Pharmacokinetics. Clopidogrel a hankali yana hana ɗaurewar adenosine diphosphate (ADP) ga masu karɓar sa a farfajiyar platelet, yana toshe kunna faranti kuma hakanan yana hana haɗarin su. Hakanan yana hana tarawar platelet ta hanyar wasu agonists. Abun lura shine agarin platelet an lura 2 sa'o'i bayan maganin baka na maganin guda na magani. Tare da sake maimaita amfani, sakamakon yana ƙaruwa, kuma an sami daidaitaccen ƙasa bayan kwanaki 3-7 na jiyya (matsakaicin matakin hana haɗarin tarawa shine 40-60%). Harshen Platelet da lokacin zubar jini suna komawa zuwa kan layi a kan 7 kwanaki bayan dakatar da magani, kamar yadda aka sabunta platelet.
Pharmacokinetics Bayan gudanar da maganin baka, ƙwayar tana cikin hanzari a cikin narkewa. Concentarfafawarsa a cikin jini na jini ba shi da mahimmanci kuma bayan 2 sa'o'i bayan aikace-aikacen ba a ƙaddara shi ba (kasa da 0.025 μg / l). Da sauri biotransformed a cikin hanta. Babban metabolite dinsa (kashi tamanin cikin dari na fili wanda yake motsa jini a cikin jini) ba ya aiki. Mai aiki na metabolite na thiol yana ɗaure da sauri kuma ba tare da izini ba ga masu karɓa na platelet. A cikin jini na jini, ba a ƙaddara shi ba. Clopidogrel da babban kewaya metabolite suna ɗaurewa tare da canza ƙirar plasma.
Bayan gudanarwar baka, kusan kashi 50% na kashi da aka dauka ana fitsari ne a cikin fitsari kuma 46% a cikin filayen a cikin sa'o'i 120 bayan aikace-aikace. Rabin rayuwar babban metabolite shine 8 hours.
Yawan maida hankali a cikin plasma na jini a cikin tsofaffi marasa lafiya (shekaru 75 da mazan jiya) ya fi girma sosai, duk da haka, yawan ƙwayar cutar plasma ba ta haɗuwa da canje-canje a cikin tarin platelet da lokacin zubar jini.

Yin amfani da miyagun ƙwayoyi Atrogrel

Ana ɗaukar miyagun ƙwayoyi a baka, 1 kwamfutar hannu (75 MG) sau 1 kowace rana, ba tare da la'akari da cin abinci ba.
Marasa lafiya tare da m jijiyoyin jini cuta ba tare da yanki na yanki ST (Rashin tsawan angina ko lalatacce ba tare da hakori ba) Tambaya a kan ECG) a ranar 1 na jiyya - Allunan 4 (allunan 300), a kwanakin masu zuwa - 1 kwamfutar hannu 1 lokaci ɗaya kowace rana, ba tare da la'akari da cin abinci ba.
Tsawon likitan yana ƙaddara tsawon likita dangane da hoton asibiti na cutar.

Contraindications zuwa ga yin amfani da miyagun ƙwayoyi Atrogrel

Rashin hankali ga miyagun ƙwayoyi,
mummunan cutar hanta
m zubar jini (intracranial basur) da cututtuka predisposing zuwa ga ci gaban (peptic miki na ciki da kuma duodenum a cikin m mataki, nonspecific ulcerative colitis),
shekaru zuwa shekaru 18.

Side effects na miyagun ƙwayoyi Atrogrel

Daga tsarin jini: leukopenia, raguwar adadin granropcytes na neutrophilic da eosinophils, karuwa a lokacin zubar jini da raguwar adadin platelet. Da wuya sosai: thrombocytopenic thrombohemolytic purpura, thrombocytopenia mai tsanani, granulocytopenia, agranulocytosis, anemia da aplastic anemia / pancytopenia. Zubar da jini na ƙyanƙyashe daban-daban. Yawancin lokuta na zubar da jini an lura da su a farkon watan jiyya.
Daga cikin hanji: zafin ciki, dyspepsia, zawo, da wuya - maƙarƙashiya, haɓakar kumburin ciki da ciwon duodenal.
Daga tsarin musculoskeletal: da wuya sosai - arthralgia, amosanin gabbai.
Daga tsarin urinary: da wuya - glomerulonephritis, haɓaka ƙwaƙwalwar ƙwayar magani.
Daga tsarin juyayi na tsakiya: ciwon kai, farin ciki, amai. Da wuya sosai - rikicewa, hallucinations, take hakkin abubuwan dandano.
Allergic halayen: rashes na fata, halayen fata anaphylactoid.
Sauran: da wuya - zazzabi.

Umarnin na musamman don amfanin Atrogrel

Tare da taka tsantsan, an tsara marasa lafiya da karuwar haɗarin zub da jini saboda rauni, aikin tiyata, da rikicewar tsarin hemostatic. Tare da abubuwan da aka shirya na tiyata (idan har ba a son wani sakamako na antiplatelet), za a dakatar da aikin jiyya tare da miyagun ƙwayoyi 7 kwanaki kafin aikin.
An wajabta yin taka tsantsan ga marasa lafiya masu fama da rauni na hanta, wanda zazzabin cizon sauro na iya faruwa.
Ba a buƙatar gyaran gyambon ciki a cikin tsofaffi marasa lafiya, marasa lafiya tare da gazawar renal.
Yakamata a gargadi marassa lafiya cewa tunda dakatar da zub da jini da ke faruwa tare da amfani da miyagun ƙwayoyi na bukatar karin lokaci, yakamata su sanar da likita game da kowane yanayi na zub da jini. Marasa lafiya yakamata su sanar da likita game da shan maganin idan sun yi tiyata (tiyata, likitan hakori, da sauransu) ko kuma idan likita ya tsara sabon magani ga mara lafiyar.
Lokacin da bayyanar cututtuka na zubar jini mai yawa (gumis na jini, menorrhagia, hematuria), bincike akan tsarin hemostasis (lokacin zubar jini, ƙididdigar platelet, gwajin aikin aikin platelet) yana nuna.
Ana bada shawarar saka idanu akai-akai game da alamun alamun aikin hanta.
PLokacin daukar ciki da lactation. Yin amfani da miyagun ƙwayoyi yayin daukar ciki yana contraindicated.
Idan ya zama dole ayi amfani da maganin yayin shayarwa, ya kamata a daina shayar da jarirai nonon.
Yara. Ba a tabbatar da aminci da tasiri na magani a cikin mutanen da ke ƙasa da shekara 18 ba.
Thearfin yin tasiri akan ƙimar amsawa yayin tuki motocin ko wasu hanyoyin. Magungunan ba ya tasiri da ikon tuki motoci kuma baya rage saurin halayen psychomotor.

