mali, vasculitis,
Sistimi ea phefumoloho: khafetsa - nosebleeds, ka seoelo - bronchospasm, ho tsoa mali ho tsoa ho sistimi ea matšoafo (pulmonary hemorrhage, hemoptysis), pneumonia ea eosinophilic, pneumonitis ea ka mpeng,
Phekolo ea ka mpeng: hangata lets'ollo, ho tsoa mali ka mpeng, ho opeloa ke mpa, bohloko ba ka mpeng, lefu la ka mpeng, ho nyekeloa, ho nyekelwa ke pelo, ho hlatsa, ho ruruha, ho ruruha, ka seoelo ho khutlisang mali, ho bolaoa ke mala ka mpeng, colitis (ho kenyeletsa le lymphocytic kapa ulcerative), pancreatitis, stomatitis,
sebete le mokhoa oa ho ruruha: ka seoelo - hepatitis, ho hloleha ha sebete ka matla, ho hlekefetsoa hoa lithuto tsa laboratori ea boemo bo sebetsang ba sebete,
sesepa sa letlalo le subcutaneous: hangata - ho longoa, hangata - ho hlohlona, lekhopho, hangata, haholo - angioedema, mothous dermatitis (erythema multiforme, Stevens-Johnson syndrome, chefo e matla ea chefo e thibelang methapo, lefu la hypersensitivity, erythematic kapa exfoliative syrup lekhopho le matšoao a tloaelo le eosinophilia, urticaria, lichen planus, eczema,
tishu ea masculoskeletal le e sebetsang: hangata ha - ramatiki, hemarthrosis (hemorrhage tsamaisong ea masculoskeletal), myalgia, arthralgia,
liphio le pampitšana ea ho ntša metsi: hangata - hematuria, hangata - keketseho ea "choleineine" maling, glomerulonephritis,
lithuto tsa lisebelisoa le tsa laboratori: khafetsa - ho fokotseha ha palo ea li-neutrophils, keketseho ea nako ea ho tsoa mali, ho fokotseha ha palo ea liplatelete,
mathata a teng sebakeng sa ente le mathata a akaretsang: khafetsa - mali a tsoang setsing sa kotlo, ka seoelo - feberu.

Ho tsoa mali, mathata a hematological

Ha matšoao a kliniki a hlaha a bonts'a ho ba le phallo ea mali le kotsi ea ho ba le litlamorao tse sa batleheng, ho hlokahala hore ho etsoe tlhahlobo ea mali ka potlako, ho khetholla nako ea ts'ebetso ea karolo ea thromboplastin, palo ea mosebetsi oa liplatelete, le tšebetso e 'ngoe e hlokahalang.

Lopirel e lokela ho sebelisoa ka hloko ho bakuli ba nang le menyetla e eketsehileng ea ho tsoa mali e amanang le ts'ebetso ea ho buoa, likotsi, maemo a mang a methapo, le ho bakuli ba fumanang lithethefatsi tse seng tsa antiidalidal (haholo-holo, acetylsalicylic acid, heparin, COX-2 inhibitors, glycoprotein IIb / IIb / inhibitors IIIa kapa serotonin reuptake inhibitors tse khethiloeng).

Libekeng tsa pele tsa kalafo ea Lopirel le / kapa ka mora ts'ebetso e hlaselang ea pelo le ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso, ho lokela ho tsamaisoa ka hloko matšoao a ho tsoa mali, ho kenyeletsoa le morao.

Ka lebaka la keketseho e kholo ea matla a ho tsoa mali, ts'ebeliso e kopaneng ea Lopirel le warfarin ha e khothalletsoe. Mokhelo ke maemo a sa tloaelehang a kliniki: ho ba teng ha leqhubu le letšehali la mokokotlo o phaphametseng, ho hohelang ho bakuli ba nang le fibrillation ea atrial, jj.

Tabeng ea ts'ebetso e tlang e lokiselitsoeng ea ts'ebetso ea ts'ebetso ea ts'ebetso le ha ho se na tlhokahalo ea ho netefatsa phello ea antiplatelet, tsamaiso ea Lopirel e lokela ho emisoa matsatsi a 7 pele ho kenella.

Pele a qala meriana efe kapa efe e ncha le pele ho ts'ebetso e tlang, mokuli o lokela ho tsebisa ngaka (ho kenyeletsa le ngaka ea meno) ka ho nka Lopirel.

Lithethefatsi li eketsa nako ea ho tsoa mali, ka hona, e lokela ho sebelisoa ka hloko ho bakuli ba nang le mafu a rerileng ho tsoa mali (haholo-holo intraocular le gastrointestinal).

Mokuli o tlameha ho lemosoa hore haeba a ka nka Lopirel (ka monotherapy kapa ka ho kopana le acetylsalicylic acid), ho emisa ho tsoa mali ho hloka nako e eketsehileng. Haeba ho tsoa mali ka mokhoa o sa tloaelehang ho etsahala (ka ho phahama kapa ho etsa lehae), o lokela ho bona ngaka ea hau.

Thrombotic Thrombocytopenic Purpura (TTP)

Le kamora ho nka nako e khuts'oane ea clopidogrel, ho bile le maemo a sa tloaelehang a "thrombocytopenic" sebakeng sa "thrombocytopenia", "microangiopathic hemolytic anemia" e tsamaeang le ts'ebetso ea ho hlaka ea mokokotlo, feberu, mathata a methapo ea methapo. TTP e nkuoa e le ntho e ka behang bophelo kotsing e hlokang kalafo e potlakileng, ho kenyelletsa plasmapheresis.

Haemophilia e fumanehang

Nakong ea kalafo ka clopidogrel, linyeoe tsa hemophilia e fumanoeng li tlalehiloe. Ha o netefatsa nako e telele ea ho sebetsa ha a sa na mali, kapa o na le eona, o lokela ho nahana ka monyetla oa hemophilia e fumanoeng, mme haeba tlhahlobo e nepahetseng ea bongaka e ka emisoa, emisa ho nka Lopirel 'me u qale kalafo e lekaneng.

Haufinyane tjena ischemic stroke

Lopirel ha e khothalletsoe ha e fana ka maikutlo a hlobaetsang a ischemic a hlobaetsang ho fihlela matsatsi a 7 a fetileng ka lebaka la khaello ea data ts'ebeliso ea eona maemong ana.Phekolo ea ho kopanya le acetylsalicylic acid le clopidogrel ho bakuli ba nang le tlhaselo ea nakoana ea ischemic kapa stroke ea ischemic le menyetla e phahameng ea ho pheta-pheta liketsahalo tsa atherothrombotic ha e atlehe ho feta monotherapy e nang le clopidogrel, empa e na le kotsi e kholo ea ho tsoa mali.

Bokhachane le pelehi

Lithuto tsa liphoofolo ha lia senola phello e mpe le e sa tobang ea clopidogrel kholisong ea embryonic, ho ima, ho beleha bana, nts'etsopele ea kamora kotlo, empa ka lebaka la khaello ea tlhaiso-leseling e hlokahalang, ts'ebeliso ea Lopirel e hanyetsanoe ho bakuli ba baimana.

Nakong ea ho etsa lipatlisiso ka likhoto, ho ile ha fumaneha hore li-clopidogrel le metabolites ea tsona li fetela lebeseng, ka hona, maemong a kalafo le Lopirel, ho anyesa ho lokela ho emisoe. Ha ho na data mabapi le excretion ea clopidogrel ka lebese la matsoele a motho.