Clinical and pharmacological group: & nbsp

Antiaggregants

Included in the formulation
  • Agregal
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    NIZHFARM, JSC     Russia
  • Déplat®-75
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  • Detromb®
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    Anvilab, OOO     Russia
  • Zilt®
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    KRKA-RUS, LLC     Russia
  • Cardogrel®
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    Sandoz d.     Slovenia
  • Cardutol®
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    Apothec Inc.     Canada
  • Klapitax
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  • Clopidex®
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  • Clopidogrel
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    REPLEK FARM Skopje, OOO     Macedonia
  • Clopidogrel
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    NANOLEC, LTD.     Russia
  • Clopidogrel
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    Zentiva c.s.     Czech Republic
  • Clopidogrel
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    RAFARMA, CJSC     Russia
  • Clopidogrel
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    BIOKOM, CJSC     Russia
  • Clopidogrel
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  • Clopidogrel-Akrihin
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  • Clopidogrel-LEXMM®
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    PROTEK-SVM, LLC     Russia
  • Clopidogrel-Richter
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    GEDEON RICHTER, OJSC     Hungary
  • Clopidogrel-SZ
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    NORTH STAR, CJSC     Russia
  • Clopidogrel-TAD
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    TAD Pharma GmbH     Germany
  • Clopidogrel-Teva
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  • Clopilet
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  • Clopirel
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    Rowecq Limited     United Kingdom
  • Lirta®
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    Alkaloid, JSC     Macedonia
  • Lopyrel
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    AKTAVIS GROUP, AO     Iceland
  • Pidogrel
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  • Plavix®
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  • Plavix®
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  • Plagril®
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  • Piltrel
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  • Targetec®
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  • Troken
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  • Thromboreal
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  • Egitromb
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  • Included in the list (Order of the Government of the Russian Federation No. 2782-r of 30.12.2014):

    VED

    ONLS

    АТХ:

    B.01.A. C.04   Clopidogrel

    Pharmacodynamics:Inhibitor of platelet aggregation. Irreversibly binds to receptors adenosine diphosphate thrombocytes, suppressing their activation.This effect develops 2 hours after admission (40% inhibition) of the initial dose of 400 mg. The maximum effect (60% suppression of aggregation) is on the 4-7th day of constant admission in a dose of 50-100 mg per day. The duration of the effect is 7-10 days, due to the renewal of the platelet pool.
    Pharmacokinetics:Bioavailability of 50%. Relationship with plasma proteins 98-94%. Biotransformation in the liver. Elimination is mainly kidney (50%) and intestine (46%).
    Indications:Prevention of atherothrombotic complications in patients who underwent myocardial infarction, ischemic stroke or with diagnosed occlusive disease of peripheral arteries.

    Acute coronary syndrome without ST segment elevation (unstable angina or myocardial infarction without Q wave).

    After stenting the coronary arteries.

    IX.I20-I25.I24.90   Acute ischemic heart disease, unspecified with hypertension

    IX.I20-I25.I25.2   Postponed myocardial infarction

    IX.I60-I69.I63   Cerebral infarction

    IX.I70-I79.I73.8   Other specified diseases of peripheral vessels

    Contraindications:Use in newborns, pregnant women is prohibited - there is insufficient data on the safety and efficacy of the drug.In elderly patients (over 75 years of age) treatment should begin without a loading dose in all cases.

    Other contraindications: hypersensitivity; hemorrhagic syndrome; peptic ulcer of the stomach and duodenum; nonspecific ulcerative colitis; tuberculosis; lung tumors; hyperfibrinolysis; Acute bleeding (including peptic ulcer and intracranial hemorrhage).

    Carefully:Diseases of the liver and kidneys, injuries, preoperative period.
    Pregnancy and lactation:The action category for the fetus is FDA-B. In animal studies fetotoxicity of the drug was not detected. There were no adequate controlled studies among pregnant women. During pregnancy clopidogrel appoint only if it is clearly necessary.

    There is no data on the penetration of the drug into breast milk. In experiments on animals, it was found in the breast milk of rats. It is necessary to decide, taking into account the importance of the drug for the patient, whether to cancel the drug for the time of breastfeeding or stop lactation for the period of treatment with clopidogrel.

    Dosing and Administration:The maximum single and daily dose of 75 mg. Clopidogrel take regardless of food intake. A powerful antiplatelet effect with a loading dose of 600 mg twice a day is described; indicates its better efficacy compared with the standard scheme of 300 + 75 mg.

    With occlusive diseases of peripheral arteries, in patients who underwent myocardial infarction, cerebral circulation impairment is prescribed internally 75 mg once a day, without a starting loading dose.

