Tương Tác Thuốc Và Chú ý Khi Chỉ Định

B y t
TNG TC THUC V
CH KHI CH NH
nh xut bn y hc
H Ni - 2006
Ch bin
GS. TS. L Ngc Trng
TS. Khng Chin
Bin son
GS. m Trung Bo
DS.CK I. Nguyn Th Phng Chm
DS.CKII. V Chu Hng
GS. TSKH. Hong Tch Huyn
GS. ng Hanh Phc
DS.CKII. Nguyn Xun Thu
DS.CK II. V Ngc Thu
BS.CK II. Nguyn Vn Tip
Hiu nh
DS. Qu Dim
GS.TSKH. Hong Tch Huyn
Th k bin son
DS CKI. Nguyn Th Phng Chm
Th k
BS. ng Thu H
DS. Phm Thanh Huyn
BS. Trng L Vn Ngc
ThS. Lng Ngc Phng
ThS. ng Quang Tn
BS. Hong Thu Thy
BS. Nguyn Hi Yn
Xy dng phn mm
ThS. Phm xun vit
LI NI U
Thc hnh k n tt, thc hnh dc tt v thc hnh chm sc ngi bnh tt l cc
khu nhm m bo s dng thuc hp l, an ton cho ngi bnh. Khi iu tr cho
ngi mc ng thi nhiu bnh th khng th trnh c phi dng ng thi nhiu
thuc. Nhng s dng ng thi nhiu thuc cng lc c th gy ra mt trng thi bnh
l do tng tc thuc - thuc. Mt khc cn thn trng khi s dng thuc trn mt s
bnh nhn c bit nh suy gan, suy thn, suy mch vnh, ngi cao tui, ph n c
thai v cho con b... Lm th no va t c hiu qu iu tr, nhng trnh c
tng tc bt li m bo an ton cho ngi bnh, c ngha l m bo s dng
thuc hp l, an ton. Yu cu ny i hi cc nh chuyn mn v y t cn thn trng
trong tt c cc khu s dng thuc cho ngi bnh: Trc ht bc s k n phi m
bo n khng c cc nguy c bit; tip theo l dc s c trch nhim pht hin cc
tng tc thuc nguy him khi c n thuc; cui cng l iu dng phi nhn bit
nhng du hiu lm sng ca mt hay nhiu tc dng nguy hi khi ngi bnh dng
thuc v m bo a thuc vo dch tim truyn, pha nhiu thuc trong cng mt bm
tim nhng hot cht tng hp v phng din l ho. Nh vy bc s, dc s v iu
dng u cn c thng tin v tng tc thuc v ch khi ch nh. Bc s, dc s v
iu dng khng phi lc no cng c th nh ht c tt c mi thng tin v tng
tc thuc v cc ch khi ch nh. Do cn c mt cun sch tra cu, gip trnh
nhng sai st do thiu thn trng t nhiu c th gy ra nguy him, hoc gip ta kim tra
li khi c nghi ng trong iu tr.
Tng tc thuc v ch khi ch nh l cun sch gip bc s thc hnh k n
tt, dc s thc hnh dc tt v iu dng thc hnh dng thuc ng cch, theo di
pht hin biu hin bt thng ca ngi bnh khi dng thuc. c bit trong nhng
trng hp bt buc cn kt hp thuc cho ngi bnh th bc s c th tin on v
chun b x tr khi c tng tc bt li xy ra. Khi nghin cu v Tng tc thuc v ch
khi ch nh bc s, dc s v iu dng c th nh gi c nguy c i vi ngi
bnh tng trng hp c th, nhm thc hin s dng thuc hp l, an ton cho ngi
bnh.
V khun kh ca cun sch (v thi im v ti liu tham kho khi bin son c hn)
nn nhng thuc khng c trong sch hoc phn mm ny khng c ngha l khng c
ch khi ch nh v khng c tng tc thuc. Tng tc thuc trong cun sch ny ch
cp n tng tc thuc - thuc, khng cp n tng tc thuc - thc n hoc
cc loi tng tc khc.
Tng tc thuc v ch khi ch nh l cun sch tra cu nhanh, thun li
trong thc hnh, ng thi l c s d liu cho phm mm km theo, do v cu trc
cun sch c mt s c im khc so vi mt cun sch thng thng (mi tng tc
thuc c trnh by hai ln, mi ln mt h tng tc vi nhau).
Phn mm dng trn h iu hnh Windows cho php tm v pht hin nhng
tng tc thuc v ch khi ch nh ca tt c cc thuc ghi trong sch, khng ph
thuc vo phn loi thuc tra cu nm trong bao nhiu h, trong khi cun sch in ch cho
php tm hiu cc thuc c trong hai h ca cun sch.
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Mc d c t chc bin son cng phu v thm nh cht ch, nhng do bin son
ln u, chc chn cun Tng tc thuc v ch khi ch nh khng trnh khi thiu
st. Ban bin son xin chn thnh cm n s ng gp qu bu ca cc chuyn gia y,
dc trong qu trnh bin son v s gp ca cc bn ng nghip trong qu trnh s
dng cun sch c hon thin hn trong nhng ln ti bn sau.
H Ni, thng 7 nm 2006
Ban bin son
MC LC
Li ni u
Hng dn s dng sch v phn mm
I. Tra cu thng tin
1. Tra sch tm thng tin
2. Tra trn phn mm tm thng tin
II. Mc tng tc v ch khi ch nh
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3. Mc ch khi ch nh
10
4. Mc tng tc thuc
10
III. nh gi nguy c tng tc thuc

