Diseases of the cardiovascular system are in modern medicine almost in the first place. The mortality rate for these diseases is the highest. There are problems in this area that can haunt a person from the moment of birth. However, there are those in whose development a person personally brings a considerable “contribution”. One of these diseases is atherosclerosis. In this problem, the arteries of the elastic and muscular-elastic types are mainly affected. The essence of the disease is that, due to a violation of protein and lipid metabolism, deposits of cholesterol and some components of lipoproteins accumulate in the arteries. Thus, atherosclerotic plaques are formed. Over time, the connective tissues of the vascular walls in these plaques expand, which leads to a narrowing of the lumen of the artery up to blockage.
In order to help such patients, scientists have developed a whole range of drugs that can slow down or completely suppress the process of aggregation (bonding, gluing) of platelets. Substances with such capabilities are called antiplatelet agents (antithrombotic agents). One of these is the drug "Plagril."
Composition and form of release
The drug is available in tablets, covered with a pink film coating. Tablets are round, biconvex. On one side is embossed “With 127”. The main active ingredient of the drug is clopidogrel. Incidentally, the drug "Plagril" INN (international non-proprietary name) is identical to the name of the main component - clopidogrel. The content in one tablet - 75 mg. In addition to the main component, the drug contains auxiliary substances: microcrystalline cellulose, mannitol, croscarmellose sodium, colloidal silicon dioxide, magnesium stearate. Manufacturers produce the drug in blisters for 10 pieces.
The mechanism of the drug
The drug is a specific inhibitor (inhibit - inhibit, suppress any process) platelet aggregation (compound). It has a coronary expanding action. The process of slowing down platelet aggregation (approximately 40%) can be seen after 2 hours have elapsed after ingestion of the drug at a dosage of 400 mg. In order to achieve maximum efficiency (60% aggregation suppression) from the effects of the Plagril tablets, the instructions for use indicate the need for therapy for 4-7 days. The total dose per day should be from 50 to 100 mg. In this case, the antiplatelet effect will continue throughout the entire life cycle of platelets (from 7 to 10 days). During 5 days after drug withdrawal, the rate of platelet aggregation and bleeding time will return to their original values.
Excreted from the body "Plagril" kidneys and intestines (50% and 46%, respectively). The withdrawal period is 120 hours after ingestion.
The main consumers of "Plugril"
There are special groups of core patients who are shown to use the drug "Plagril". The instruction prescribes taking the drug to people suffering from vascular atherosclerosis. The drug is effective in prophylactic purposes to reduce the likelihood of complications associated with thrombosis in people who have had a myocardial infarction or ischemic stroke. It is also important for patients suffering from occlusion (impaired patency) of peripheral arteries.
In tandem with acetylsalicylic acid (aspirin), it is possible to use Plagril to prevent thrombotic complications in those suffering from acute coronary syndrome. This can include people with angina pectoris (unstable form), with myocardial infarction without the formation of Q wave. You can use the drug in patients who have undergone stenting. The essence of the operation is the installation of a stent in the affected vessel (a thin, finely metallic metal tube), which is subsequently inflated with a special balloon, thereby increasing the patency of the vessel and improving the blood supply to the heart.
Dosing: modes of use
The drug "Plagril" patients can take orally, regardless of the diet. In patients undergoing myocardial infarction, ischemic stroke or having an established diagnosis for worsening patency of the arteries, the dose in the amount of 75 mg is taken once a day. The period of treatment therapy after Q-forming myocardial infarction can last up to 35 days. In patients with ischemic stroke, depending on the severity of the condition, the treatment can range from 7 days to six months.
При стенокардии в нестабильной форме и инфаркте миокарда без образования Q-зубца обычно стандартная схема приема таблеток выглядит следующим образом: вначале однократная нагрузочная доза в 300 мг, далее по 75 мг в сутки параллельно с приемом аспирина (от 75 до 325 мг в сутки). Поскольку на фоне приема аспирина увеличивается риск развития кровотечений, то максимальная однократная доза не должна быть более 100 мг. Курс лечебной терапии – до 1 года.
When myocardial infarction is also shown taking antiplatelet "Plagril." Tablets are prescribed to take in the dosage of 75 mg, one per day. It is recommended to begin therapy with an initial loading dose in combination with acetylsalicylic acid. It is possible to take trombolitics in parallel (or you can not take it).
If patients have stepped over the 75-year-old age, “Plagril” (analogs with clopidogrel is also acceptable to be taken) is prescribed without an initial loading dose. After the onset of symptoms, the combined treatment should be started as early as possible. The course must last at least 4 weeks.
Possible adverse events
During the course of treatment with the drug "Plagril", the instructions for use bring to the attention that various side effects are possible from various systems and organs.
The blood coagulation system can most often respond with the appearance of gastrointestinal bleeding. Less commonly, hemorrhagic strokes, nosebleeds and, in general, an increase in bleeding time are possible. In rare cases, hematomas and hematuria may appear.
There are various manifestations of the hematopoietic system. These include eosinophilia, neutropenia, thrombocytopenia. Granulocytopenia, simple or aplastic anemia is much less common.
On the part of the central and peripheral nervous systems, headaches, dizziness, paresthesia, vertigo (loss of balance, accompanied by a sense of rotation of objects around the body or vice versa - body rotation), hallucinations, confusion can occur. Quite rarely, but there are cases of adverse events on the part of the cardiovascular system, which are expressed in lowering blood pressure, the development of vasculitis. Bronchospasms and interstitial pneumonitis - this may be the reaction of the respiratory system to the drug.
