Dosage diphosphate receptor located on the surface of platelets, and activation of GP II / IIIa complex. This leads to the inhibition of ADP-dependent platelet aggregation. This also leads to inhibition of platelet aggregation under the influence of other stimuli; ADP decreased the effect produced by each activated platelet, and stimulated platelet aggregation remaining. Clopidogrel effect lasts throughout the life of the platelet, platelet function is restored in 7-10 days after discontinuation of clopidogrel.
In the long-term administration of therapeutic doses of clopidogrel (75 mg daily), a significant inhibition of platelet aggregation is celebrated on the first day of treatment and then primobolan dosage gradually increases antiplatelet effect and It reaches a maximum at 3-7 days of regular treatment. Chronic administration of therapeutic doses of the average level of inhibition is between 40 and 60%. After the treatment effect of clopidogrel on the aggregation and bleeding time usually decreases within 5 days.
- hypersensitivity to clopidogrel and / or any of the components;
- severe hepatic impairment;
- gemorrargichesky syndrome, acute bleeding (including intracranial hemorrhage) and diseases that predispose to its development (gastric ulcer and 12 duodenal ulcer in the acute stage, ulcerative colitis, tuberculosis, lung cancer, hyperfibrinolysis);
- pregnancy and lactation;
- age 18 years.
Precautions: the drug is not administered in the first few days after a heart attack. Clopidogrel prolongs bleeding time. Use with caution in patients with increased risk of bleeding after injuries, operations or as a result of other pathological conditions, as well as patients with a propensity to bleed (particularly gastrointestinal and intraocular bleeding) in patients with impaired renal function with severe hepatic insufficiency.
Dosing and Administration
Inside, regardless of meals.
- Myocardial infarction, stroke, diagnosed peripheral arterial occlusive disease :
drug Zilt® recommended to take 1 tablet (75 mg), 1 per day.
- Acute coronary syndrome: segment elevation ST (unstable angina or myocardial infarction without the formation of the tooth the Q):
treatment with clopidogrel should be initiated with a single dose of a loading dose (300 mg) and then continued taking a dose of 75 mg once daily (in combination with ASA in doses of 75-325 mg per day).Since higher doses of ASA associated with greater risk of bleeding, the recommended dose of ASA should not exceed 100 mg. The maximum beneficial effect is observed for the third month of treatment.The course of treatment up to 1 year.
- In patients with acute myocardial infarction segment elevation ST:
clopidogrel assigned once daily at a dose of 75 mg with an initial loading dose in combination with acetylsalicylic acid, with or without thrombolysis.For patients older than 75 years of clopidogrel treatment should be carried out without the use of a loading dose.Combination therapy is started as soon as primobolan dosage possible after the onset of symptoms, and continued for at least four weeks.The safety of the combination of clopidogrel with ASA for more than 4 weeks has not been studied.Side effects
Adverse events rarely require discontinuation of treatment with clopidogrel.
- Common: chest pain, injury, flu-like symptoms, pain, fatigue, asthenia, hernia;
- Central and peripheral nervous system: headache, dizziness, paresthesia, leg cramps, hypersthesia, neuralgia;
- The autonomic nervous system: syncope, palpitations;
- Cardiovascular system: peripheral edema, hypertension, heart failure, generalized edema;
- Gastrointestinal tract: abdominal pain, dyspepsia, diarrhea, nausea, constipation, vomiting, taste disturbances, perforation of the stomach ulcer, hemorrhagic gastritis, ulcers, bleeding from the upper gastrointestinal tract;
- Liver and biliary ways: increase in liver enzymes, hyperbilirubinemia, hepatitis, hepatic steatosis;
- Blood and blood forming organs: thrombocytopenia, anemia (aplastic or hypochromic), agranulocytosis, leukopenia, neutropenia;
- Coagulation disorders and bleeding: purple, extravasates, epistaxis, gastrointestinal bleeding, bleeding in the joints, bleeding from the urinary tract, hemoptysis, intracranial bleeding, retroperitoneal bleeding, bleeding from surgical wounds, eye hemorrhage, hemothorax, pulmonary hemorrhage, allergic purpura, thrombotic thrombocytopenic purpura;
- Musculoskeletal system: arthralgia, back pain, arthritis, arthrosis;
- Respiratory system: inflammation of the upper respiratory tract, shortness of breath, rhinitis, bronchitis, cough, pneumonia, sinusitis;
- Skin: rash, itching, eczema, skin ulceration, bullous dermatitis, erythematous rash, maculopapular rash, urticaria;
- Senses: cataract, conjunctivitis;
- Urogenital: urinary tract infections, cystitis, menorrhagia.