Mu'amala da Magunguna a Cikin Atrogrel

Clopidogrel yana kara haɗarin zubar jini na ciki tare da NSAIDs.
Ba a ba da shawarar amfani da warfarin ba, tun da haɓaka da yawan zubar jini zai yiwu.
Amfani da acetylsalicylic acid ko heparin baya tasiri tasirin antiplatelet na miyagun ƙwayoyi, duk da haka, amincin amfani da dogon lokacin da aka hada irin waɗannan haɗuwa ba'a riga an kafa shi ba, don haka amfani da lokaci ɗaya na waɗannan kwayoyi yana buƙatar taka tsantsan.
Lokacin amfani da phenytoin da tolbutamide, haɓaka matakin su a cikin jini yana yiwuwa. Koyaya, yin amfani da su tare da clopidogrel amintaccen ne.
Babu wata hulɗar magani mai mahimmanci a cikin asibiti tare da diuretics, blo-adrenoreceptor blockers, ACE inhibitors, alli tashar alli, antacids, hypoglycemic, hypocholesterolemic da magungunan maye gurbin magunguna, magungunan antiepileptic, phenobarbital, cimetidine, digoxin da theofinomine da digoxin da theofinom.

Kungiyar magunguna

Magungunan Antithrombotic. Lambar PBX B01A C04.

Yin rigakafin bayyanar cututtuka na atherothrombosis:

• a cikin marasa lafiyar da suka sami infarction na myocardial (farkon farawa shine 'yan kwanaki, amma ba a wuce kwanaki 35 ba bayan farawa), bugun jini na ischemic (farkon farawa shine kwanaki 7, amma ba a wuce watanni 6 ba bayan farawa) ko kuma waɗanda ke kamuwa da cutar na wurare masu tasowa
• a cikin marasa lafiya tare da m na jijiyoyin jini ciwo:
• tare da ciwo na jijiyoyin zuciya ba tare da haɓakawa na yanki na ST ba (tsayayyen angina ko myocardial infarction ba tare da raƙumar Q ba), ciki har da marasa lafiya waɗanda aka shigar da ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwayar cuta a yayin cutarwa na jijiyoyin zuciya wanda ke haɗuwa da acetylsalicylic acid
• tare da matsanancin rauni na myocardial infarction tare da haɓaka sashi na ST a haɗe tare da acetylsalicylic acid (a cikin marasa lafiya da ke karɓar magani na yau da kullun kuma waɗanda aka nuna su da maganin thrombolytic).

Yin rigakafin atherothrombotic da abubuwan thromboembolic a cikin firamillation na atrial .

An nuna Clopidogrel a hade tare da acetylsalicylic acid don majiɓincin manya da ke fama da cututtukan ƙwayar cuta a ciki wanda aƙalla akwai haɗari ɗaya don haɗarin abubuwan da suka faru na jijiyoyin jiki, contraindications don magani tare da bitamin K antagonists (AVK), ƙananan haɗarin zub da jini, don rigakafin atherothrombotic da thromboembolic abubuwan, gami da bugun jini.

Sashi da gudanarwa

Manya da tsofaffi marassa lafiya. An wajabta maganin a 1 kwamfutar hannu 1 (75 MG) sau 1 a rana, komai girman abincin.

A cikin marasa lafiya tare da m jijiyoyin jini cuta ba tare da ST kashi haɓaka (Rashin tsayayyen angina pectoris ko infarction na myocardial ba tare da raunin Q a kan ECG ba), jiyya tare da clopidogrel yana farawa tare da kwayar iko guda ɗaya na 300 MG, sannan ya ci gaba a kashi 75 MG sau ɗaya a rana (tare da acetylsalicylic acid (ASA) a kashi 75-325 mg a kowace rana). Tunda yawan amfani da allurai na ASA yana kara hadarin zubar jini, ana bada shawarar kar a wuce kashi 100 na ASA. Ba a kafa ingantaccen lokacin magani ba bisa ƙa'ida. Sakamakon binciken ya ba da shawarar yin amfani da miyagun ƙwayoyi har zuwa watanni 12, kuma an lura da mafi girman tasirin bayan watanni 3 na magani.

A cikin marasa lafiya tare da m myocardial infarction tare da ST kashi na haɓaka An wajabta clopidogrel 75 MG sau ɗaya a rana, farawa tare da ɗaukar nauyin guda na 300 MG a hade tare da ASA, tare da ko ba tare da magungunan thrombolytic ba. Kulawa da marasa lafiya masu shekaru 75 da sama sun fara ba tare da amfani da adadin maganin Clopidogrel ba. Ya kamata a fara amfani da maganin hadewa da wuri-wuri bayan fara bayyanar cututtuka kuma ya kamata ya ci gaba da aƙalla makonni 4. Fa'idodin yin amfani da haɗakar clopidogrel tare da ASA na fiye da makonni 4 tare da wannan cutar ba a yi nazari ba.

Ana amfani da Clopidogrel a cikin kashi ɗaya na 75 MG ga marasa lafiya da ƙwayoyin cutar firamil. Tare tare da clopidogrel, yin amfani da ASA (a kashi 75 na 100 MG a kowace rana) ya kamata a fara kuma ya ci gaba.

Idan aka rasa kashi:

• idan daga lokacin da ya zama dole a dauki kashi na gaba, kasa da 12:00 ya wuce, mara lafiya ya kamata kai tsaye ya sha maganin da aka rasa, kuma kashi na gaba ya kamata a riga an sha shi a daidai lokacin,
• idan sama da 12:00 ya wuce, mara lafiya ya kamata ya ɗauki kashi na gaba a lokacin da ya saba amma ba ninka ninki na biyu ba don rama maganin da aka rasa.

Pharmacogenetics. Lencearfin CYP2C19 alleles, wanda ke haifar da matsakaici da rage ayyukan metabolic na CYP2C19, ya bambanta da launin fata / kabila. Ba a kafa ingantaccen tsarin magani a cikin mutane masu rauni na metabolism na CYP2C19 ba tukuna.

Yara. Ba a tabbatar da aminci da tasiri na clopidogrel a cikin yara ba, saboda haka, bai kamata a yi amfani da miyagun ƙwayoyi a cikin yara ba.