Phn mt
10
13
Khi nim v tng tc thuc
13
I. Tng tc thuc - thuc
14
1. Tng tc dc ng hc
14
2. Tng tc dc lc hc
22
II. Tng tc thuc - thc n
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1. nh hng ca thc n ti ng hc, tc dng v c tnh ca thuc
26
2. nh hng ca thc ung ti ng hc, tc dng v c tnh ca thuc
28
III. Tng tc thuc - trng thi bnh l

Phn hai
Ni dung tng tc thuc v ch khi ch nh
Phn tra cu
30
35
35
1109
Mc lc tra cu cc nhm thuc
1109
Mc lc tra cu tn thuc v bit dc
1115
Ti liu tham kho
1159
HNG DN S DNG SCH V PHN MM

Trc khi s dng sch cn c k phn m u, hng dn s dng v
khi nim v tng tc thuc nm chc thng tin nhm s dng tt nht
cun sch
I. TRA CU THNG TIN
1. Tra sch tm thng tin
Khi bit thuc thuc nhm no xin s dng Mc lc tra cu nhm thuc tm s
trang ca h thuc. Nu khng nh thuc thuc nhm no ch bit tn thuc hoc tn
bit dc xin s dng Mc lc tra cu thuc v bit dc tm s trang ca thuc.
Tm n trang bit, tm thuc trong mc Cc thuc trong nhm, tm tip mc Ch
khi ch nh c thng tin v thuc ny. Mun tm tng tc ca hai thuc khi bit
thuc th 1 (hoc th 2) thuc nhm no xin s dng Mc lc tra cu nhm thuc v
tm thuc trong mc Cc thuc trong nhm v mc Tng tc thuc tm thuc th 2
(dng cng lc vi thuc th 1) tm tng tc gia thuc th 1 v thuc th 2
V d: Tm ch khi s dng ca acyclovir v tng tc gia acyclovir vi
theophylin.
Trc tin s dng Mc lc tra cu nhm thuc (hoc Mc lc thuc v bit dc)
tm s trang c nhm thuc (hoc tn thuc acyclovir), tip theo tra mc Ch khi ch
nh tm thng tin v phn ny. Tm trong mc Tng tc thuc ta thy dng di c
ch in m u dng Tng tc cn thn trng : mc 2, c ngha l cc thuc vit
u dng m pha di (c thuc theophylin) s c tng tc cn thn trng (mc 2)
vi acyclovir, thng tin ny cho ta bit acyclovir tng tc vi theophylin mc 2 v
cn thn trng khi dng kt hp hai thuc ny.
2. Tra trn phn mm tm thng tin
Phn mm cho php cp nht thng tin nhanh hn sch v tra cu gn nh tc
th. Th t tm kim nh sau:
Trc ht cn nhn chut vo phn tn gc hay tn bit dc (tu theo thuc
mang tn gc hay tn bit dc). G tn thuc cn tm, nhn chut vo tn thuc
tng ng trong danh mc pha di. Vi mt thuc nu ca s n thuc xut hin
mt chm vng bn tri tn thuc chng t c chng ch nh. nh du tn thuc
v nhn chut vo mc Ch khi ch nh s xut hin cc mc ch khi ch nh.
G tip tn thuc khc, nhn chut vo tn thuc tng ng trong danh mc pha di.
Nu xut hin mt chm bn tri ca hai thuc trong phn n thuc l c tng
tc thuc. Nhn chut vo mc Tng tc thuc s xut hin phn phn tch v x l
tng tc. Nu n thuc c nhiu thuc v xut hin nhiu tng tc, nh du mi
tng tc s cho kt qu phn tch v x l mi tng tc pha di.
II. MC TNG TC V CH KHI CH NH
