Mofumahali. Clopidogrel ka boikhethelo e thibela ho tlama ha adenosine diphosphate (ADP) ho li-receptor tsa eona tse holim'a liplatelete, e thibela ts'ebetso ea liplatelete mme ka hona e thibela ho kopana ha tsona. E boetse e thibela ho kopana ha liplatelete tse bakoang ke agonists tse ling. Ho thibeloa ha motsoako oa liplatelete ho bonoa lihora tse 2 kamora ho tsamaisoa ha molomo ka tekanyetso e le 'ngoe ea moriana. Ha u sebelisoa khafetsa, phello e ea matlafala, 'me boemo bo tsitsitseng bo fihlelleha kamora matsatsi a 3-7 a kalafo (boemo bo bohareng ba thibelo ea ho kopana ke 40-60%). Phatlalatso ea liplatelete le nako ea ho tsoa mali e khutlela metheong ka kakaretso matsatsi a 7 ka mor'a ho khaotsa lithethefatsi, ha liplatelese li nchafatsoa.
Mofumahali Kamora ho tsamaisoa ka molomo, sethethefatsi se kenella ka potlako mokokotlong oa lijo. Ho ts'oaroa ha eona ka plasma ea mali ha ho na letho mme kamora lihora tse peli kamora ts'ebeliso ha e khethoe (ka tlase ho 0,025 μg / l). Ka potlako biotransformed ka har'a sebete. Metabolite ea eona e ka sehloohong (85% ea motsoako o potolohang ka plasma ea mali) ha e sebetse. Metabolite e sebetsang ea thiol e tlama ka potlako le ka mokhoa o sa fetoheng ho li-receptor tsa liplatelete. Ka plasma ea mali ha e khethoe. Clopidogrel le metabolite ea mantlha e potoloha ka mokhoa o ikatileng ho li-protein tsa plasma.
Kamora ho tsamaisoa ka molomo, hoo e ka bang 50% ea lethal dose e nkuoeng e hlobolisoa ka har'a moroto le 46% metsong ka mor'a lihora tse 120 ka mor'a kopo. Bophelo ba halofo ea metabolite ea mantlha ke lihora tse 8.
Khatello ea metabolite ea mantlha ho plasma ea mali ho bakuli ba tsofetseng (ba lilemo li 75 le ho feta) e phahame haholo, leha ho le joalo, lintlha tse phahameng tsa plasma ha li tsamaisane le liphetoho tsa nako ea ho kopana ha liplakate le nako ea ho tsoa mali.

Tšebeliso ea lithethefatsi Atrogrel

Lithethefatsi li nooa ka molomo, letlapa le le leng (75 mg) nako e le ngoe ka letsatsi, ho sa tsotelehe lijo tse ngata.
Bakuli ba nang le hlobaetsang le coronary syndrome ntle le ho phahamisa karolo ST (e sa tsitsang angina kapa myocardial infarction ntle le leino la methapo Q. ho ECG) ka letsatsi la 1 la kalafo - matlapa a 4 (300 mg), ka matsatsi a latelang - Letlapa le le leng la 1 ka letsatsi, ho sa natsoe hore na o ja eng.
Nako ea kalafo e khethoa ke ngaka ho latela setšoantšo sa lefu lena.

Contraindication mabapi le ts'ebeliso ea lithethefatsi Atrogrel

Hypersensitivity ho lithethefatsi,
lefu le matla la sebete
ho tsoa mali ho hoholo (intracranial hemorrhage) le mafu a rerileng ho hola ka tsona (peptic ulcer of the tumbo and duodenum in the acute phase, nonspecific ulcerative colitis),
lilemo tse 18.

Litla-morao tsa lithethefatsi Atrogrel

Ho tsoa tsamaisong ea mali: leukopenia, ho fokotseha hoa palo ea li-granulocytes tsa neutrophilic le eosinophils, keketseho ea nako ea ho tsoa mali le ho fokotseha ha palo ea liplatelete. Ka seoelo: thrombocytopenic thrombohemolytic purpura, thrombocytopenia e matla, granulocytopenia, agranulocytosis, anemia le aplastic anemia / pancytopenia. Ho tsoa mali ka mekhoa e fapaneng ea lehae. Maemo a mangata a ho tsoa mali a ile a bonoa khoeling ea pele ea kalafo.
Ho tsoa pampiring ea ka mpeng: bohloko ba ka mpeng, dyspepsia, lets'ollo, seoelo - ho sokela, ho mpefatsa leqeba la ka mpeng le seso sa duodenal.
Ho tsoa tsamaisong ea musculoskeletal: ka seoelo - arthralgia, ramatiki.
Ho tsoa ts'ebetsong ea moroto: ka seoelo - glomerulonephritis, eketseha serumininine.
Ho tsoa ho tsamaiso ea methapo e bohareng: hlooho e opang, ho tsekela, parasthesia. Ke ka seoelo - pherekano, hallucinations, tlolo ea maikutlo a tatso.
Litla-morao: makhopho a letlalo, karabelo ea anaphylactoid.
Tse ling: ka seoelo - feberu.

Litaelo tse khethehileng bakeng sa ts'ebeliso ea lithethefatsi Atrogrel

Ka hloko, bakuli ba nang le monyetla oa ho tsoa mali ka lebaka la khatello ea maikutlo, ho kenella ha ts'ebetso ea ts'ebetso ea bongaka, le mathata a tsamaiso ea methapo. Ka ts'ebetso e reriloeng ea ho buoa (haeba phello ea antiplatelet e sa ratehe), nako ea kalafo ka sethethefatsi e lokela ho emisoa matsatsi a 7 pele a buuoa.
Ho fanoa ka temoso bakeng sa bakuli ba nang le ts'ebetso e matla ea sefuba e sa sebetseng hantle, eo ho ka hlaha li-hemorrhagic diathesis.
Phetoho ea mori ha e hlokoe ho bakuli ba tsofetseng, bakuli ba nang le bothata ba ho phekoloa ka methapo.
Bakuli ba lokela ho lemosoa hore kaha ho emisa ho tsoa mali ho etsahalang ka ts'ebeliso ea moriana ho hloka nako e eketsehileng, ba lokela ho tsebisa ngaka ka nyeoe e 'ngoe le e' ngoe ea ho tsoa mali e sa tloaelehang. Bakuli ba boetse ba lokela ho tsebisa ngaka ka ho nka moriana ona haeba ba entse opereishene (ho buoa, ho phekola meno, jj) kapa haeba ngaka e fa mokuli moriana o mocha.
Ha ho hlaha matšoao a ho tsoa mali ho hoholo (ho hlaka mali, ho ruruha, hematuria), ho bontšoa tlhahlobo ea system ea hemostatic (nako ea ho tsoa mali, palo ea liplatele, liteko tsa tšebetso ea mosebetsi oa liplatelete).
Ho khothalletsoa ho lekola khafetsa matšoao a laboratori ea ts'ebetso ea sebete.
PNako ea bokhachane le pelehi. Ts'ebeliso ea moriana nakong ea kemolo e kopantsoe.
Haeba ho hlokahala ho sebelisa moriana nakong ea lebone, ho anyesa ho lokela ho emisoa.
Bana. Tšireletseho le katleho ea lithethefatsi ho batho ba ka tlase ho lilemo tse 18 ha li e-so theoe.
Bokhoni ba ho susumetsa sekhahla sa karabelo ha u khanna makoloi kapa mekhoa e meng. Setlhare ha se ame bokhoni ba ho khanna likoloi ebile ha se fokotse lebelo la maikutlo a psychomotor.