Rashin wahala. Kwarewar warkewar amfani da miyagun ƙwayoyi a cikin marasa lafiya da keɓaɓɓen renal yana da iyakatacce (duba sashin "Siffofin amfani").

Rashin hanta. Kwarewar warkewa game da amfani da miyagun ƙwayoyi a cikin marasa lafiya da cututtukan hanta na wucin gadi da kuma yiwuwar cututtukan cututtukan basur yana iyakantuwa (duba sashe "Siffofin amfani").

M halayen

Yawancin cutarwar da ta fi dacewa ita ce zubar da jini, wanda aka fi lura da shi a farkon watan jiyya.

Tsarin jini da jijiyoyin jini

• thrombocytopenia, leukopenia, eosinophilia,
• neutropenia, gami da mummunar neutropenia,
• thrombotic thrombocytopenic purpura (TTP) (duba sashin "Peculiarities of amfani"), aplastic anemia, pancytopenia, agranulocytosis, thrombocytopenia mai girma, granulocytopenia, anemia, hemophilia A.

tsarin rigakafi

• cutar kansa, cutar anaphylacticid / anaphylactic,
• giciye hypersensitivity tsakanin thienopyridines (kamar ticlopidine, prasugrel) (duba sashe "Siffofin amfani").

rikicewar kwakwalwa

• hallucinations, rikicewa.

tsarin juyayi

• zubar jini cikin intracranial (a wasu lokuta, mai kisa), ciwon kai, paresthesia, dizziness
• canza yanayin dandano.

Ilimin halittar mutum na hangen nesa

• zub da jini a cikin yankin ido (conjunctiva, spectacle, retinal).

Pathology na kunne da labyrinth

cuta na jijiyoyin jiki

• hematoma
• amai da jini, zubar jini daga rauni na aiki, vasculitis, jijiyoyin jini.

Kwayar numfashi, thoracic da cuta

• hanci
• zubar jini daga jijiyoyin numfashi (hawan jini, huhun jini), bronchospasm, cututtukan huhun ciki, huhun huhu.

Rashin Tsarin ciki

• na ciki, gudawa, ciwon ciki, dyspepsia
• ciki da duodenal miki, gastritis, amai, tashin zuciya, maƙarƙashiya, ƙwanƙwasa,
• bashin jini na baya
• na ciki da na baya da na baya tare da sakamako mai kisa, pancreatitis, colitis (musamman ulcerative ko lymphocytic), stomatitis.

tsarin hepatobiliary

• gazawar hanta, hepatitis, ƙarancin sakamako na alamomin aikin hanta.

Fata da ƙananan nama

• subcutaneous basur,
• kurji, itching, zubar cikin ciki (purpura),
• bullous dermatitis, guba epidermal necrolysis, cututtukan Stevens-Johnson, erythema multiforme, angioneurotic edema, erythematous rash, urticaria, cututtukan cututtukan ƙwayar cuta, cututtukan ƙwayoyi tare da eosinophilia da kuma bayyanar tsarin (DRESS-lichen, eczema.

Tsarin tsoka, haɗin kai da kasusuwa na kasusuwa

• toshewar mahaifa (hemarthrosis), amosanin gabbai, arthralgia, myalgia.

Tsarin koda da urinary

• hematuria
• glomerulonephritis, karuwar creatinine a cikin jini.

yanayin gaba daya

gwaje-gwaje na dakin gwaje-gwaje

• tsawanta lokaci na zub da jini, da raguwa da yawan yawan abubuwan da ke faruwa a cikin jini.

Yi amfani da lokacin daukar ciki ko lactation

Sakamakon rashin bayanan asibiti game da amfani da clopidogrel yayin daukar ciki, ba a ba da shawarar sanya magunguna ga mata masu juna biyu ba.

Ba a sani ba ko ana amfani da clopidogrel a cikin madara, sabili da haka, ya kamata a daina shayar da jarirai yayin jiyya tare da magani.

Ba a tabbatar da aminci da tasiri na clopidogrel a cikin yara ba, saboda haka, bai kamata a yi amfani da miyagun ƙwayoyi a cikin yara ba.

Siffofin aikace-aikace

Zub da jini da cutawar jini.

Sakamakon haɗarin zub da jini da halayen da ke haifar da tasirin ƙwayar cuta, cikakken gwajin jini da / ko wasu gwaje-gwajen da suka dace yakamata a yi su nan da nan idan an lura da alamun zub da jini yayin amfani da miyagun ƙwayoyi. Kamar sauran wakilan antiplatelet, Clopidogrel yakamata a yi amfani da shi tare da taka tsantsan a cikin marasa lafiya da haɓakar haɗarin zub da jini sakamakon rauni, tiyata ko wasu yanayin cututtukan, har ma da batun marasa lafiya da ke amfani da acetylsalicylic acid (ASA), heparin, IIb / IIIA glycoprotein inhibitors ko magungunan anti-steroidal anti-inflammatory, ciki har da masu hana COX-2. Wajibi ne a lura da alamun bayyanar alamun bayyanar zub da jini a cikin marassa lafiya, gami da zubar jinni a ɓoye, musamman a farkon makonni na jiyya da / ko bayan hanyoyin ɓarna a kan zuciya da ayyukan tiyata. Ba a bada shawarar amfani da clopidogrel lokaci guda tare da maganin anticoagulants na baki ba, tunda yana iya ƙaruwa da zub da jini (duba Sashe "hulɗa da wasu kwayoyi da sauran nau'ikan hulɗa").

Game da batun aikin tiyata da aka shirya, idan tasirin maganin antithrombotic ba na wani dan lokaci bane, yakamata a daina jinya da Clopidogrel kwana 7 kafin tiyata. Marasa lafiya yakamata su sanar da likitoci da likitocin hakora cewa suna shan maganin Clopidogrel kafin a rubuta duk wani tiyata ko kafin a yi amfani da sabon magani. Clopidogrel yana tsawanta lokacin zubar jini, don haka yakamata a yi amfani dashi da taka tsantsan a cikin marassa lafiyar da ke da haɗarin zubar jini (musamman na ciki da na ciki).

Yakamata a gargadi marassa lafiya cewa yayin jiyya tare da clopidogrel (shi kadai ko a hade tare da ASA), zub da jini na iya tsayawa daga baya fiye da yadda aka saba, cewa suna buƙatar sanar da likita game da kowane yanayi na sabon abu (ta wurin ko tsawon lokaci) zubar jini.

Gagarin thrombotic thpbobotoptopenic purpura (TTP).