Mc ch khi ch nh (gm cc thn trng v chng ch nh khi dng thuc)
v mc tng tc thuc c xp theo 4 mc :
1. Mc ch khi ch nh:
Mc 1: Cn theo di
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Mc 2: Thn trng
Mc 3: Cn nhc nguy c / li ch
Mc 4: Chng ch nh
2. Mc tng tc thuc:
Mc 1: Tng tc cn theo di
Mc 2: Tng tc cn thn trng
Mc 3: Cn nhc nguy c / li ch
Mc 4: Phi hp nguy him
Mc ch khi ch nh v mc tng tc thuc khc nhau vi cc dng bo
ch khc nhau (dng thuc nh mt khc dng tim tnh mch). Cc thuc dng theo
ng ton thn c nhiu kh nng gy tng tc. Cc thuc di dng bo ch dng
ti ch nguy c gy tng tc cn c nh gi theo cc yu t lin quan khi s dng
thuc (trng thi sinh l, bnh l ca bnh nhn, liu lng, ng dng thuc).
III. NH GI NGUY C TNG TC THUC
nh gi v x l tng tc thuc cn xem xt c nguy c b r i lo n s cn
bng trong iu tr hay khng? (ngi bnh mc cc bnh i tho ng, tng
cholesterol mu, gt (gout), tng huyt p, dng thuc khng vitamin K, tim mch,
hen, ng kinh... l nhng ngi bnh kh kim sot cn bng iu tr ). Ng i th y
thuc cn lp li trng thi cn bng ngi bnh, cn a huyt p v gi tr bnh
thng, a t l prothrombin v mt gi tr no , tm li u thuc thch h p cho mt
ngi ng kinh... Trong tnh hung ny cn c bit phi cnh gic khi phi hp
thuc v cn cung cp thng tin cho ngi bnh v cc nguy c khi t dng thu c;
nhng thay i trong ch n ung khi iu tr. Nguyn tc u tin ngi thy
thuc cn phi tun th l khng lm o ln trng thi cn bng ca ngi bnh.
Mt tng tc thuc khng phi lc no cng nguy him. i khi ch cn ch
thn trng c bit cng lm gim nguy c (theo di iu tr v mt sinh hc, dng
liu thch hp, phn b cc ln dng thuc, hng dn ngi bnh t theo di khi dng
thuc, cung cp thng tin cho ngi bnh v t dng thuc...).
Mt tng tc thuc khng phi lc no cng nghim trng. C th x l c
tng tc thuc theo nhiu cch:
-
Thay thuc khc khng c hoc c tng tc mc thp hn;
Theo di nng ca mt thuc (trong cc thuc) trong huyt tng.

iu ny c th thc hin nhng c s chuyn su;
-
iu chnh liu khi c s tng hoc gim tc dng ca mt thuc;
Thay i ng dng ca mt thuc ny hay thuc khc.
Ngng iu tr t ngt mt trong nhng thuc dng ng thi c th xut hin

tai bin do qu liu thuc khc (do khng cn tng tc gy gim nng thuc trong
mu ca mt thuc no ).
Nu pht hin tng tc thuc khng nghim trng, khng c ngha l khng cn
cnh gic. Ngi k n cng nh ngi cp pht thuc cn phi qun l tng tc
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ny, phng cc nguy him c th xy ra. iu ny ch c th thc hin nu trc

c s nh gi v nguy c, nh vy s hiu bit v cc c ch t ng tc thuc
(tng tc dc lc hc hay dc ng hc) l rt quan trng.
Phn mt
KHI NIM V TNG TC THUC