Ho sebelisana le lithethefatsi Atrogrel

Clopidogrel e eketsa kotsi ea ho tsoa mali ka mpeng le NSAIDs.
Tšebeliso e nang le warfarin ha e khothalletsoe, kaha keketseho ea matla a ho tsoa mali e ka etsahala.
Ts'ebeliso le acetylsalicylic acid kapa heparin ha e ame phello ea antiplatelet ea lithethefatsi, leha ho le joalo, polokeho ea tšebeliso ea nako e telele ea metsoako e joalo ha e e-so ka e theoa, ka hona ts'ebeliso e tšoanang ea lithethefatsi tsena e hloka tlhokomeliso.
Ha e sebelisoa ka phenytoin le tolbutamide, keketseho ea boemo ba tsona maling a mali e ka etsahala. Leha ho le joalo, ts'ebeliso ea bona e kopaneng le clopidogrel e bolokehile.
Ho ne ho se na ts'ebelisano e kholo ea lithethefatsi ka li-diuretics, li-blockers tsa β-adrenoreceptor, li-inhibitors tsa ACE, li-blockchain tsa calcium, li-antacids, hypoglycemic, hypocholesterolemic le li-drug replacement, lithethefatsi tsa antiepileptic, phenobarbital, cimetidine, digoxin le theofininine le theofinine le theofininine.

Sehlopha sa mahlale

Li-antithrombotic agents. Khoutu ea PBX B01A C04.

Thibelo ea lipontšo tsa atherothrombosis:

• ho bakuli ba nang le infraction ea myocardial (ho qaleha ha kalafo ke matsatsi a 'maloa, empa ha ho sa feta matsatsi a 35 kamora ho qala), lefu la sechemic (ho qala ha kalafo ke matsatsi a 7, empa ha ho so fete likhoeli tse 6 kamora ho qala kapa ba fumanoeng methapo ea kutlo
• ho bakuli ba nang le a hlobaetsang le coronary syndrome:
• le acute coronary syndrome ntle le ST karolo ea phaellano (angina e sa tsitsang kapa infaration ea myocardial ntle le Q wave), ho kenyelletsa le ho bakuli ba neng ba e-na le stent e kentsoeng nakong ea percutaneous coronary angioplasty, hammoho le acetylsalicylic acid
• infarction ea hlobaetsang ea myocardial e nang le karolo e phahameng ea ST hammoho le acetylsalicylic acid (ho bakuli ba fumanang meriana e tloaelehileng le ba bontšitsoeng kalafo ea thrombolytic).

Thibelo ea liketsahalo tsa atherothrombotic le thromboembolic ho atraya fibrillation .

Clopidogrel e bontšoa hammoho le acetylsalicylic acid ho bakuli ba baholo ba nang le fibrillation ea atria moo ho nang le bonyane kotsi e le 'ngoe ea ho hlaha ha liketsahalo tsa vascular, contraindication bakeng sa kalafo le li-antagonists tsa Vitamin K (AVK), kotsi e tlase ea ho tsoa mali, bakeng sa thibelo ea liketsahalo tsa atherothrombotic le thromboembolic, ho ho kenyelletsa le stroke.

Tekanyetso le tsamaiso

Batho ba baholo le bakuli ba tsofetseng. Moriana o fuoa letlapa le le leng (75 mg) nako e le ngoe ka letsatsi, ho sa tsotelehe lijo tse ngata.

Ho bakuli le acute coronary syndrome ntle le ho phahamisa karolo ea ST (e sa tsitsang angina pectoris kapa infraction ea myocardial ntle le Q wave ho ECG), kalafo ka clopidogrel e qala ka tekanyo e le 'ngoe ea ho jarisa 300 mg, ebe e tsoela pele ka tekanyo ea 75 mg hang ka letsatsi (le acetylsalicylic acid (ASA) ka lethal dose ea 75-325 mg ka letsatsi. Kaha tšebeliso ea litekanyetso tse phahameng tsa ASA e eketsa menyetla ea ho tsoa mali, ho khothaletsoa hore e se ke ea feta tekanyo ea ASA 100 mg. Nako e nepahetseng ea kalafo ha e e-so theoe ka molao. Liphetho tsa lithuto li bontša tšebeliso ea moriana ona ho isa ho likhoeli tse 12, 'me phello e phahameng e ile ea bonoa kamora likhoeli tse 3 tsa kalafo.

Ho bakuli ka infarction ea hlobaetsang ea myocardial e nang le sekhahla sa ST clopidogrel e beoa 75 mg hang ka letsatsi, ho qala ka lethal dose le le leng la 300 mg hammoho le ASA, ka lithethefatsi tsa thrombolytic kapa ntle le tsona. Phekolo ea bakuli ba lilemo li 75 ho ea pele e qala ntle le tekanyetso ea ho jara ea Clopidogrel. Phekolo ea ho kopanya e lokela ho qaloa kapele ka mor'a ho qala ha matšoao mme e lokela ho tsoela pele bonyane libeke tse 4. Melemo ea ho sebelisa motsoako oa Clopidogrel le ASA bakeng sa libeke tse fetang tse 4 ka lefu lena ha e e-so ithutoe.

Clopidogrel e sebelisoa ka tekanyetso e le 'ngoe ea 75 mg ho bakuli ba nang le fibrillation ea atrial. Hammoho le clopidogrel, ts'ebeliso ea ASA (ka tekanyo ea 75-100 mg ka letsatsi) e lokela ho qala le ho tsoela pele.

Haeba u lahleheloa ke tekanyetso:

• haeba ho tloha nakong ea ha ho ne ho hlokahala hore u noe tekanyetso e latelang, nako e ka tlase ho 12:00 e fete, mokuli o lokela ho nka tekanyetso e lahlehileng hanghang, 'me tekanyo e latelang e lokela ho nkuoa ka nako e tloaelehileng.
• haeba ho se ho fetile 12:00, mokuli o lokela ho nka tekanyetso e latelang ka nako e tloaelehileng empa a se ke a eketsa lethalinyana ka makhetlo a mabeli ho fana ka tefo ea tekanyetso e lahlehileng.

Pharmacogenetics. Ho ata ha linyeoe tsa CYP2C19, tse bakang ts'ebetso ea methapo ea methapo ea CYP2C19, li fapana ho latela morabe / morabe. Mokhoa o nepahetseng oa litekanyetso ho batho ba nang le metabolism e fokolang ea CYP2C19 ha o e-so thehoe.

Bana. Tšireletseho le katleho ea Clopidogrel ho bana ha e so theoe, ka hona, lithethefatsi ha lia lokela ho sebelisoa ho bana.