Ba a daɗe da lura da maganganu na thrombotic thrombocytopenic purpura (TTP) ba bayan aikin Clopidogrel, wani lokacin har bayan amfani da ɗan gajeren lokacin. TTP yana bayyana ta thrombocytopenia da microangiopathic hemolytic anemia tare da bayyanar cututtukan jijiyoyi, tabarbarewa koda, ko zazzabi. TTT cuta ce mai yuwuwar mutuwa wacce ke buƙatar magani cikin gaggawa, musamman plasmapheresis.

Lauyoyi masu haɓaka haɓakar haemophilia bayan amfani da Clopidogrel an ba da rahotonsu. A cikin lamuran da aka tabbatar da haɓaka yaduwa a cikin APTT (wani lokaci ana kunna shi a cikin jini), wanda aka haɗu da ko ba tare da zub da jini ba, yakamata a bincika batun gano cutar haemophilia. Marasa lafiya tare da ingantaccen ganewar asali game da cutar haemophilia ya kamata ya kasance a ƙarƙashin kulawar likita da karɓar magani, ya kamata a dakatar da amfani da clopidogrel.

Kwanan nan bugun jini na ischemic.

Saboda ƙarancin bayanai, ba a ba da shawarar yin amfani da Clopidogrel a cikin kwanakin 7 na farko ba bayan bugun zuciya mai ƙuna mai rauni.

Cytochrome P450 2 C19 (CYP2C19 ). Pharmacogenetics.

Marasa lafiya tare da rage girman ƙwayar jini na CYP2C19 suna da ƙananan taro na ƙwaƙwalwar clopidogrel metabolite a cikin jini na jini da ƙarancin maganin antiplatelet, ƙari, suna da rikitarwa na zuciya da yawa bayan rikicewar myocardial idan aka kwatanta da marasa lafiya tare da aiki na al'ada na CYP2C19.

Tunda Clopidogrel yana metabolized kafin samuwar metabolite dinsa mai aiki a sashi ta hanyar CYP2C19, yin amfani da magungunan da ke rage ayyukan wannan enzyme yana iya haifar da raguwa a cikin taro na aiki na clopidogrel a cikin jini na jini. Tunda ba a fayyace mahimmancin asibitin wannan hulɗa ba, yakamata a guji amfani da kwayoyi waɗanda ke hana ayyukan CYP2C19 (duba Sashe "hulɗa tare da wasu kwayoyi da sauran nau'ikan hulɗa").

Komawar sakewa tsakanin thienopyridines.

Yakamata a bincika masu haƙuri don tarihin rashin lafiyar zuwa wasu ƙwayoyin cuta (kamar su ticlopidine, prasugrel), tunda akwai rahotanni game da rashin lafiyan halayen tsakanin thienopyridines (duba sashin "Abubuwan da ba a dace ba"). Thienopyridines na iya haifar da laushi zuwa ga rashin lafiyan halayen, kamar su naƙuda, kumburin Quincke, ko halayen hematologic, kamar su thrombocytopenia da neutropenia. Marasa lafiya waɗanda suka yi tarihin halayen halayen rashin lafiyan cuta da / ko halayen hematologic zuwa guda ɗaya na sitenopyridine na iya samun haɓakar haɗarin haɓaka guda ɗaya ko daban-daban ga sauran ƙwayoyin cuta. Kulawar da aka ba da shawarar don alamun rashin hankali a cikin marasa lafiya rashin lafiyar ƙwayoyin cuta.

Paarancin aiki na haya.

Kwarewar warkewar amfani da clopidogrel a cikin marasa lafiya tare da gazawar renal yana iyakantacce, sabili da haka, ana tsara irin wannan marasa lafiya tare da taka tsantsan (duba Sashe "Sashi da Gudanarwa").

Rashin aikin hanta.

Kwarewar yin amfani da miyagun ƙwayoyi a cikin marasa lafiya da cututtukan hanta na matsakaita da yiwuwar basur na basir ya iyakance. Sabili da haka, ya kamata a sanya wa alluran Clopidogrel irin wannan marasa lafiya da taka tsantsan (duba Sashe "Sashi da Gudanarwa").

Magungunan sun ƙunshi lactose. Marasa lafiya da keɓaɓɓen rashin haƙuri na galactose rashin haƙuri, rashi Lappase, gurguntawar glucose-galactose malabsorption bai kamata amfani da wannan magani ba.

Magungunan yana dauke da sinadarin castor na hydrogenated, wanda zai iya haifar da rashin kwanciyar hankali da gudawa.

Idan mara lafiya ya manta da shan maganin kuma ya zama bai wuce 12:00 ba bayan shirin da aka shirya, to dole ne a dauki maganin da wuri-wuri, bayan wannan ya kamata a dauki kashi na gaba akan lokaci. Idan sama da 12:00 ya wuce, yakamata ku tsallake shan maganin da aka manta kuma ku ɗauki kashi na gaba akan lokaci. Ba a yarda a sha kashi biyu na magani ba.

Yayin jiyya, bai kamata ku sha giya ba saboda karuwar haɗarin cututtukan jini na gastrointestinal.

Gargaɗi na musamman don zubar da sharan gona da sharar gida. Duk wani samfurin da ba'a amfani dashi ko sharar gida dole ne a zubar dashi daidai da bukatun gida.

Yin hulɗa tare da wasu kwayoyi da sauran nau'ikan ma'amala

Maganin anticoagulants na baka amfani da Clopidogrel lokaci guda tare da maganin anticoagulants na baki, gami da warfarin, ba a bada shawara ba, tunda irin wannan haɗin na iya ƙara yawan zubar jini.

Masu hana Glucoprotein IIb / IIIa aiki: Ya kamata a yi amfani da Clopidogrel tare da taka tsantsan a cikin marasa lafiya da ke da haɗarin haɗarin zub da jini saboda raunin da ya faru, aiki, ko wasu yanayi na jijiyoyin da ake amfani da inhibitors glycoprotein IIb / IIIa lokaci guda.

Acetylsalicylic acid (ASA): acetylsalicylic acid ba ya canza tasirin hanawa na clopidogrel akan haɗarin platelet na ADP, amma clopidogrel yana haɓaka tasirin ASA akan haɗarin platelet wanda ya haifar da ƙwayoyin platelet. Koyaya, amfani da lokaci guda na 500 MG na ASA sau ɗaya a rana ɗaya ba ya haifar da ƙaruwa a cikin lokacin zubar jini, tsawaita saboda clopidogrel. Tunda haɓakar haɗarin zub da jini na yiwuwa, yin amfani da waɗannan magunguna a lokaci ɗaya yana buƙatar taka tsantsan. Koyaya, akwai kwarewa ta amfani da Clopidogrel da ASA tare har zuwa shekara guda.