C th s dng nhiu phng php khng dng thuc phng v cha bnh
vi mt s bnh v chng, nhng vi nhiu bnh cn phi dng thuc. Trong trng thi
a bnh l, a triu chng li cng cn phi phi hp nhiu loi thuc. Khi s d ng
ng thi nhiu thuc cho ngi bnh nguy c tng tc thuc c th xy ra.
Tng tc thuc l mt phn ng gia mt thuc vi mt tc nhn th hai (thuc,
thc phm, ho cht khc). Phn ng c th xy ra khi tip xc vi c th hay hon
ton bn ngoi c th khi bo ch, bo qun, th nghim hay ch bin cc thuc.
T l cc phn ng c hi (ADR) khi kt hp nhiu loi thuc s tng theo cp
s nhn. Mt thng k dch t hc cho thy t l ADR l 7% bnh nhn dng phi
hp 6-10 loi thuc, nhng t l ny s l 40% khi dng phi hp 16-20 loi.
Tng tc c th gy hi, nh warfarin lm chy mu t khi phi hp vi
phenylbutazon. Bnh nhn dng thuc chng trm cm c ch mono amino oxydase
(MAOI) ln cn tng huyt p cp tnh e da tnh mng nu ch n qu nhi u
tyramin (ch phm t sa, phomat; hi chng phomat (cheese syndrome). Li u thp
cimetidin cng c th lm tng nng theophylin trong huyt tng ti mc gy ng
c (co git). Isoniazid (INH) lm tng nng phenytoin trong huyt tng ti ngng
gy c.
Tng tc thuc c khi lm gim hiu lc thuc. Ung cc tetracyclin hoc
fluoroquinolon cng thuc khng acid hoc ch phm ca sa s to phc hp v mt
tc dng khng khun.
Tng tc thuc i lc mang li li ch ng k, nh phi hp thuc h huyt p
vi thuc li tiu iu tr tng huyt p.
Tng tc thuc c th va li va hi (con dao 2 li), v d kt hp rifampicin vi
isoniazid chng trc khun lao (c li), nhng d gy vim gan (c hi).
C khi tng tc thuc dng ch nhng phn ng l, ho gp khi trn ln
thuc trong dung dch, gy kt ta, vn c, i mu, mt tc dng..., thng gi l
tng k thuc (incompatibility). Tng tc cng c th nu nh hng ca thuc
lm sai lch nhng kt qu th nghim v ho sinh, huyt hc.
C hai loi tng tc thuc: tng tc thuc vi thuc v tng tc thuc vi thc
n v ung.
Tng tc thuc - thuc, bao gm:
1. Tng tc dc ng hc:
i khng khi hp thu, phn b, chuyn ho, o thi thuc
Hip ng khi hp thu, phn b, chuyn ho, o thi thuc
2. Tng tc dc lc hc:
Tng tc i khng c cnh tranh, khng cnh tranh.
Tng tc hip ng:
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+ Hip ng cng th th
+ Hip ng trc tip, nhng khc th th
+ Hip ng vt mc
Tng tc thuc - thc n, bao gm:
2. nh hng ca thc ung (nc, sa, c ph, nc ch, ru ethylic...) ti
ng hc, tc dng v c tnh ca thuc.
Ngoi ra cn c s tng tc cn lu : Tng tc thuc trng thi bnh l.
I. TNG TC THUC - THUC

1. Tng tc dc ng hc
Thuc c a vo c th bng nhiu ng. Sau khi c hp thu pht
huy tc dng dc l, thuc c coi l vt l, c th s tm mi cch thi tr. S
sau y cho thy s vn chuyn ca thuc trong c th t lc hp thu n khi b
thi tr:
Trong qu trnh hp thu, phn b, chuyn ha, tch ly v o thi, thuc ph i

vt qua nhiu mng sinh hc sang v tr mi. C ba giai on chnh:
- Hp thu: Thuc t ni tip nhn (ung, tim di da, tim bp, t trc
trng...) c chuyn vo i tun hon.
- Phn b: Trong mu, thuc kt hp vi protein - huyt tng; phn khng kt
hp s chuyn vo cc m, ri gn vi th th c hiu, vo v tr ch pht huy
hot tnh.
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- Chuyn ha v o thi: Thuc c chuyn ha, cht chuyn ha s thi