Ho hloleha hape Phihlelo ea kalafo ea ho sebelisa lithethefatsi ho bakuli ba nang le bothata ba ho phekola ba renal e lekantsoe (bona karolo "likarolo tsa ts'ebeliso").

Ho hloleha ha sebete. Phihlelo ea kalafo ea tšebeliso ea lithethefatsi ho bakuli ba nang le mafu a lekaneng a sebete le monyetla oa hemorrhagic diathesis o lekantsoe (bona karolo "likarolo tsa ts'ebeliso").

Boikutlo bo fapaneng

Karabelo e atileng haholo e ne e le ho tsoa mali, e neng e atisa ho bonoa khoeling ea pele ea kalafo.

Mokhoa oa mali le lymphatic

• thrombocytopenia, leukopenia, eosinophilia,
• neutropenia, ho kenyelletsa neutropenia e matla,
• thrombotic thrombocytopenic purpura (TTP) (bona karolo "Peculiarities of use"), anemia ea aplasiki, parytopenia, agranulocytosis, thrombocytopenia e matla, granulocytopenia, anemia, hemophilia A.

sesole sa mmele

• serum syndrome, anaphylactoid / anaphylactic reaction,
• sefapano hypersensitivity lipakeng tsa thienopyridine (joalo ka ticlopidine, prasugrel) (bona karolo "likarolo tsa ts'ebeliso").

mathata a kelello

• hallucinations, pherekano.

tsamaiso ea methapo

• ho tsoa mali ka intracranial (maemong a mang, ho bolaea), hlooho e bohloko, paresthesia, ho tsekela
• phetoho molemong oa tatso.

Pathology ea litho tsa pono

• ho tsoa mali sebakeng sa leihlo (conjunctiva, sebonoang, retinal).

Pathology ea tsebe le labyrinth

mathata a methapo

• hematoma
• ho tsoa mali haholo, mali a tsoang leqeba le sebetsang, vasculitis, hypotension ea methapo.

Mathata a khalemelo, thoracic le mediastinal

• nosebleeds
• Ho tsoa mali ho tsoa pampiring ea matšoafo (hemoptysis, hemorrhage ea pulmonary), bronchospasm, pneumonitis e ka nako e telele, pneumonia ea eosinophilic.

Mathata a amanang le mala

• ho tsoa mali ka mpeng, lets'ollo, bohloko ba ka mpeng, dyspepsia
• seso sa ka mpeng le duodenal, gastritis, ho hlatsa, ho nyekeloa, ho ruruha, ho ruruha,
• hemoperhaena hemorrhage
• gastrointestinal le retroperitoneal hemorrhages tse nang le sephetho se bolaeang, pancreatitis, colitis (haholo-holo olcerative kapa lymphocytic), stomatitis.

hepatobiliary system

• ho hloleha ha sebete haholo, hepatitis, litholoana tse sa tloaelehang tsa matšoao a ho sebetsa ha sebete.

Letlalo le lisele tse nyane

• hemorrhage subcutaneous
• rash, ho hlohlona, ​​intradermal hemorrhage (purpura),
• oxous dermatitis, chefo e kotsi ea epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, angioneurotic edema, erythematous rash, urticaria, drug hypersensitivity syndrome, rash ea lithethefatsi eosinophilia le lipontšo tsa systemic (DRESS-lichen, eczema.

Sistimi ea musculoskeletal, connective le masapo a masapo

• musculoskeletal hemorrhages (hemarthrosis), ramatiki, arthralgia, myalgia.

Tsamaiso ea fig le tsamaiso ea mokokotlo

• hematuria
• glomerulonephritis, e leng tlhahiso ea creatinine maling.

boemo bo akaretsang

liteko tsa laboratori

• ho lelefatsa nako ea ho tsoa mali, ho fokotseha hoa palo ea li-neutrophils le liplatelete.

Sebelisa nakong ea bokhachane kapa leboteng

Ka lebaka la khaello ea tlhaiso-leseling ea ts'ebeliso ea Clopidogrel nakong ea kemolo, ha ho khothalletsoe ho fana ka litlhare ho basali baimana.

Ha ho tsejoe hore na Clopidogrel e qepiloe ka lebese la matsoele, ka hona, matsoele a lokela ho emisoa nakong ea kalafo le moriana.

Tšireletseho le katleho ea Clopidogrel ho bana ha e so theoe, ka hona, lithethefatsi ha lia lokela ho sebelisoa ho bana.

Likarolo tsa ts'ebeliso

Ho tsoa mali le mathata a hematological.

Ka lebaka la kotsi ea ho tsoa mali le maikutlo a mabe a hematological, tlhahlobo e qaqileng ea mali le / kapa liteko tse ling tse nepahetseng li lokela ho etsoa hang hang haeba matšoao a ho tsoa mali a shejoa nakong ea ts'ebeliso ea moriana. Joalo ka lisebelisoa tse ling tsa antiplatelet, clopidogrel e lokela ho sebelisoa ka hloko ho bakuli ba nang le menyetla e eketsehileng ea ho tsoa mali ka lebaka la ho sithabela maikutlo, ho buuoa kapa maemo a mang a methapo, hammoho le maemong a bakuli ba sebelisang acetylsalicylic acid (ASA), heparin, IIb / IIa glycoprotein inhibitors, kapa lithethefatsi tse seng tsa anti-antiidal. ho kenyelletsa li-inhibitors tsa COX-2. Hoa hlokahala ho hlokomela ka hloko lipontšo tsa matšoao a ho tsoa mali ho bakuli, ho kenyelletsa ho tsoa mali ho patehileng, haholo-holo libekeng tsa pele tsa kalafo le / kapa ka mor'a lits'ebetso tse hlaselang pelong le ts'ebetsong ea ho buuoa. Tšebeliso e tšoanang ea clopidogrel e nang le li-anticoagulants tsa molomo ha e khothalletsoe, hobane e ka eketsa matla a ho tsoa mali (bona Karolo "Ho sebelisana le lithethefatsi tse ling le mefuta e meng ea litšebelisano").

Tabeng ea ts'ebetso e reriloeng ea ho buoa, haeba phello ea antithrombotic e sa ratehe ka nakoana, kalafo e nang le clopidogrel e lokela ho khaotsa matsatsi a 7 pele ho buuoa. Bakuli ba lokela ho tsebisa lingaka le lingaka tsa meno hore ba nka Clopidogrel pele ho etsoa opereishene leha e le efe kapa pele ho sebelisoa moriana o mocha. Clopidogrel e eketsa nako ea ho tsoa mali, ka hona e lokela ho sebelisoa ka tlhokomeliso ho bakuli ba nang le kotsi e eketsehileng ea ho tsoa mali (haholo-holo gastrointestinal le intraocular).

Bakuli ba lokela ho lemosoa hore nakong ea kalafo ka clopidogrel (a le mong kapa e kopane le ASA), ho tsoa mali ho ka emisa kamora nako e tloaelehileng, hore ba hloka ho tsebisa ngaka ka nyeoe e 'ngoe le e' ngoe ea ho tsoa mali ka mokhoa o sa tloaelehang (ka sebaka kapa nako).

Thrombotic thrombocytopenic purpura (TTP).