Heparin: A cikin binciken da aka gudanar tare da masu ba da lafiya, masu amfani da clopidogrel basu buƙatar canji a cikin maganin heparin ba kuma bai canza tasirin heparin akan coagulation ba. Yin amfani da heparin a lokaci guda bai canza tasirin maganin clopidogrel akan haɗin platelet ba. Tunda hulɗar pharmacodynamic tsakanin clopidogrel da heparin mai yiwuwa ne tare da haɓakar haɗarin zub da jini, yin amfani da waɗannan magunguna a lokaci ɗaya yana buƙatar taka tsantsan.

Magungunan Thrombolytic: amincin rashin jituwa game da amfani da clopidogrel, ƙayyadaddun fibrin ko ƙayyadaddun ƙwayoyin thrombolytic da heparin an tantance tare da halartar marasa lafiya tare da matsanancin myocardial infarction. Halin da ke haifar da zubar da jini a asibiti ya kasance daidai da faruwar lamarin da aka lura yayin shan magungunan thrombolytic da heparin tare da ASA.

Magungunan rigakafin ƙwayar cutar mahaifa (NSAIDs): A cikin wani binciken da aka gudanar kan masu bayar da lafiyayyun lafiya, yin amfani da Clopidogrel da naproxen a lokaci daya ya ninka yawan zubar jini na hanji. Koyaya, saboda karancin karatu game da hulɗa da miyagun ƙwayoyi tare da sauran NSAIDs, har yanzu ba a bayyane ba, haɗarin zubar jini na haɓaka yayin amfani da clopidogrel tare da sauran NSAIDs. Sabili da haka, yin taka tsantsan wajibi ne tare da yin amfani da NSAIDs a lokaci guda, ciki har da inhibitors na COX-2, tare da clopidogrel.

Amfani da wasu magunguna a lokaci guda: tunda Clopidogrel yana metabolized kafin samuwar metabolite dinsa mai aiki a sashi ta hanyar CYP2C19, amfani da magungunan da ke rage ayyukan wannan enzyme da alama yana iya rage haɗuwa da ƙwaƙwalwar ƙwayar clopidogrel a cikin jini na jini. Muhimmancin asibiti na wannan hulɗa ba a bayyane yake ba, saboda haka, ya kamata a guji amfani da kwayoyi na lokaci guda waɗanda ke hana ayyukan CYP2C19.

Magunguna waɗanda ke hana ayyukan CYP2C19 sun haɗa omeprazole, esomeprazole, fluvoxamine, fluoxetine, moclobemide, voriconazole, fluconazole, ticlopidine, ciprofloxacin, cimetidine, carbamazepine, oxcarbazepine da Chloramphenicol.

Proton Pump Inhibitors (PPIs): Za'a iya rage tasirin maganin antithrombotic na clopidogrel da kusan rabi yayin da aka haɗa shi da PPI. Kodayake matakin hanawar ayyukan CYP2C19 a ƙarƙashin aikin kwayoyi daban-daban mallakar ajin PPI ba ɗaya bane, bincike ya nuna kasancewar hulɗa tare da kusan dukkanin wakilan wannan aji. A wannan yanayin, banbancin gudanarwa a kan lokaci ba ya shafar raguwar tasiri clopidogrel. Saboda haka, ya kamata a guji amfani da PPIs a lokaci daya sai dai idan lallai ya zama tilas.

Shaida cewa wasu kwayoyi waɗanda ke rage samar da acid a cikin ciki, kamar su

H 2 masu toshewa (ban da cimetidine wanda ke hana ayyukan CYP2C19) ko antacids , shafar ayyukan antiplatelet na clopidogrel, a'a.

Haɗuwa da sauran magunguna: An gudanar da bincike da yawa kan clopidogrel da sauran kwayoyi don nazarin yiwuwar haɗin magunguna da hulɗar magunguna, wanda ya nuna cewa lokacin amfani da Clopidogrel tare da:

• atenolol, nifedipine ko tare da magungunan biyu, babu wata babbar ma'amala ta hanyar magani da aka gano,
• ban mamaki da isrogen babu wani tasiri mai tasiri akan magunguna na clopidogrel,
• digoxin ko akarijin: ma'aunin magunguna ba su canza ba,
• maganin rigakafi: babu wani tasiri akan matakin yawan amfani da Clopidogrel
• phenytoin da tobutamide: carboxyl metabolites na clopidogrel na iya hana ayyukan cytochrome P450 2C9, wanda zai iya haɓaka matakan plasma na kwayoyi kamar su phenytoin , tolbutamide da NSAIDs waxanda suke da metabolized 450 2C9. Amma duk da wannan, ana iya amfani da phenytoin da tolbutamide a lokaci guda tare da clopidogrel,
• diuretics, β-blockers, ACE inhibitors, alluran antagonists, cholesterol lowering jamiái, na jijiyoyin zuciya vasodilators, hypoglycemic jamiái (gami da insulin), magungunan antiepileptik, maganin maye gurbin maganin da GPIIb / IIIa antagonists: A cikin karatun asibiti, babu wasu sakamako masu illa da aka samu.

Umarnin don amfani da Atrogrel

abu mai aiki: Clopidogrel,

1 kwamfutar hannu 1 ya ƙunshi clopidogrel a cikin nau'i na clopidogrel bisulfate, cikin sharuddan 100% clopidogrel - 75 mg.

Wadanda suka karɓi: sassum croscarmellose, celclose microcrystalline, lactose, hydrogenated castor oil,

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

Yin rigakafin bayyanar cututtuka na atherothrombosis: a cikin marasa lafiya waɗanda suka sami infarction myocardial (farkon farawa 'yan kwanaki ne, amma ba za a wuce kwanaki 35 ba bayan faruwar hakan), bugun jini na ischemic (farkon farawa shine kwanaki 7, amma ba daga baya ba bayan watanni 6 bayan faruwar hakan) ko wadanda suka kamu da cutar ta jijiya, a cikin marasa lafiya da ke fama da cutar sankarar mahaifa: tare da matsanancin jijiyoyin jini ba tare da ciwuka bangaren ST ba (tsayayyen angina ko infarction na myocardial ba tare da raunin Q) ba, ciki har da a cikin marassa lafiyar da aka gano cutar ta NT a lokacin percutaneous transluminal jijiyoyin zuciya angioplasty, a hade tare da acetylsalicylic acid, tare da m tsokar zuciya infarction da ST kashi tadawa a hade tare da acetylsalicylic acid (a cikin marasa lafiya da samun misali magani da kuma wanda thrombolytic far).

