Acidogrel 75mg An Thien room atherosclerotic room (10 blisters x 10 tablets)

Blood vessels: Staphylococcus (under the skin).

Be cautious when using

Bleeding and hematological disorders

Due to the risk of hemorrhage or adverse hematological reactions, the number of blood cells and other appropriate tests should be determined in time when clinical symptoms suggest hemorrhage occurring during treatment.

As well as other anti-plateletic drugs, Clopidogrel should be used cautiously in patients who increase the risk of bleeding caused by trauma, surgery or other pathological conditions and in patients treated with ASA, Heparin, Glycoprotein IIB/IIIA inhibitors or non-steroid anti-inflammatory drugs (NSAID), including cyclooxygenase-2 inhibitors Serotonin (SSRI).

Patients must be carefully monitored any signs of bleeding including internal bleeding, especially in the first weeks of treatment and after the procedure of heart invasion or surgery. Concomitant use with oral anticoagulant is not recommended because it can enhance bleeding.

If a patient undergo surgery, Clopidogrel should stop for 7 days before surgery. It is necessary to notify patients to know they are susceptible to bruising and bleeding, prolonged bleeding time during clopidogrel treatment. Patients should notify the doctor that they are using clopidogrel before they have surgery or other medications. The drug should be used cautiously in patients who tend to hurt with bleeding trends (especially digestive and intraocularity).

Plateletal hemorrhage (within the first 2 weeks of treatment) occurred in some cases leading to death, in the event of a plateletal hemorrhage that needs to be replaced with emergency plasma.

In patients with a history of transient or stroke anemia, there is a risk of recurrence of ischemic anemia if combined with Aspirin treatment in combination with clopidogrel increases efficiency compared to using clopidogrel simply but also increases the risk of large bleeding.

The risk of gastrointestinal bleeding increases when using clopidogrel. Therefore, it is necessary to be cautious when used for patients with gastrointestinal damage to the trend of bleeding such as ulcers. During Clopidogrel treatment also need to be cautious when using other drugs at risk of gastrointestinal ulcers.

Cytochrom P450 2C19 (CYP219)

Genetically: In poor patients with CYP2C19 metabolic enzymes, in the recommended dose, Clopidogrel is less metabolized into more active substances and reduces anti -platelet aggregation. Test to determine the patient's CYP2C19 genotype.

Clopidogrel is converted into a partially active metabolic substance because CYP2C19, using the enzyme inhibitors can lead to a decrease in the concentration of clopidogrel's active metabolites. The clinical involvement of this interaction is uncertain. To prevent the recommendation of the strong or medium CYP2C19 inhibitors.

Cross reactions between thienopyridine

Patients need to be evaluated for hypersensitivity to Thienopyridine (such as clopidogrel, ticlopidine, prasugrel) since the cross -reaction between the Thienopyridine has been reported. Thienopyridine can cause mild to severe allergic reactions such as rash, angioedema or cross -hematoid reaction such as platelets and neutrophils. Patients with a history of allergies or hematological reactions to a Thienopyridine may increase the risk of reaction to another Thienopyrine. Recommendation to monitor hypersensitive signs in patients with allergies to Thienopyridine.

kidney failure

Experience treatment with clopidogrel in patients with renal failure is limited. So clopidogrel should be used cautiously in these patients.

Hepatic failure

Experience is limited in patients with average liver disease, who may have organs bleeding.

Clopidogrel should be used carefully in these patients.

Autodity warning

This drug contains hydrogenated costor oil, which can cause abdominal pain and diarrhea.

Excipients contain erythrosin red color, which is at risk for allergic reactions.

The ability to drive and operate machinery

drugs do not affect or affect the ability to drive or operate machinery.

Pregnancy

The safety of drugs in pregnant women has not been studied, but should not use clopidogrel for pregnant women.

The period of breastfeeding

Experiments on animals shows clopidogrel and metabolites excreted in milk. So far, no information shows that Clopidogrel has excreted through breast milk or not. Therefore, it is necessary to consider stopping breastfeeding when taking the drug or stopping clopidogrel, depending on the level of need to use the drug in the nursing mother.