    In acute coronary syndrome without ST segment elevation, and also after stenting of the coronary arteries, a loading dose of clopidogrel 300 mg orally is required once. Then the treatment scheme is the same.

    In acute coronary syndrome with ST segment elevation, a loading dose of 300 mg is given intravenously, then according to the usual schedule. At the same time, in addition, acetylsalicylic acid is additionally administered; this combination of drugs has proven effective in patients in this group. The course of treatment is at least 4 weeks after the event.

    Application in elderly patients

    Patients older than 75 years clopidogrel is prescribed in a dose of 75 mg per day without a loading dose. The course of treatment is 28 days.

    Use in children

    The drug is well tolerated by children, the recommended dose is 1 mg / kg per day.

    Side effects:From the nervous system and sensory organs: fatigue, asthenia, headache, dizziness, paresthesia, leg cramps, hyperesthesia, neuralgia, cataracts, conjunctivitis.

    From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): peripheral edema, arterial hypertension, heart failure, generalized edema, syncope, palpitation, thrombocytopenia, anemia (aplastic or hypochromic), agranulocytosis, leukopenia, neutropenia.

    Coagulation disorders and bleeding: purpura, extravasates, epistaxis, gastrointestinal bleeding, joint bleeding, bleeding from the urinary tract, hemoptysis, intracranial hemorrhage, retroperitoneal hemorrhage, bleeding from the operating wound, intraocular hemorrhage, hemothorax, pulmonary hemorrhage, allergic purpura, thrombocytopenic thrombohemolytic purpura.

    On the part of the digestive system: abdominal pain, indigestion, diarrhea, nausea, vomiting, constipation, taste disturbance, perforation of the stomach ulcer, hemorrhagic gastritis,bleeding from the ulcers of the upper gastrointestinal tract, increased activity of hepatic enzymes, hyperbilirubinemia, hepatitis, steatosis of the liver.

    From the musculoskeletal system: arthralgia, back pain, arthritis, arthrosis.

    On the part of the respiratory system: inflammation of the upper respiratory tract, dyspnea, rhinitis, bronchitis, cough, pneumonia, sinusitis.

    From the genitourinary system: urinary tract infection, cystitis, menorrhagia.

    From the skin: rash, itching, eczema, skin ulcerations, bullous dermatitis, erythematous rash, maculopapular rash, urticaria.

    Other: pain in the chest, trauma, flu-like symptoms, pain. Individual cases of hemolytic uremic syndrome, membranous nephropathy and hypersensitivity reactions (angiootec, bronchospasm, anaphylactic reactions) have been reported.

    Overdose:No data.
    Interaction:The drug does not interact with food.

    Acetylsalicylic acid. Strengthens (mutually) anti-aggregation effect and increases the risk of hemorrhagic complications.

    Sodium Heparin. Clopidogrel increases (mutually) the effect and risk of hemorrhagic complications.

    Warfarin. Joint use of clopidogrel with warfarin may increase the intensity of bleeding, therefore, with the exception of special rare clinical situations (such as the presence of a floating thrombus in the left ventricle, stenting in patients with atrial fibrillation), co-administration with warfarin is not recommended.

    Omeprazole. The simultaneous use of omeprazole and clopidogrel should be avoided, as the results of studies indicate an interaction between these drugs, which leads to a decrease in the concentration of the active metabolite of clopidogrel by an average of 40% and a decrease in inhibition of platelet aggregation by an average of 14%.

    Non-steroidal anti-inflammatory drugs. Simultaneous administration of clopidogrel and non-steroidal anti-inflammatory drugs increases the risk of ulcers of the gastrointestinal tract and ulcer bleeding.

    Special instructions:In the treatment of clopidogrel, bleeding time should be monitored (usually an increase of 2-5 times, may be delayed): a detailed blood test (including platelets, neutrophils, erythrocytes) before therapy, every 2 weeks for the first 3 months, in If canceled, 2 weeks after discontinuation of the drug.

    Treatment with a combination of clopidogrel with acetylsalicylic acid should last 12 months from the time of the last acute coronary syndrome without ST-segment elevation, then the transition to standard treatment with low doses of acetylsalicylic acid is recommended.

    Clopidogrel in the form of monotherapy is recommended for patients with intolerance to acetylsalicylic acid or in the case of development of vascular disorder or symptoms of peripheral arterial disease.

    In patients who underwent myocardial infarction, treatment begins as quickly as possible and lasts up to 35 days after a heart attack.

    In post-stroke patients, clopidogrel treatment begins strictly from the 7th day and lasts 6 months.

    Instructions
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