Most often, the digestive system responds to the drug "Plagril" (reviews of doctors and patients confirm this fact). The reaction of the body is manifested in the development of diarrhea, dyspepsia, abdominal pain. Less common reactions in the form of nausea, vomiting, constipation, exacerbation of gastritis and gastric and duodenal ulcers, flatulence. Rarely, but the occurrence of such diseases as colitis, pancreatitis, stomatitis, hepatitis, changes in taste, the development of acute liver failure.
The musculoskeletal system can declare itself arthritis, myalgia. Although this does not happen often. Glomerulonephritis can result from a urinary tract reaction. Doctors, dermatologists say that a possible consequence of the use of "Plagril" is itching, bullous rash, erythematous rash, lichen planus, eczema. Perhaps the development of allergic reactions in the form of angioedema, anaphylaxis, serum sickness. Of the common side effects can be noted increased body temperature, elevated serum creatinine.
The use of "Plagril": what to look for
If an antiplatelet effect is undesirable for a particular situation, or surgical intervention is assumed, then treatment with Plagril should be discontinued. Instructions for use recommends doing so at least 7 days before surgery. After discontinuation of the medication, it will take longer to stop the bleeding that suddenly began. Patients should be warned about this and advised to inform the attending physician about each unusual bleeding. It is in the interest of the patient to inform the doctor about the treatment with “Plagril” in those cases, if any surgical intervention is to be performed, or if a patient is prescribed some new drug.
In the process of conducting therapeutic therapy, it is important to keep control over the indicators of the homeostasis system (platelet count, tests of their functional activity, APTT). The functional activity of the liver should also be regularly monitored and analyzed, as severe abnormalities in its work may increase the risk of hemorrhagic diathesis.
Medicines in which clopidogrel is the main active ingredient (“Plagril”, analogues) are not recommended for people who have had an acute myocardial infarction, at least for the first few weeks after the onset of the disease. Medical workers do not recommend to carry out therapy with “Plagril” in the presence of unstable angina, in patients with ischemic stroke, with coronary bypass surgery.
With a certain degree of caution, they are prescribed to take the drug to people with impaired kidney function.
Who is contraindicated reception "Plagril"?
"Plagril" (pills) instruction prohibits patients with hypersensitivity or individual intolerance to the main and auxiliary components of the drug. You can not take the drug for any diseases that predispose to the development of bleeding (gastric ulcer and duodenal ulcer, hyperfibrinolysis, lung tumors, tuberculosis, etc.). A weighty reason for not using Plagril is acute hepatic failure, hemorrhagic syndrome. In addition to the foregoing, taking medication is contraindicated for pregnant women and nursing mothers. Drug prescription is unacceptable for children under the age of 18.
On the modern pharmaceutical market, the group of antiplatelet drugs (“Plagril”, its synonyms in terms of the content of the main active ingredient) is represented quite widely. More than 3 dozens of drugs - antiplatelet agents have the same active ingredient (clopidogrel) and in the same dosage (75 mg). In addition to Russian manufacturers, antiplatelet drugs are manufactured by Indian pharmaceutical companies, enterprises of Hungary, Israel, Malta, and France.
The Plagril itself is produced by the Indian company Dr. Reddis Laboratories. The analogs include the French Plavix, the German Klopidogrel-ratiofarm, the Hungarian Klopidogrel-Richter, the Israeli Klopidogrel-Teva, the Maltese Liporel, the Macedonian Liszt 75. Of the most well-known and widely sought after Russian drugs can be distinguished "Zilt".
Zilt - Russian "Plugril"
The main active ingredient of the drug "Zilt" ("Plagril" in this fully corresponds to it) is clopidogrel. The drug belongs to the group of antiplatelet agents. The initial dose (for "Zilt" - 400 mg) after 2 hours after administration slows down platelet aggregation. As well as “Plagril”, “Zilt”, subject to receiving 50-100 mg per day, the maximum therapeutic effect will be given after 4-7 days.
The drug is metabolized in the liver. In the composition of the blood active metabolites are not detected. Approximately 50% "Zilta" is excreted by the kidneys, the remaining 46% within 5 days after administration will be excreted through the intestines.
The indications for use in Zilt are the same as in Plagril: prevention of thrombosis in patients who have had a myocardial infarction, ischemic stroke or artery impaired.
Like any drug, "Plugril" has both positive consumer ratings and negative reviews. There are patients to whom the drug was prescribed for the treatment of angina and showed itself to be a very effective drug. With its use, the attacks either went away at all, or they became significantly smaller. Are in solidarity with consumers in the evaluation of the drug "Plagril" reviews of doctors.
However, you can also find comments on side effects caused by the use of the drug. Some patients wrote about the appearance of hematomas, while others clearly showed anemia. The patients also had bouts of severe headaches, and the most diverse orientation disorders in the digestive system. Rarely, but you can hear about a gastric ulcer or duodenal ulcer developed in the process of “Plagrila” intake.
In general, it should be said that the drug "Plagril" instructions for use is positioned as a fairly serious drug that is not compatible with all medicines. It has a fairly extensive list of contraindications, can cause a lot of side effects from a variety of systems and organs. Uncontrolled use can stimulate quite negative (and sometimes irreversible) consequences for the patient's health.
The conclusion from all of the above suggests itself. "Plagril" for treatment should be appointed by the attending physician. And the most optimal treatment option for this drug is in the hospital and under the supervision of a leading specialist. Only in this case, you can hope for a positive effect from taking the drug with minimal risk of side effects.