Yin rigakafin atherothrombotic da abubuwan thromboembolic a cikin firamillation na atrial.

An nuna Clopidogrel a hade tare da acetylsalicylic acid don majiɓincin manya da ke fama da cututtukan ƙwayar cuta a ciki wanda aƙalla akwai haɗari ɗaya don haɗarin abubuwan da suka faru na jijiyoyin jiki, contraindications don magani tare da bitamin K antagonists (AVK), ƙananan haɗarin zub da jini, don rigakafin atherothrombotic da thromboembolic abubuwan, gami da bugun jini.

Miyagun ƙwayoyi Atrogrel: umarnin don amfani

Atrogrel magani ne wanda ke da tasirin antiplatelet. Ana amfani dashi don magancewa da kuma hana farko, cututtukan zuciya na maimaitawa, bugun jini a cikin yanayin tsinkayar marasa lafiya. Magungunan yana taimakawa kawar da cututtukan jijiyoyin bugun gini saboda ƙirar ƙwaƙwalwar ƙwayoyin cuta na clopidogrel don hana haɗuwar platelet. Yana da mahimmanci a la'akari cewa lokacin jiyya, lokacin da za a dakatar da zubar jini yana ƙaruwa.

Pharmacokinetics

Bayan gudanarwa, ana amfani da maganin a cikin hanzari daga hanji. Hankali a cikin plasma na jini ba shi da sakaci kuma bayan 2:00 bayan ba a ƙaddamar da aikace-aikacen ba (ƙasa da 0.025 mcg / l). Da sauri biotransformed a cikin hanta. Babban metabolite dinsa (kashi 85 cikin 100 na plasma circulating compound) baya aiki. Mai aiki na metabolite na thiol yana ɗaure da sauri kuma ba tare da izini ba ga masu karɓa na platelet. A cikin jini na jini, ba a gano shi ba. Clopidogrel da babban jijiyar metabolite suna hade da sunadaran plasma.
Bayan shan, kusan 50% na kashi da aka ɗauka an fallasa shi a cikin fitsari da kuma 46% tare da feces a cikin sa'o'i 120 bayan aikace-aikace. Rabin rayuwar babban metabolite shine 8:00.
Hankalin babban metabolite a cikin plasma a cikin tsofaffi marasa lafiya (shekaru 75 da mazan jiya) ya fi girma, duk da haka, mafi girma yawan abubuwan haɗuwa ba a haɗa tare da canje-canje a cikin tarin platelet da lokacin zubar jini.

Saki siffofin da abun da ke ciki

Ana yin magungunan a cikin kwamfutar hannu. Nau'in magungunan an rufe shi da farar fata, fenti. 1 kwamfutar hannu 1 ya ƙunshi 75 MG na ƙwayar aiki - clopidogrel bisalte. Componentsarin abubuwan da aka haɗa sun haɗa da:

• microcrystalline cellulose,
• hydrogenated castor mai,
• madara sukari
• croscarmellose sodium.

Harsashin kwandon ya ƙunshi carmin, hypromellose, sukari lactose, titanium dioxide, triacetin.

Ana yin magungunan a cikin kwamfutar hannu. 1 kwamfutar hannu 1 ya ƙunshi 75 MG na ƙwayar aiki - clopidogrel bisalte.

Aikin magunguna

Magungunan yana hana ɗaure adenosine diphosphate ga masu karɓa mai dacewa a kan farfajiyar platelet, sakamakon abin da ya rage yawan aikin platelet na jini. Sakamakon aikin clopidogrel, an rage yawan haɗin platelet da mannewa, lalacewa ta halitta ko ta tsokanar da wasu magunguna. An rubuta sakamako na warkewa a cikin binciken dakin gwaji 2 sa'o'i bayan maganin baka na maganin.

Tare da ci na sakandare, sakamakon maganin yana haɓakawa kuma an daidaita shi ne kawai bayan kwanaki 3-7 na maganin ƙwayoyi. A lokaci guda, matsakaiciyar hanawar platelet ya kai 45-60%.Tasirin warkewa ya ci gaba har sati guda, bayan haka tarawar tarin jini da kuma aikin jiyya suka koma ga dabi'unsu na asali. Wannan saboda sabuntawar sel ne (rayuwar platelet kwana 7 kenan).

Menene taimaka?

Ana amfani da miyagun ƙwayoyi azaman matakan kariya a cikin maganin atherothrombosis a cikin marasa lafiyar manya kuma don kawar da halaye masu zuwa:

• cututtukan cututtukan jijiyoyin jijiyoyin jijiyoyi a yayin da ake ci gaba da aiwatar da cututtukan cututtukan ƙwayar cuta saboda atherothrombosis a cikin ƙananan ƙarshen,
• m jijiyoyin zuciya da bugun zuciya game da bugun zuciya tare da rashiwar karfin Q a kan na'urar electrocardiogram (ECG) ko kuma gaban angina mai tsayayye,
• rigakafin infarction na sakandare na myocardial da hanzarta farfadowa da ƙwayar zuciya (ana amfani da miyagun ƙwayoyi ba bayan kwanaki 35 ba bayan faruwar cutar),
• rigakafin kwatsam mutuwar zuciya,
• m infushin myocardial infarction lokacin haɓaka sashin ST a kan ECG tare da kulawa da ra'ayin mazan jiya tare da acetylsalicylic acid,
• ischemic bugun jini a farkon farfajiya bayan kwanaki 7 (ba a wuce watanni 6 ba) daga haɓakar ƙwayar cuta.

Ana amfani da miyagun ƙwayoyi azaman matakan kariya a cikin maganin atherothrombosis a cikin marasa lafiyar manya.
Hakanan, ana amfani da miyagun ƙwayoyi don hana infarction na biyu na myocardial infarction.
An wajabta atrogrel ga marasa lafiya don rigakafin mutuwa kwatsam.
Alamar amfani da miyagun ƙwayoyi shine bugun jini na ischemic a farkon farawa bayan kwanaki 7 (ba a wuce watanni 6 ba) daga haɓakar ƙwayar cuta.

Ana amfani da miyagun ƙwayoyi don hana faruwar wani yanayin rashin lafiyar atherothrombotic da kuma toshewar (embolism) na lumen jirgin ruwa ta hanyar thrombus yayin atbr firamillation na atrial. A cikin wannan yanayin, ana bada shawara don amfani da maganin haɗin maganin acetylsalicylic acid tare da clopidogrel.