Litaba tsa thrombotic thrombocytopenic purpura (TTP) ha li sa ka tsa bonoa haholo ka mor'a taolo ea clopidogrel, ka linako tse ling esita le ka mor'a tšebeliso ea eona ea nakoana. TTP e bonts'oa ke "anemia" ea "thrombocytopenia" le "hemangi" (hemangi). TTP ke boemo bo ka 'nang ba bolaea bo hlokang kalafo e potlakileng, haholo-holo plasmapheresis.

Tlaleho ea nts'etsopele ea hemophilia e fumanoeng kamora ts'ebeliso ea Clopidogrel e tlalehiloe. Maemong a keketseho e ikhethileng ea APTT (nako e sebelisitsoeng ea karolo ea thromboplastin), e tsamaeang le kapa e sa tsamaisane le ho tsoa mali, potso ea ho fumana hemophilia e fumanoeng e lokela ho nahanoa. Bakuli ba nang le ts'oaetso e netefalitsoeng ea hemophilia e fumanoeng ba tlameha ho ba tlasa tlhokomelo ea ngaka mme ba fumane kalafo, ts'ebeliso ea clopidogrel e lokela ho emisoa.

Haufinyane tjena o ile a tšoaroa ke lefu la ischemic.

Ka lebaka la data e sa lekaneng, ha ho kgothaletswe ho fana ka Clopidogrel matsatsing a 7 a pele ka mor'a ho otloa ke sethoathoa haholo.

Cytochrome P450 2 C19 (CYP2C19 ). Pharmacogenetics.

Bakuli ba nang le ts'ebetso ea liphatsa tsa lefutso tse fokotsang liphatsa tsa lefutso ba CYP2C19 ba na le khatello e tlase ea "metabolism" ea Clopidogrel le plasma e seng e boletsoeng ka mokhoa o fokolang, ho feta moo, ba na le mathata a pelo le ho feta kamora lefu la pelo le lengata ha le bapisoa le bakuli ba nang le ts'ebetso e tloaelehileng ea CYP2C19.

Kaha clopidogrel e tšelisoa pele ho thehoa metabolite ea eona e sebetsang ka karolo ea CYP2C19, ts'ebeliso ea lithethefatsi tse fokotsang ts'ebetso ea enzyme ena e kanna ea lebisa ho fokotseha ha khatello ea metabolite ea Clopidogrel e sebetsang ka plasma ea mali. Kaha bohlokoa ba bongaka ba ts'ebelisano ena ha bo so hlakisoe, tšebeliso ea lithethefatsi tse sitisang ts'ebetso ea CYP2C19 e lokela ho qojoa (bona Karolo "Ho sebelisana le lithethefatsi tse ling le mefuta e meng ea ts'ebetso").

Phapang e khutlelang pakeng tsa thienopyridine.

Bakuli ba lokela ho hlahlojoa bakeng sa nalane ea hypersensitivity ho li-thienopyridine tse ling (tse kang ticlopidine, prasugrel), kaha ho bile le litlaleho tsa tšebelisano lipakeng tsa thienopyridines (bona karolo "Karabelo e mpe"). Li-Thienopyridine li ka baka maikutlo a bobebe ho a kulang, a joalo ka lekhopho, "edema" ea Quincke, kapa karabelo ea hematologic, joalo ka thrombocytopenia le neutropenia. Bakuli ba kileng ba ba le nalane ea liphetoho tsa mmele le / kapa ho fetoha hoa hematologic ho thienopyridine e 'ngoe ba ka ba le kotsi e eketsehileng ea ho ba le karabelo e ts'oanang kapa e fapaneng le li-thienopyridine tse ling. Khothaletso ea ho shebella matšoao a hypersensitivity ho bakuli ba hanang mefuta e meng ea thienopyridines.

Ts'ebetso ea mokokotlo e sa sebetseng.

Phihlelo ea kalafo ea ho sebelisa Clopidogrel ho bakuli ba nang le ho se sebetse hantle ha methapo e fokola, ka hona, bakuli ba joalo ba laetsoe ka hloko (bona Karolo "Karolo le Tsamaiso").

Ts'ebetso ea sebete e sa sebetseng.

Phihlelo ea ho sebelisa lithethefatsi ho bakuli ba nang le mafu a leka-lekaneng a sebete le monyetla oa hemorrhagic diathesis li lekanyelitsoe. Ka hona, Clopidogrel e lokela ho fuoa bakuli ba joalo ka tlhokomeliso (bona Karolo "Karolo le Tsamaiso").

Setlhare se na le lactose. Bakuli ba nang le ts'oaetso ea lefutso ea galactose e fumanehang ka mokhoa o sa tloaelehang, khaello ea Lappase ea lactase, lefu la tsoekere la glucose-galactose ha lea lokela ho sebelisa lithethefatsi.

Setlhare sena se na le oli ea hydrogenated castor, e ka lebisang ho nyemeng le lets'ollo.

Haeba mokuli a lebetse ho nka tekanyetso ea moriana 'me e ka tlase ho 12:00 kamora moriana o reriloeng, moriana o lokela ho nooa kapele kamoo ho ka khonehang, ka mor'a moo tekanyo e latelang e lokela ho nkuoa ka nako. Haeba ho feta 12:00 ho se ho fetile, o lokela ho tlola ho nka tekanyo e sa lebelloang 'me u noe lethal dose le latelang ka nako. Ha ho amohelehe ho nka tekanyetso habeli ea moriana.

Nakong ea kalafo, ha ua lokela ho noa joala ka lebaka la menyetla e eketsehileng ea ho tsoa mali ka mpeng.

Boitlhokomelo bo ikhethileng ba ho lahla masalla le litšila. Sehlahisoa se seng le se seng se sa sebelisoeng kapa litšila se lokela ho lahloa ho latela litlhoko tsa lehae.

Ho sebelisana le lithethefatsi tse ling le mefuta e meng ea litšebelisano

Li-anticoagulants tsa molomo tšebeliso e tšoanang ea "clopidogrel" e nang le li-anticoagulants tsa molomo, ho kenyelletsoa le warfarin, ha e khothalletsoe, hobane motsoako o joalo o ka eketsa matla a tsoa mali.

Glycoprotein IIb / IIIa Inhibitors: clopidogrel e lokela ho sebelisoa ka hloko ho bakuli ba nang le menyetla e eketsehileng ea ho tsoa mali ka lebaka la likotsi, ts'ebetso, kapa maemo a mang a methapo eo ho eona ho sebelisang li-inhibitors tsa glycoprotein IIb / IIIa ka nako e tšoanang.

Acetylsalicylic acid (ASA): acetylsalicylic asiti ha e fetole phello ea ha e sa kopane le "" copidogrel "e amanang le methapo ea methapo ea methapo, empa" Clopidogrel "e ntlafatsa phello ea ASA ho kopaneng ea liphale tsa collagen. Leha ho le joalo, ts'ebeliso e le 'ngoe ea 500 mg ea ASA hang ka letsatsi ka letsatsi le le leng ha ea baka keketseho e kholo ea nako ea ho tsoa mali, e telele ka lebaka la clopidogrel. Kaha monyetla oa ho tsoa mali o ka khoneha, tšebeliso e tšoanang ea meriana ena e hloka tlhokomeliso. Leha ho le joalo, ho na le boiphihlelo ba ho sebelisa Clopidogrel le ASA hammoho ho fihlela selemo se le seng.