Interactive drug

oral anticoagulant drugs

Concomitance Clopidogrel use with anticoagulant drugs is not recommended because it can increase bleeding. Although using Clopidogrel 75 mg/day does not change the pharmacokinetics of s-warfarin or international normalization index (INR) in patients treated with long-term warfarin, simultaneous use of clopidogrel with warfarin increases the risk of bleeding due to independent effects on coagulation.

Glycoprotein IIB/IIIA inhibitors

Clopidogrel should be used carefully in patients with simultaneous use of Glycoprotein IIB/IIIA inhibitors.

acetylsalicylic acid (ASA)

ASA does not change the inhibition of clopidogrel through the ADP intermediaries causing platelet collection, but Clopidogrel makes ASA capable of acting on collagen causing platelet aggregation. However, simultaneous use of ASA 500 mg x 2 times/day in a day does not significantly increase the extension of the bleeding time caused by clopidogrel.

Histopherological interaction between clopidogrel and acetylsalicylic acid may occur, resulting in an increased risk of bleeding. Therefore, it is necessary to be cautious when used simultaneously. However, Clopidogrel and ASA are used for up to 1 year.

heparin

In a clinical study conducted in healthy people, no need to change heparin doses or change the effects of heparin on blood clots. Simultaneous use with heparin does not affect the inhibition of platelets caused by clopidogrel. The pharmacokinetic interaction between clopidogrel and heparin may occur, resulting in an increased risk of bleeding. Therefore, be careful when using clopidogrel and heparin simultaneously.

Blood Blood Protection Drugs

Safety when used simultaneously clopidogrel, fibrin or non-fibrin thrombosis drug and heparin are assessed in patients with acute myocardial infarction. The clinical significant bleeding rate is similar to the use of medications for thrombosis and heparin in combination with ASA.

Non -steroid anti -inflammatory drugs (NSAIDs)

In a clinical study conducted in healthy volunteers, simultaneously using clopidogrel and Naproxen increased gastrointestinal loss. However, due to the lack of interactive studies with other NSAIDs, it is unclear whether it increases the risk of gastrointestinal bleeding with all NSAIDs. Therefore, NSAID drugs include selective inhibitors Cycloxygenase-2 and Clopidogrel should be used cautiously.

SSRIS

SSRI affects platelet activation and increases the risk of bleeding, simultaneous use of SSRI with clopidogrel should be used carefully.

Other simultaneous treatment

Clopidogrel is converted into a partial metabolic metabolitus, using enzyme inhibitors that can lead to a reduction in clopidogrel metabolic concentration. Clinically related of uncertain interactions.

To prevent, do not recommend the use of strong or medium CYP2C19 inhibitors with Clopidogrel. Strong or medium CYP2C19 inhibitors include, for example, Omeprazole and Esomeprazole, Fluoxetine, Fluvoxamine, Moclobemide, Voriconazole, Fluconazole, Ticlopidine, Carbamazepine and Efavirenz.

Proton pump inhibitors (PPI)

Omeprazole 80 mg once a day used at the same time as Clopidogrel or medium of 12 hours between 2 times of medication will reduce the contact of metabolites that are active in 45% (loaded dose) and 20% (maintenance dose). This leads to reduced inhibition of platelet gathering 39% (loaded dose), and 21% (maintenance dose). Esomeprazole also has similar interactions with Clopidogrel.

Data from both observation and clinical studies heterogeneity of pharmacokinetic interaction (PK)/ Pharmacological (PD) on cardiovascular events have been reported. To prevent and use simultaneously with Omeprazole and Esomeprazole is not recommended.

Reducing the exposure of less obvious metabolites has been observed with Pantoprazole or Lansoprazole. The plasma concentration of metabolites has a 20% decrease in activity (loaded dose) and 14% decrease (maintenance dose) when treating simultaneously pantoprazole 80 mg once a day. This leads to reduction in platelet gathering, equivalent to 15% and 11%.

These results show that Clopidogrel can be used simultaneously with Pantoprazole. There is no evidence that other drug products reduce gastric acid such as H2 hypotrusic receptor blockers or anti -acid anti -acid drugs that prevent plateloon resistant activity of clopidogrel.