In addition to the above expected undesirable effects in the treatment of clopidogrel was reported a primobolan dosage few cases of hemolytic uremic syndrome, membranous nephropathy and hypersensitivity reactions (angioedema, bronchospasm, anaphylactic reactions).
In the literature, there is one report of an intentional overdose (intoxication). Upon receiving 1050 mg of clopidogrel (14 tablets) was not observed signs and symptoms of overdose.
Interaction with other medicinal products
is not recommended to co-administration of clopidogrel and warfarin due to the increased risk of bleeding.
Aspirin does not alter the adenosine diphosphate-induced platelet aggregation induced by clopidogrel. However, periodic assignment acetylsalicylic acid (maximum 1000 mg per 24 hours) did not cause prolonged bleeding time. Clopidogrel can potentiate the effect of aspirin on platelet aggregation induced by collagen. Potential pharmacodynamic interaction between clopidogrel and acetylsalicylic acid increases the risk of bleeding, so concomitant use of clopidogrel and acetylsalicylic acid is possible not more than one year. The issue of joint use of these drugs should be comprehensively evaluated.
In connection with the increased risk of bleeding is recommended to be cautious while appointing clopidogrel and heparin or other thrombolytic agents.
Co-administration of clopidogrel and NSAIDs increases the risk of ulcers of the gastrointestinal tract and ulcer bleeding. Therefore, caution should be exercised while appointing them.
There were no significant clinical interactions with concomitant administration of clopidogrel and:. Atenolol, ACE inhibitors, agents reduce blood cholesterol, nifedipine, digoxin, phenobarbital, cimetidine, estrogen, or theophylline
Clopidogrel inhibits enzyme activity CY2C9 cytochrome P450 system while the use of drugs metabolized with the participation of the enzyme (phenytoin, tolbutamin) may increase their blood plasma.Antacids do not affect the absorption of clopidogrel.
Clopidogrel prolongs bleeding time. It should be administered with caution in patients with an increased risk of bleeding after injuries, operations or as a result of other pathological conditions, as well as patients with a propensity to bleed (particularly gastrointestinal and intraocular hemorrhage). Clopidogrel treatment should be discontinued at least 7 days before the planned surgery (including dental procedures).
Patients should be advised that during treatment with clopidogrel has an increased tendency to bleeding and bleeding may last a little longer than usual before you yourself stop. In the case of minor cuts (e.g., during shaving) and injuries usually not require any special measures. For large cuts or injuries require immediate consultation with a physician.
In the period of treatment is necessary to monitor the performance of the hemostatic system (platelet count, platelet function tests); regularly examine the functional activity of the liver.
Patients with severe hepatic impairment, caution should prescribe clopidogrel in mind the increased risk of bleeding.
Co-administration of warfarin and clopidogrel is not recommended due to increased risk of bleeding.
Co-administration of clopidogrel and non-steroidal anti-inflammatory drugs increase the risk of gastrointestinal ulcers tract. Therefore, this combination is used in exceptional cases.
The safety and efficacy of clopidogrel use in children and adolescents under 18 years of age has not been established, so it is not assigned to patients in this age group.
Effects on ability to motor vehicles and management mechanisms.
Do not set the effect of the primobolan dosage drug on the ability to drive vehicles and operate machinery.
Film-coated tablets 75 mg. 10 tablets in a blister pack. 3 or 9 blisters in a carton box together with instructions for use
According to 7 tablets in a blister. 2, 4, 8 or 12 in the blister pack carton along with instructions for use.
Do not use after the expiration date printed on the package.