Heparin: Phuputsong e entsoeng le baithaopi ba phetseng hantle, tšebeliso ea clopidogrel ha e hloke phetoho ea tekanyetso ea heparin mme ha e fetole phello ea heparin ho coagulation. Tšebeliso e tšoanang ea heparin ha ea ka ea fetola phello ea inhibitory ea clopidogrel ho kopaneng ea platelet. Kaha tšebelisano ea pharmacodynamic pakeng tsa clopidogrel le heparin e ka etsahala ka kotsi e eketsehang ea ho tsoa mali, ts'ebeliso e tšoanang ea meriana ena e hloka tlhokomeliso.

Lithethefatsi tsa Thrombolytic: polokeho ea tšebeliso e kopaneng ea li-clopidogrel, fibrin-itseng kapa fibrin e ikhethang ea li-thrombolytic agents le heparin li ile tsa hlahlojoa ka ho nka karolo ha bakuli ba nang le infarction e mpe ea myocardial. Ts'ebetso ea ho tsoa mali ka mokhoa o ikhethang e ne e ts'oana le ts'oaetso e ileng ea bonoa ha ho ntse ho nkuoa li-antiges tsa thrombolytic le heparin le ASA.

Lithethefatsi tse sa sebetseng ka matla ho feliseng tšoaetso (NSAIDs): Phuputsong e entsoeng ho baithaopi ba phetseng hantle, tšebeliso ea nako e tšoanang ea Clopidogrel le naproxen li ekelitse palo ea ho tsoa mali ka mpeng. Leha ho le joalo, ka lebaka la khaello ea lithuto mabapi le tšebelisano ea lithethefatsi le li-NSAIDs tse ling, ha e e-so hlake, menyetla ea ho tsoa mali ka mpeng e eketseha ha o sebelisa Clopidogrel le li-NSAID tse ling. Ka hona, ho hlokahala tlhokomeliso ka tšebeliso e tšoanang ea NSAIDs, ho kenyelletsa li-inhibitors tsa COX-2, tse nang le clopidogrel.

Tšebeliso e tšoanang ea lithethefatsi tse ling: kaha Clopidogrel e qapiloe pele ho thehoa metabolite ea eona e sebetsang ka karolo ea CYP2C19, ts'ebeliso ea lithethefatsi tse fokotsang ts'ebetso ea enzyme ena e kanna ea fokotsa khatello ea "metabolite" e sebetsang ea Clopidogrel maling a mali. Bohlokoa ba ts'ebelisano ena ha bo hlake, ts'ebeliso e tšoanang ea lithethefatsi tse sitisang ts'ebetso ea CYP2C19 e lokela ho qojoa.

Lithethefatsi tse thibelang ts'ebetso ea CYP2C19 li kenyeletsa omeprazole, esomeprazole, fluvoxamine, fluoxetine, moclobemide, voriconazole, fluconazole, ticlopidine, ciprofloxacin, cimetidine, carbamazepine, oxcarbazepine le chloramphenicol.

Proton Pump Inhibitors (PPIs): katleho ea ketso ea antithrombotic ea clopidogrel e ka fokotsoa ke halofo ha e kopantsoe le PPI. Le ha tekanyo ea thibelo ea ts'ebetso ea CYP2C19 tlasa ts'ebetso ea lithethefatsi tse fapaneng tsa sehlopha sa PPI e sa tšoane, lithuto li bonts'a ho ba teng ha tšebelisano le baemeli bohle ba sehlopha sena. Maemong ana, ho se lumellane ho tsamaiso ea nako ha ho ame ho fokotseha ha katleho ea ts'ebetso ea clopidogrel. Ka hona, tšebeliso e tšoanang ea PPIs e lokela ho qojoa ntle le haeba ho hlokahala ka botlalo.

Bopaki ba hore lithethefatsi tse ling tse fokotsang tlhahiso ea acid ka mpeng, joalo ka

H 2 lithibelo (ntle le cimetidine e sitisang ts'ebetso ea CYP2C19) kapa antacid , ama mesebetsi ea antiplatelet ea clopidogrel, che.

Ho kopana le meriana e meng: Boithuto bo bongata bo mabapi le Clopidogrel le lithethefatsi tse ling bo ile ba etsoa ho ithuta tšebelisano-'ngoe ea pharmacodynamic le pharmacokinetic, e bonts'itseng hore ha ho sebelisoa Clopidogrel le:

• atenolol, nifedipine kapa ka lithethefatsi ka bobeli, ha ho na ts'ebelisano e kholo ea pharmacodynamic e fumanoeng,
• phenobarbital le estrogen ha ho na phello e matla ho pharmacodynamics ea clopidogrel,
• digoxin kapa theophylline: paracokinetic parameeter ha ea fetoha,
• antacid: ha ho na phello boemong ba ho amoheloa ha clopidogrel
• phenytoin le tobutamide: carboxyl metabolites ea clopidogrel e ka thibela ts'ebetso ea cytochrome P450 2C9, e ka eketsang maemo a plasma a lithethefatsi joalo ka phenytoin , tolbutamide le NSAIDs tse entsoeng ka 450 2C9. Empa leha ho le joalo, phenytoin le tolbutamide li ka sebelisoa ka mokhoa o sireletsehileng ka nako e le ngoe le clopidogrel,
• diuretics, β-blockers, inhibitors tsa ACE, bahanyetsi ba calcium, ba sebetsang ka k'holeseterole, li-vasodilators tsa coronary, baemeli ba hypoglycemic (ho kenyeletsa insulin), lithethefatsi tsa antiepileptic, kalafo ea phetoho ea li-hormone le GPIIb / IIIa bahanyetsi: lithutong tsa bongaka, ha ho litla-morao tse bohlokoa tse fumanoeng.

Litaelo tsa ho sebelisa Atrogrel

ntho e sebetsang: Clopidogrel,

Letlapa le le leng le na le "" "" "" "" "" "" "" "" "ho na le" "" "" "" "" Letlapa le 1 le na le "" "" "" "" "" "" "" "" "" "" Letlapa le 1 le na le "" "" "" "" "" "" "" "" "" "" "" "" "" "" "Letlapa le na le" "" "" "" "" "" "" "" "Letlapa le 1 le na le" "" "" "" "" "" "" "" "" "" "" Clopidogrel "-" "" "" "" "Clopidogrel bisulfate"

Baeti: croscarmellose sodium, microcrystalline cellulose, lactose, oli ea hydrogenated castor,

membrane ea filimi: hypromellose, lactose, titanium dioxide (E171), triacetin, carmine (E120).