Tare da kulawa

Anyi taka tsantsan ga marasa lafiya da ke cikin hatsarin zub da jini sakamakon rauni, na aikin tiyata, da kuma rashin daidaituwa a ma'aunin acid-jikin. Adaddamar da Atrogrel ba a da ake so ga marasa lafiya da aikin hanta ba daidai ba, saboda akwai haɗarin haɓakar cutar basur.

Ba a sanya magani ba don tsarin cututtukan cuta mai tsanani a cikin hanta.
Ba a amfani da Atrogrel don cututtukan cututtukan cututtukan ciki na ciki da kuma duodenum a cikin babban mataki.
Ba a ba da shawarar yin amfani da maganin ba yayin shayarwa da mata masu juna biyu.
An ba da shawara mai hankali a cikin marasa lafiya waɗanda ke da haɗarin zub da jini.

Yadda ake ɗaukar Atrogrel?

Magungunan an yi shi ne don gudanar da maganin baka, ba tare da la'akari da abincin ba. Daidaitaccen maganin yau da kullun shine 75 MG sau ɗaya. Marasa lafiya da ke fama da cututtukan jijiyoyin zuciya, angina marasa daidaituwa da infarction na myocardial suna bada shawarar daukar 300 MG na miyagun ƙwayoyi a ranar farko - Allunan 4. M allurai masu daidaituwa.

Tsawon kwastom ɗin an ƙaddara shi ne ta hanyar halartar likitocin daban-daban, gwargwadon hoto na asibiti na tsarin ilimin cututtukan cuta. An tsara maganin haɗin gwiwa tare da wasu magunguna da wuri-wuri. Matsakaicin lokacin kulawa shine makonni 4.

Sakamakon sakamako na Atrogrel

Abubuwan da ba su dace ba daga gabobin da tsarin suna ci gaba a cikin mafi yawan lokuta idan mai haƙuri yana da tsinkaye don aiki mai aiki na gabobin ko kuma lokacin da aka ɗauki allunan da ba su dace ba.

Magungunan an yi shi ne don gudanar da maganin baka, ba tare da la'akari da abincin ba.
Marasa lafiya da ke fama da cututtukan jijiyoyin zuciya, angina marasa daidaituwa da infarction na myocardial suna bada shawarar daukar 300 MG na miyagun ƙwayoyi a ranar farko - Allunan 4.
Masu ciwon sukari basu buƙatar canza tsarin magani tare da magani ba.

Hematopoietic gabobin

Yawan abubuwan da aka kafa a cikin jini yana raguwa, samar da leukocytes da eosinophilic granulocytes sun tarwatse. Lokacin daina zubar jini yana ƙaruwa. Thrombocytopenic purpura, anemia, thrombocytopenia da agranulocytosis na iya haɓaka tare da lalacewar tsarin hematopoietic.

Marasa lafiya lura da ci gaban da zub da jini bayan wata daya na magani.

Tsarin juyayi na tsakiya

Tare da sakamako mai guba na miyagun ƙwayoyi akan tsarin mai juyayi, ciwon kai, tsananin farin ciki da asarar jijiyoyin haɓaka. A cikin halayen da ba a sani ba, asarar iko, tunanin mutum, rikicewa da asarar hankali, raunin dandano mai yiwuwa.

Sakamakon sakamako na Atrogrel a cikin tsarin musculoskeletal yana bayyana a cikin nau'i na jin zafi a cikin tsokoki da gidajen abinci.
A matsayin sakamako na gefen magani, dyspepsia na iya faruwa.
Tare da tsawanta amfani da miyagun ƙwayoyi, gajeriyar numfashi da ciwon makogwaro na iya haɓaka.

Alamu don amfani

Magunguna Atrogrel Ana amfani dashi don hana bayyanar cututtuka na atherothrombosis a cikin marasa lafiya bayan infarction myocardial (farkon magani - 'yan kwanaki, amma ba a wuce kwanaki 35 ba bayan abin da ya faru), bugun jini na ischemic (farkon farawa - kwanaki 7, amma ba a wuce watanni 6 ba bayan faruwar hakan) ko waɗanda ke fama da cutar ta jijiyoyin jiki
A cikin marasa lafiya da m jijiyoyin jini cuta:
- tare da ciwo na rashin jijiya mara nauyi ba tare da haɓakawa na yanki na ST ba (tsayayyen angina ko myocardial infarction ba tare da raƙumar Q ba), ciki har da marasa lafiya waɗanda aka shigar da ƙwanƙwasa ƙwanƙwasa a yayin angronlasty na jijiya, tare da acetylsalicylic acid
- tare da matsanancin rauni na myocardial infarction tare da haɓaka sashi na ST a haɗe tare da acetylsalicylic acid (a cikin marasa lafiya suna karbar daidaitattun magunguna kuma waɗanda aka nuna su ta hanyar maganin thrombolytic).
Yin rigakafin atherothrombotic da abubuwan thromboembolic a cikin firamillation na atrial.
An nuna Clopidogrel a hade tare da acetylsalicylic acid don majiɓincin manya da ke fama da cututtukan ƙwayar cuta a ciki wanda aƙalla akwai haɗari ɗaya don haɗarin abubuwan da suka faru na jijiyoyin jiki, contraindications don magani tare da bitamin K antagonists (AVK), ƙananan haɗarin zub da jini, don rigakafin atherothrombotic da thromboembolic abubuwan, gami da bugun jini.

Daga tsarin zuciya

Tare da sakamako mai guba na miyagun ƙwayoyi akan tsarin wurare dabam dabam, tachycardia ya bayyana, rushewa da jijiyoyin zuciya da jin zafi a cikin kirji.

Tare da sakamako mai guba na miyagun ƙwayoyi akan tsarin wurare dabam dabam, tachycardia ya bayyana.
Tare da haɓaka sakamako masu illa a cikin ƙwayar gastrointestinal, rage yawan ci yana yiwuwa.
Yawancin marasa lafiya suna da urticaria, rashes.

Daga gefen metabolism

Magungunan ba su da tasiri kai tsaye a kan metabolism, amma tare da haɓaka sakamako masu illa a cikin ƙwayar gastrointestinal, rage yawan ci yana yiwuwa.

A cikin marasa lafiya sun yi niyya ga ci gaban halayen anaphylactoid, a lokuta mafi ƙarancin gaske akwai haɗarin girgiza kwayar cutar anaphylactic, edema Quincke, zazzabi. Yawancin marasa lafiya suna da amya, rashes, da fatar fata.