qua thn, qua mt hoc qua cc ni khc.
Trong mi giai on trn trong c th ngi, cc thuc s gp nhau v tng
tc ln nhau, cho kt qu lm sng, hoc c li, hoc c hi. Thuc cn gp thc
n, ung, nn cn c tng tc thuc - thc n.
1.1. i khng do nh hng ti dc ng hc
1.1.1. Cn tr hp thu qua ng tiu ha
Nhm hydroxyd cn tr hp thu phosphat, INH, doxycyclin carbonat lm gim
hp thu st qua ng tiu ha.
Thuc chng toan d dy lm tng pH trong dch ng tiu ha, nn ngn cn s
hp thu ca nhng thuc l acid yu (phenylbutazon, ketoconazol, aspirin, sulfamid,
mt s barbiturat, coumarin chng ng...).
Thuc khng cholinergic, thuc c ch histamin H2 (nh cimetidin), thuc c ch
bm proton (nh omeprazol) cng lm tng pH d dy, nn lm gim ha tan, gim hp
thu ketoconazol (ung). Khi cn, phi ung ketoconazol trc 2 gi.
Thuc khng sinh dit vi khun c ch rut, ngn cn tng hp cc vitamin E, K.
Thuc nhun trng loi mui (magnesi sulfat, natri sulfat), cisaprid, metoclopramid lm tng
nhu ng ca ng tiu ha, nn lm gim hp thu nhiu thuc (v b tng nhanh khi rut).
Thuc nga thai (ung) b lin hp gan (chuyn ha pha II; xem cc trang
sau), ri ti rut, theo chu k rut - gan, quay tr li gan duy tr hiu lc. Dng khng
sinh ph rng c th lm ri lon h vi khun trong rut, nhng vi khun c ch b tiu
dit nn khng ph dng lin hp ca thuc nga thai nh thng l, thuc
khng theo chu k quay tr li gan c, phi thi theo phn. Hu qu c th l
mang thai ngoi mun.
Vi thuc ung di ngy, mi ngy nhiu ln (nh thuc chng ng mu), th
nh hng ti tc hp thu khng quan trng, v tng lng hp thu khng thay i
ng k. Nhng vi cc thuc dng liu duy nht hng ngy, cn hp thu nhanh (nh
thuc ng, gim au), cn c nhanh nng cao trong mu, th t ng tc no lm
chm tc hp thu qua ng tiu ha (tc dng i khng) s d lm gim hot tnh
ca thuc.
Bng 1: Mt s v d Tng tc thuc theo ng ung
Thuc
tng
tc
Thuc b nh
Hu qu ca tng tc khi
hng
ung
Metoclopramid
Digoxin
Gim hp thu digoxin do b tng

nhanh khi rut
Cholestyramin
Digoxin,
thyroxin
Gim hp thu digoxin,

thyroxin, tetracyclin, acid mt
Colestipol
- Warfarin do b cholestyramin
Warfarin,
v colestipol hp ph, cn ung cch
tetracyclin, acid mt, nhau 4 gi
ch phm cha st
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Thuc
chng
toan d dy; thuc c
ch H2
Ketoconazol
Thuc
chng
Khng
sinh
toan d dy cha Al3+, nhm fluoroquinolon
Mg2+, Zn2+, Fe2+; sa
(nh ciprofloxacin)
Gim hp thu ketoconazol do

lm tng pH d dy v lm gim tan r
ketoconazol
To phc hp t hp thu.
Ung cch nhau 2 gi
Thuc
chng
Khng
sinh
To chelat (phc cng cua)
toan d dy cha Al3+, nhm tetracyclin
vng bn, t tan v gim hp thu
Ca2+, Mg2+, Bi2+, Zn2+,
tetracyclin
2+
Fe ; sa
Thuc cha Al3+
Doxycyclin,
minocyclin
To chelat gim hp thu
Ranitidin
Paracetamol
Ranitidin lm tng pH d dy,

nn lm gim hp thu paracetamol
rut
Propanthelin
Paracetamol
Propanthelin lm gim tho

sch d dy, lm gim hp thu
paracetamol
rut
1.1.2. i khng khu chuyn ha

C thuc vo c th, ri thi nguyn vn, khng qua chuyn ha (nh bromid,
saccharin, lithi, mt s khng sinh nhm aminoglycosid...). C thuc khi ung b trung
ha ngay bi dch v, nh natri bicarbonat. Nhng nhiu thuc sau khi hp thu, ph i
c chuyn ha, ri mi thi. Nhng cht va c chuyn ha (metabolit) s c tnh
phn cc (polarity) cao, t tan trong lipid hn cht m, d tan trong nc hn, nn kh
khuch tn th ng qua cc mng sinh hc trong c th, do d thi hn. Kt qu
thng thng l sau khi chuyn ha, thuc s mt tc dng, mt c tnh.
Gan gi vai tr quan trng nht trong chuyn ha thuc. Nhiu enzym xc tc cho
chuyn ha thuc nm mng li ni bo khng ht ca t bo gan ( Smooth surfaced Endoplasmic Reticulum; SER). cc h enzym ca dch c th cng c mt
s enzym xc tc cho chuyn ha thuc, nh huyt tng c esterase gip thy phn
ester (procain, cocain, acetylcholin, suxamethonium...).
Nhng phn ng ging ha