Thibelo ea lipontšo tsa atherothrombosis: ho bakuli ba kileng ba tšoaroa ke lefu la myocardial (ho qala kalafo ke matsatsi a 'maloa, empa ha ho sa feta matsatsi a 35 kamora ketsahalo), lefu la ischemic (ho qala ha kalafo ke matsatsi a 7, empa ha ho sa feta likhoeli tse 6 kamora ketsahalo) ba fumanoeng ba na le lefu la ho ruruha ha methapo ea methapo, le ho bakuli ba nang le lefu la ho hlobaela le honyenyane: ba nang le lefu la ho hlobaela le honyenyane ntle le ST wave elegment (angina e sa tsitsang kapa myocardial infarction ntle le Q wave), ho kenyeletsoa le ho bakuli ba fumanoeng ba na le nt nakong percutaneous transluminal gogoga angioplasty, hammoho le asiti acetylsalicylic, le a hlobaetsang le infarction myocardial le ST karolo bophahamo hammoho le asiti acetylsalicylic (bakuli fumana meriana maemo a le eo thrombolytic phekolo).

Thibelo ea liketsahalo tsa atherothrombotic le thromboembolic ho atraya fibrillation.

Clopidogrel e bontšoa hammoho le acetylsalicylic acid ho bakuli ba baholo ba nang le fibrillation ea atria moo ho nang le bonyane kotsi e le 'ngoe ea ho hlaha ha liketsahalo tsa vascular, contraindication bakeng sa kalafo le li-antagonists tsa Vitamin K (AVK), kotsi e tlase ea ho tsoa mali, bakeng sa thibelo ea liketsahalo tsa atherothrombotic le thromboembolic, ho ho kenyelletsa le stroke.

Atrogrel ea lithethefatsi: litaelo tsa tšebeliso

Atrogrel ke lithethefatsi tse nang le phello ea antiplatelet. E sebelisetsoa ho phekola le ho thibela ho nyekeloa ke pelo ha mantlha, ho hlaseloa khafetsa ka pel'a lefutso. Setlhare sena se thusa ho felisa khatello ea methapo ea methapo ka lebaka la lintho tse bonoang ke clopidogrel ho thibela lintho tse ngata tse amanang le mokokotlo. Ho bohlokoa ho nahana hore nakong ea kalafo, nako ea ho emisa ho tsoa mali e eketseha.

Mofumahali

Kamora ho tsamaisoa, sethethefatsi se kenngoa ka potlako ho tsoa mokokotlong oa mpa. Ts'oarello ea plasma ea mali ha e tsotelle le ka mor'a 2:00 kamora ts'ebeliso ha e e-so tsejoe (ka tlase ho 0,025 mcg / l). Ka potlako biotransformed ka har'a sebete. Metabolite ea eona e ka sehloohong (85% ea potoloho ea potoloho ea plasma) ha e sebetse. Metabolite e sebetsang ea thiol e tlama ka potlako le ka mokhoa o sa fetoheng ho li-receptor tsa liplatelete. Ka plasma ea mali, ha e fumanoe. Clopidogrel le metabolite ea mantlha e potoloha li khutlela ho liprotheine tsa plasma.
Kamora ho nka, 50% ea lethal dose e nkuoeng e hloelisoa ka har'a moroto le 46% metsong ka mor'a lihora tse 120 ka mor'a kopo. Bophelo ba halofo ea metabolite ea mantlha ke 8:00.
Ho bokellana ha metabolite ea mantlha ho plasma ho bakuli ba tsofetseng (ba lilemo li 75 le ho feta) ho phahame haholo, leha ho le joalo, lintlha tse phahameng tsa plasma ha li tsamaisane le liphetoho tsa nako ea platma le nako ea ho tsoa mali.

Lokolla liforomo le sebopeho

Setlhare se entsoe ka foromo ea lipilisi. Yuniti ea lithethefatsi e koahetsoe ka bosoeu ba filimi. Letlapa le le leng le na le 75 mg ea motsoako o sebetsang - Clopidogrel bisulfate. Likarolo tse ling li kenyelletsa:

• phospholle cellulose,
• hydrogenated castor oli,
• tsoekere ea lebese
• sodium croscarmellose.

Khetla e kantle e na le carmine, hypromellose, tsoekere ea lactose, titanium dioxide, triacetin.

Setlhare se entsoe ka foromo ea lipilisi. Letlapa le le leng le na le 75 mg ea motsoako o sebetsang - Clopidogrel bisulfate.

Ketso ea pharmacological

Lithethefatsi li thibela ho tlangoa ha adenosine diphosphate ho li-receptor tse tsamaellanang le mokokotlo oa mokokotlo, ka lebaka leo ts'ebetso ea liplatelete tsa mali e fokotsehang. Ka lebaka la ts'ebetso ea clopidogrel, pokello ea liplatele le ho khomarela li fokotsehile, li hlahisoa ka tlhaho kapa li susumetsoa ke tšusumetso ea meriana e meng. Tšusumetso ea kalafo e tlalehiloe lithutong tsa laboratori lihora tse 2 kamora ho tsamaisoa ha moriana ka molomo.

Ka tšebeliso ea bobeli, phello ea lithethefatsi e ntlafatsoa le ho tloaela maemo feela kamora matsatsi a 3-7 a kalafo ea lithethefatsi. Ka nako e ts'oanang, thibelo e tloaelehileng ea platelet aggregation e fihla ho 45-60%.Phello ea kalafo e tsoela pele beke kaofela, kamora moo bongata ba liplatelete tsa mali le tšebetso ea serum li khutlelang litekanyetsong tsa tsona tsa pele. Sena se bakoa ke nchafatso ea lisele tsa mali (bophelo ba liplatele ke matsatsi a 7).

Ho thusang?

Moriana o sebelisoa e le mokhoa oa ho thibela kalafo ea atherothrombosis ho bakuli ba baholo le ho felisa maemo a latelang.

• mafu a methapo ea methapo ea methapo nakong ea nts'etsopele ea methapo ea methapo ka lebaka la atherothrombosis lipheletsong tse tlase,
• acute coronary syndrome khahlano le ho otla ha pelo ka ho se be le maqhubu a Q ho electrocardiogram (ECG) kapa boteng ba angina e sa tsitsang.
• Thibelo ea inflation ea bobeli ea myocardial le ho potlakisa ho hlaphoheloa ha mesifa ea pelo (moriana o sebelisitsoeng ha o sa fetile matsatsi a 35 kamora ho hlaha hoa lefu la pelo),
• thibelo ea lefu la tšohanyetso la coronary,
• infarction e mpe ea myocardial ha o phahamisa karolo ea ST ho ECG ka kalafo e bolokang methapo e nang le acetylsalicylic acid,
• ischemic stroke ho qaleha ha kalafo kamora matsatsi a 7 (eseng kamora likhoeli tse 6) ho tloha nts'etsopele ea methapo.

Moriana o sebelisoa e le mokhoa oa ho thibela kalafo ea atherothrombosis ho bakuli ba baholo.
Hape, lithethefatsi li sebelisoa ho thibela infarction ea myocardial ea bobeli.
Atrogrel e fuoe bakuli bakeng sa thibelo ea lefu la tšohanyetso la coronary.
Tšoaetso ea ts'ebeliso ea lithethefatsi ke lefu la ischemic qalong ea kalafo kamora matsatsi a 7 (eseng kamora likhoeli tse 6) ho tloha ntlafatsong ea methapo ea mafu.