Amfani da barasa

A lokacin da ake shan magani, ba da shawarar sha giya ba. Ethyl barasa yana cutar da yanayin jijiyoyi na tsakiya da jijiyoyin jini, yana kara yawan tasirin sakamako a cikin narkewar abinci da kuma tsawan lokacin zubar jini. Ethanol na iya haifar da rauni na ganuwar ciki.

Yi amfani da lokacin daukar ciki da lactation

An sanya maganin ne don amfani da mata masu juna biyu, saboda Clopidogrel na iya hana kwanciya da gabobin jiki da tsarin yayin haihuwa, ko kuma zai sami damar zub da jini yayin aikin, wanda ke haifar da mawuyacin hali ga rayuwar mahaifiyar.

An tattara magungunan a cikin gland na dabbobi masu shayarwa kuma an keɓe shi a cikin madara, sabili da haka, yayin kulawa da Atrogrel, ana bada shawarar dakatar da shayarwa.

Ba a buƙatar adjustarin gyaran kashi don lalacewar koda.

Yawan abinciki na Atrogrel

Tare da cin zarafin miyagun ƙwayoyi, haɓakar halayen da ba su da kyau a cikin narkewa na ciki (rauni na huhun ciki, jin zafi a cikin yankin epigastric, zawo da amai, gudawa zuwa gaɓoɓin ƙwayoyin hanji) da kuma tsawan lokaci na zub da jini zai yiwu. Tare da kashi ɗaya na babban kashi, wanda aka azabtar dole ne ya kira motar asibiti. A cikin tsakaitattun wurare, ana yin jigilar jigilar jini don hanzarta mayar da rheological Properties na jini.

Idan mai haƙuri ya shigar da adadin kwamfutoci masu yawa a cikin sa'o'i 4 da suka gabata, to mai haƙuri yana buƙatar shigar da tashin hankali, matse ruwan ciki kuma ya ba da wani abu mai narkewa don rage yawan ƙwayoyin cuta.

Idan ana amfani da miyagun ƙwayoyi, halayen da ba su dace ba a cikin narkewa, misali, amai, na iya haɓaka.
Tare da kashi ɗaya na babban kashi, wanda aka azabtar dole ne ya kira motar asibiti.
A cikin tsakaitattun wurare, ana yin jigilar jigilar jini don hanzarta mayar da rheological Properties na jini.
Thearfafawar basur a cikin gabobin mara amfani yana ƙaruwa ta hanyar aikin Warfarin.

Yin hulɗa tare da wasu kwayoyi

Tare da amfani da Arthrogrel lokaci guda tare da wasu kwayoyi, ana lura da ma'amala tsakanin magunguna masu zuwa:

1. Yayin shan magungunan hana-steroidal anti-mai kumburi, akwai karuwa a cikin yiwuwar zub da jini a cikin gastrointestinal tract. Thearfafawar basur a cikin gabobin mara amfani yana ƙaruwa ta hanyar aikin Warfarin.
2. Yawan plasma na phenytoin da tolbutamide suna ƙaruwa. A wannan yanayin, ba a lura da mummunan halayen daga jiki ba.
3. Heparin da acetylsalicylates ba su tasiri tasirin warkewar Atrogrel.

Babu halayen sunadarai a hade tare da masu hana beta-adrenoreceptor, diuretics, antiepilepti da magungunan hypoglycemic.

Tasiri kan ikon sarrafa abubuwan inji

Magungunan ba ya keta motsin motsi da yanayin aiki na tsokoki mai narkewa. Sabili da haka, yayin lokacin jiyya, an ba da izinin tuki, ikon sarrafa abubuwa masu rikitarwa da sauran ayyukan da ke buƙatar saurin haƙuri na halayen psychomotor da taro.

Abubuwan da aka maye gurbin atrogrel sun haɗa da magunguna masu zuwa, tare da sashi mai aiki mai kama da sakamako na magunguna:

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

Maganin Cardiomagnyl da tafarnuwa Clopidogrel Cardiomagnyl Akwai Koyarwa

Idan babu sakamako na warkewa lokacin shan Atrogrel, ya zama dole a nemi shawara tare da likitanka game da maye gurbin maganin. Sauyawa zuwa wani magani shi kadai ba'a bada shawarar ba.

Ranar karewa

Shahararren maganin analogue shine Cardiomagnyl.
Idan ya cancanta, ana iya maye gurbin maganin da Zilt.
Abubuwan da ke kama da wannan shine Clopidogrel.

Mai masana'anta

Cibiyar Kimiyya da Lafiya ta JSC "Borshchagovsky Chemical da Magungunan Magunguna", Ukraine.

Oleg Hvorostnikov, shekara 52, Ivanovo.

A kan shawarar likita, ya fara shan 1 kwamfutar hannu na 75 MG da dare dangane da bayyanar cututtuka na atherosclerosis na ƙananan ƙarshen. Magungunan sun taimaka, tsananin ya fara jin kasa. Amma a rana ta 5 na magani na kira motar asibiti. Ciwon ciki a cikin kogon ciki ya fara. Ba na ba da shawarar mutane da ke daɗaɗar ci gaba da cututtukan ciki da cututtukan fata. A halin da nake ciki, kuskure ne.

Victor Drozdov, dan shekara 45, Lipetsk.

Aboki wanda, bayan fama da bugun jini, ya zama nakasa, an wajabta shi 1 kwamfutar hannu na Atrogrel na makonni 2. Bayan bugun jini, ischemia ya fara, don haka da wuya hannun dama ya ji. A ƙarshen makon farko na far, farawar ya fara ne a cikin gabar jiki. Magungunan sun ba da sakamako. Likitocin sun ce maganin ya lalata tasoshin jini da karuwar samar da jini a yankin ischemic. Na bar magana mai inganci.

Fom ɗin saki

Atrogrel - Allunan.
Allunan 10 a cikin kumburi, 1 kumburi a cikin fakiti, allunan 10 a cikin boro, 3 fitsari a cikin fakitin.

Kwamfutar hannu 1Atrogrel ya ƙunshi clopidogrel a cikin nau'i na clopidogrel bisulfate, cikin sharuddan 100% clopidogrel - 75 MG.
Mahalarta: croscarmellose sodium, celclose microcrystalline, lactose, castor hydrogenated fim membrane mai: hypromellose, lactose, titanium dioxide (E171), triacetin, carmine (E120).