y l nhng phn ng oxy ha, kh hoc thy phn (gi chung l phn ng pha
I).
Phn ng oxy ha
+ Oxy ha thuc qua s xc tc enzym ca li ni bo khng ht ca t bo
gan. Thng thng, cc yu t c hot tnh enzym oxy ha thuc thuc loi ny g i l
"microsom".
Nhng loi phn ng chnh gm: hydroxyl ha nhn thm hoc chui thng,
oxy ha N mt alkyl, oxy ha O mt alkyl...

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H enzym quan trng nht cho chuyn ha pha I l cytochrom P450 (vit tt: CYP),
l mt h ln ca microsom, gm cc isoenzym chuyn electron, qua xc tc cho s
oxy ha ca rt nhiu thuc. Nhng electron ny do enzym NADPH cytochrom P450 reductase vn chuyn t NADPH a ti cytochrom P 450. Cc enzym cytochrom P450
c sp xp vo 14 h gen ca ng vt c v v 17 di lp (sub-families), c
vit theo quy c sau:
V d: CYP3A4, trong CYP = cytochrom P450; cn 3 l h; A = di lp; 4 = gen
c hiu.
Vi ng vt c v v ngi, cc enzym quan trng nht cho chuyn ha thuc l
CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4.
Tnh c hiu ca cc CYP ny rt quan trng ct ngha v tng tc khu
chuyn ha thuc.
+ Phn ng oxy ha khc: v d oxy ha ru v aldehyd nh xc tc ca alcol
dehydrogenase v aldehyd dehydrogenase.
Phn ng thy phn
Cc ester, amid b thy phn nh xc tc ca esterase, amidase.
Nhng phn ng lin hp (phn ng pha II)

Sau khi ging ha pha I, cht chuyn ha va to thnh c th lin hp vi cc
cht sn c trong c th (nh cc acid glucuronic, acetic, sulfuric, mercapturic hoc
glycocol, glutathion), cui cng cho cht lin hp t tan trong lipid hn, tnh phn cc
mnh hn, d tan trong nc hn, cui cng l hon thin khu thi qua thn, qua
mt... v mt c tnh.
Nhiu thuc c th c ch cc di lp ca cytochrom P450 (pha I) v enzym UDP glucuronyl - transferase (xc tc cho s lin hp ca thuc vi acid glucuronic phn ng
chuyn ha pha II), c thuc li gy cm ng, lm tng sinh CYP v UDP - glucuronyl transferase, cho nn trong tng giai on ca s chuyn ha k trn, cc thuc c th
tng tc vi nhau cho, hoc tc dng i khng, hoc tc dng hip ng, c l i
hoc c hi cho ngi bnh, ty thuc cch tng tc ca thuc.
Cm ng enzym chuyn ha thuc gan
Barbiturat (nh phenobarbital), doxycyclin, spironolacton, rifampicin, glutethimid,
carbamazepin, phenytoin, nghin thuc l, DDT... gy cm ng cytocrom P450 (CYP), s
lm tng lng CYP mi sinh (ch khng lm tng lng CYP c), kt qu l lm
cho nhiu thuc khc chuyn ha mnh qua gan (cng l tng thanh lc) v mt nhanh
tc dng.
Bng 2. Mt s v d v Cm ng enzym chuyn ho thuc gan
Thuc gy cm
Thuc b gim tc dng, do b chuyn ha nhanh
ng enzym
gan
Phenobarbital
Phenytoin, warfarin, dicoumarol, theophylin, primidon,

thuc chng trm cm ba vng, lidocain, vitamin D, corticoid
tng hp, griseofulvin, aminazin, desipramin, nortriptylin,
diazepam, sulfamid chng tiu ng, cyclophosphamid,
doxycyclin, metronidazol, oestrogen, bilirubin, digitoxin v.v...
14
Rifampicin
Thuc khng vitamin K, corticoid, cyclosporin, digitoxin,