Setlhare sena se sebelisetsoa ho thibela ho hlaha ha boemo ba atherothrombotic le blockage (embolism) ea lumen ea sekepe ke thrombus nakong ea atrose fibrillation. Boemong bona, ho khothalletsoa ho sebelisa kalafo ea ho kopanya ea acetylsalicylic acid e nang le clopidogrel.

Ka tlhokomelo

Ho hlokomelisoa bakuli ba kotsing e kholo ea ho tsoa mali ka lebaka la khatello ea maikutlo, ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso le ho se leka-lekane litekong tsa acid ea mmele. Ho amoheloa ha Atrogrel ha ho ratehe ho bakuli ba nang le ts'ebetso e fosahetseng ea sebete, hobane ho na le kotsi ea ho ba le hemorrhagic diathesis.

Moriana ha o fuoe ts'ebetso ea methapo e matla ea sebete.
Atrogrel ha e sebelisoe bakeng sa lcerative elrosive lesions ea mala le duodenum sethaleng se matla.
Setlhare ha se khothalletsoe ho nooa nakong ea ho anyesa le basali baimana.
Ho eletsoa ho bakuli ba kotsing e kholo ea ho tsoa mali.

U ka nka Atrogrel joang?

Setlhare sena se etselitsoe ho tsamaisoa ka molomo, ho sa tsotelehe ho ja lijo tse ngata. Tekanyetso e tloaelehileng ea letsatsi le letsatsi ke 75 mg hang. Bakuli ba nang le lefu la methapo ea methapo ea pelo le methapo e sa sebetseng, angina e sa tsitsang le myocardial infarction ba khothalletsoa ho nka 300 mg ea moriana ka letsatsi la pele - matlapa a 4. Litekanyetso li latelang ke tse tloaelehileng.

Nako ea thupelo e khethoa ke ngaka e eang ka bonngoe, ho latela setšoantšo sa kliniki ea ts'ebetso ea methapo ea methapo. Phekolo ea ho kopanya le meriana e meng e fanoe kapele kamoo ho ka khonehang. Nako e phahameng ea kalafo ke libeke tse 4.

Litla-morao tsa Atrogrel

Boitšoaro bo bobe bo tsoang ho litho le lits'ebetso li ba teng maemong a mangata haeba mokuli a e-na le tšekamelo ea ho se sebetse hantle ha litho kapa ha matlapa a nkuoa hampe.

Setlhare sena se etselitsoe ho tsamaisoa ka molomo, ho sa tsotelehe ho ja lijo tse ngata.
Bakuli ba nang le lefu la methapo ea methapo ea pelo le methapo e sa sebetseng, angina e sa tsitsang le myocardial infarction ba khothalletsoa ho nka 300 mg ea moriana ka letsatsi la pele - matlapa a 4.
Litsebi tsa lefu la tsoekere ha li hloke ho fetola mofuta oa kalafo le sethethefatsi.

Hematopoietic litho tsa ka hare

Palo ea lintho tse thehiloeng maling e ea fokotseha, tlhahiso ea li-leukocytes le eosinophilic granulocytes ea senyeha. Nako ea ho emisa ho tsoa mali e ea eketseha. Thrombocytopenic purpura, phokolo ea mali, thrombocytopenia le agranulocytosis li ka hlaha ka ts'ebetso ea hematopoietic system.

Bakuli ba hlokomela nts'etsopele ea ho tsoa mali ka mor'a khoeli ea kalafo ea lithethefatsi.

Tsamaiso ea methapo e bohareng

Ka phello e chefo ea lithethefatsi tsamaisong ea methapo, hlooho ea hlooho, ho tsekela le ho felloa ke matla a kutlo. Maemong a sa tloaelehang, tahlehelo ea taolo ea maikutlo, ho ferekana kelellong, pherekano le ho felloa ke kelello, ho utloahala ho utloisang bohloko ho ka etsahala.

Litla-morao tsa Atrogrel tsamaisong ea musculoskeletal li bonahala ka mokhoa oa bohloko mesifa le manonyeletso.
Ha litla-morao tsa lithethefatsi li ka hlaha.
Ka tšebeliso ea nako e telele ea lithethefatsi, ho hema ka thata le ho opeloa ke 'metso.

Matšoao a ho sebelisoa

Lithethefatsi Atrogrel E sebelisoa ho thibela lipontšo tsa atherothrombosis ho bakuli ba kileng ba tšoaroa ke lefu la myocardial (ho qala kalafo ke matsatsi a 'maloa, empa ha ho sa feta matsatsi a 35 kamora ketsahalo), lefu la ischemic (ho qala ha kalafo ke matsatsi a 7, empa ha ho sa feta likhoeli tse 6 kamora ketsahalo) kapa ba fumanoang ba e-na le lefu la ho ruruha ha methapo
Ho bakuli ba nang le a hlobaetsang le coronary syndrome:
-e nang le acute coronary syndrome ntle le ST karolo ea phaellano (angina e sa tsitsang kapa infyction ea myocardial ntle le Q wave), ho kenyelletsa le ho bakuli ba nang le stent e kentsoeng nakong ea percutaneous coronary angioplasty, hammoho le acetylsalicylic acid
- infarction ea hlobaetsang myocardial e nang le karolo e phahameng ea ST hammoho le acetylsalicylic acid (ho bakuli ba fumanang meriana e tloaelehileng le ba bontsitsoeng kalafo ea thrombolytic).
Thibelo ea liketsahalo tsa atherothrombotic le thromboembolic ho atraya fibrillation.
Clopidogrel e bontšoa hammoho le acetylsalicylic acid ho bakuli ba baholo ba nang le fibrillation ea atria moo ho nang le bonyane kotsi e le 'ngoe ea ho hlaha ha liketsahalo tsa vascular, contraindication bakeng sa kalafo le li-antagonists tsa Vitamin K (AVK), kotsi e tlase ea ho tsoa mali, bakeng sa thibelo ea liketsahalo tsa atherothrombotic le thromboembolic, ho ho kenyelletsa le stroke.

Ho tsoa ho tsamaiso ea methapo ea pelo

Ka phello e chefo ea lithethefatsi tsamaisong ea mali, ho bonahala tachycardia, ho senyeha ha methapo ea mokokotlo le bohloko sefubeng.

Ka phello e chefo ea lithethefatsi tsamaisong ea potoloho ea mali, tachycardia e hlaha.
Ka nts'etsopele ea litla-morao mokhoeng oa ka mpeng, ho fokotseha ha takatso ea lijo hoa khoneha.
Bakuli ba bangata ba na le urticaria, rashes.

Ho tloha ka lehlakoreng la metabolism

Setlhare ha se na phello e tobileng ho metabolism, empa ka nts'etsopele ea litla-morao ka mpeng ea gastrointestinal, ho fokotseha ha takatso ea lijo ho ka etsahala.

Ho bakuli ba reriloeng pele ho nts'etsopele ea karabelo ea anaphylactoid, maemong a sa tloaelehang ho na le kotsi ea ho thothomela ha anaphylactic, edema ea Quincke, feberu ea lithethefatsi. Boholo ba bakuli ba na le marikhoe, makhopho le letlalo le boreleli.

Tekanyo ea joala

Nakong ea phekolo ea lithethefatsi, ha ho khothalletsoe ho noa lino tse tahang. Joala ba Ethyl bo mpefatsa boemo ba methapo ea methapo le methapo ea pelo, bo eketsa menyetla ea litla-morao mokoping oa lijo le ho lelefatsa nako ea ho tsoa mali. Ethanol e ka baka liso tsa marako a mpa.

Sebelisa nakong ea bokhachane le pelehi

Setlhare sena se kopantsoe hore se sebelisoe ke basali ba baimana, hobane Clopidogrel e ka sitisa ho beoa ha litho le lits'ebetso nakong ea nts'etsopele ea embryonic kapa ea eketsa monyetla oa ho tsoa mali nakong ea pelehi, e leng se bakang boemo bo boima bophelong ba mme.

Lithethefatsi li kopantsoe le litšoelesa tsa mammary le ho pepesetsoa ka lebeseng la matsoele, ka hona, nakong ea kalafo le Atrogrel, ho khothaletsoa ho emisa matsoele.

Phetoho ea lethal dose bakeng sa senya ea meno ha e hlokahale.

Tekanyetso e fetelletseng ea Atrogrel

Ka tšebeliso e mpe ea lithethefatsi, nts'etsopele ea maikutlo a mabe kahara tšilo ea lijo (maqeba a ho ruruha a lcerative, bohloko sebakeng sa epigastric, letšollo le ho hlatsa, hemorrhage kahara litho tsa mokokotlo oa mpa) le nako ea nako e telele ea ho tsoa mali e ka khonahala. Ka tekanyo e le 'ngoe ea lethal dose e phahameng, motho ea hlokofalitsoeng o lokela ho letsetsa ambulense. Maemong a sa tsitsang, ho tšeloa mali ho etsoa ho khutlisetsa thepa ea mali kapele.

Haeba mokuli a kentse litafole tse ngata lihora tse 4 tse fetileng, ka nako eo mokuli o hloka ho hlatsa, a hlatsoe lesapo la mokokotlo mme a fane ka ntho e kenang ho fokotsa ho kenella ha clopidogrel.

Haeba moriana o hlekefetsoa, ​​ho ka ba le karabelo e mpe pampiring ea tšilo ea lijo, ka mohlala, ho hlatsa.
Ka tekanyo e le 'ngoe ea lethal dose e phahameng, motho ea hlokofalitsoeng o lokela ho letsetsa ambulense.
Maemong a sa tsitsang, ho tšeloa mali ho etsoa ho khutlisetsa thepa ea mali kapele.
Botebo ba matla a hemorrhages kahara litho tsa ka hare bo ntlafatsoa ke ketso ea Warfarin.

Ho sebelisana le lithethefatsi tse ling

Ka tšebeliso e tšoanang ea Arthrogrel le lithethefatsi tse ling, ts'ebelisano e latelang ea lithethefatsi e bonoa:

1. Ha u ntse u sebelisa lithethefatsi tse seng khahlanong le 'mele oa ho ruruha, ho na le keketseho ea menyetla ea ho tsoa mali mokhoeng oa ka mpeng. Botebo ba matla a hemorrhages kahara litho tsa ka hare bo ntlafatsoa ke ketso ea Warfarin.
2. Phula ea plasma ea phenytoin le tolbutamide ea eketseha. Tabeng ena, karabelo e mpe e tsoang 'meleng ha e bonoe.
3. Heparin le acetylsalicylates ha li ame phello ea kalafo ea Atrogrel.

Ha ho na karabelo ea lik'hemik'hale hammoho le lithethefatsi tsa beta-adrenoreceptor, diuretics, antiepileptic le hypoglycemic.

Tšusumetso ho bokhoni ba taolo ea methapo

Moriana ha o pepese ho sebetsa le mesifa ea marapo. Ka hona, nakong ea kalafo, ho khanna, taolo ea methapo e rarahaneng le mesebetsi e meng e hlokang lebelo la mokuli la karabelo ea maikutlo le khatello ea kelello li lumelloa.

Sebaka sa Atrogrel se kenyelletsa meriana e latelang, ka motsoako o tšoanang o sebetsang le phello ea pharmacological:

• Sylt,
• Clopacin,
• Clopidogrel,
• Acecor Cardio,
• Agrelide,
• Cormagnyl
• Ecorin
• Cardiomagnyl.

Pilisi ea Cardiomagnyl le konofolo Clopidogrel Cardiomagnyl Taeo e fumanehang

Ha ho na le phello ea kalafo ha u nka Atrogrel, ho hlokahala hore u buisane le ngaka ea hau mabapi le phetisetso ea moriana. Ho fetohela moriana o mong o le mong ha ho khothalletsoe.

Letsatsi la ho felloa ke nako

Analogue e tsebahalang ea lithethefatsi ke Cardiomagnyl.
Haeba ho hlokahala, moriana o ka nkeloa sebaka ke Zilt.
Moetso o ts'oanang ke Clopidogrel.

Moetsi

Setsi sa Saense le Setsi sa Bongaka sa JSC "Borshchagovsky Semela sa Khemikhali le sa Bongaka", Ukraine.

Oleg Hvorostnikov, ea lilemo li 52, Ivanovo.

Ka tlhahiso ea ngaka, o ile a qala ho nka letlapa le le leng la 75 mg bosiu bosiu mabapi le tlhahlobo ea lefu la atherosclerosis ea likarolo tse tlase. Setlhare se thusitse, ho teba ha eona ho ile ha qala ho fokola. Empa ka letsatsi la 5 la kalafo ke ile ka tlameha ho letsetsa ambulense. Hemorrhage ka hara mothapo oa mpeng e ile ea qala. Ha ke khothaletse batho ba tloaetseng ho ba le gastritis le liso. Molemong oa ka, sena e ne e le phoso.

Victor Drozdov, ea lilemo li 45, Lipetsk.

Motsoalle eo ka mor'a ho tšoaroa ke stroke o ile a holofala, o ile a fuoa letlapa le le leng la Atrogrel libeke tse peli. Kamora ho otloa, ischemia e qalile, kahoo letsoho le letona le ne le sa utloe hantle. Qetellong ea beke ea pele ea kalafo, ho luma ho ile ha qala ka maoto le matsoho. Lithethefatsi li ile tsa fana ka sephetho. Lingaka li re moriana ona o kentse methapo ea mali le ho eketsa phallo ea mali sebakeng sa ischemic. Ke siea maikutlo a monate.

Fomu ea tokollo

Atrogrel - matlapa.
Matlapa a 10 ka blister, 1 blister ka paketeng, matlapa a 10 ka blister, 3 lithupa tse ka paketeng.

Letlapa le le lengAtrogrel e na le Clopidogrel ka sebopeho sa Clopidogrel bisulfate, ho latela 100% Clopidogrel - 75 mg.
Ba hlahisang: croscarmellose sodium, microcrystalline cellulose, lactose, castor hydrogenated film membrane film: hypromellose, lactose, titanium dioxide (E171), triacetin, carmine (E120).