INH, quinidin, sulfamid chng tiu ng, hormon steroid,
phenytoin, ketoconazol, theophylin.
Barbiturat,
carbamazepin,
phenytoin, rifampicin
Thuc ung nga thai, corticoid
Nghin thuc l
Haloperidol,
theophylin,
(cha hydrocarbon a propoxyphen, clopromazin.
vng)
diazepam,
pentazocin,
V d, ph n b lao dng rifampicin hoc b ng kinh dng phenobarbital,

phenytoin, carbamazepin d "v k hoch" do hot cht ca thuc chng th thai b
tng nhanh chuyn ha, mt tc dng nga thai (rifampicin, phenobarbital, phenytoin,
carbamazepin l nhng thuc gy cm ng mnh CYP v UDP - glucuronyl transferase gan).
Rifampicin c th lm INH tng nhanh chuyn ha qua CYP, to nn nhng cht
chuyn ha gy c.
Pyridoxin (vitamin B6) gy cm ng dopa - decarboxylase lm tng phn ng kh
carboxyl ca levodopa, nn levodopa b chuyn thnh dopamin ti ngay m ngoi
bin (nhc im!). Dopamin s khng vt qua c hng ro mu - no ch a
bnh Parkinson. Cn phi hp levodopa vi carbidopa (l cht c ch decarboxylase
ngoi bin) bo v levodopa, trnh b hy sm bi vitamin B6 m ngoi bin.
Ngn cn ti hp thu qua ng thn

Kim ha nc tiu s lm tng o thi nhng thuc l acid yu. Ngc li, acid
ha nc tiu s lm tng thi nhng thuc l kim yu.
Natri bicarbonat (kim) gip tng thi phenobarbital, salicylat (acid); amoni clorid
(acid) lm tng thi amphetamin (kim). V d, 54,5% ca liu dng dextroamphetamin
(kim) s thi trong vng 16 gi nu nc tiu c gi pH ~ 5, nhng ch thi 2,9%
cng trong thi gian ny, nu pH nc tiu l ~ 8.
1.2. Hip ng do nh hng ti dc ng hc
Tc dng hip ng:
15
Thuc A c tc dng l m, thuc B c tc dng l n. Gi l hip ng (hp lc),

nu khi kt hp A vi B, tc dng cui cng c th l:
= m + n l hip ng cng (additiv effect);
> m + n l hip ng vt mc (synergism).
Cng c khi A khng c tc dng ging B, nhng A vn lm tng tc dng ca B,
ta ni A lm tng tim lc (potentiation) ca B.
1.2.1. nh hng ti hp thu
Adrenalin lm co mch ngoi bin ti ch: Tim di da procain trn l n
adrenalin, th thuc gy t procain s chm hp thu (nh tc dng hip ng vi
adrenalin), tc dng gy t s ko di. Insulin trn ln protamin v km (protamin - zinc
- insulin; PZI) s chm hp thu ni tim, ko di tc dng chng tiu ng. Procain
lm chm hp thu penicilin G khi tim di da (penicilin - procain). Ung d u parafin
nhun trng lm tng hp thu nhiu thuc tan trong lipid v gy c (nh thuc chng
giun sn).
1.2.2. y nhau ra khi protein huyt tng
Nguy c ca tng tc loi ny ch yu xy ra vi nhng thuc kt hp mnh
90% ti cng nhng v tr phn t protein huyt tng (y nhau c cnh tranh;
competitive displacement), v d vi warfarin, diazepam, furosemid, dicloxacilin,
propranolol, phenytoin v.v...
Aspirin, phenylbutazon y warfarin khi protein huyt tng, hm lng dng t
do (khng gn) ca warfarin khi tng gp ba, tc dng chng ng mu nhn ln h
s 3.
Sulfamid km khun, cloramphenicol, cc salicylat, thuc chng vim khng
steroid huyt tng y bilirubin sang dng t do, gy vng da tr s sinh, bilirubin
dng t do c th vo ti thn kinh trung ng, gy vng da nhn no (Kernicterus).
Acid valproic y phenytoin khi ni gn protein huyt tng, li cn c ch
chuyn ha ca phenytoin. Tng tc gia hai thuc ny c th gy phn ng c hi
nghim trng, v nng dng t do (khng gn) ca phenytoin trong huyt thanh tng
ln r rt.
Phenylbutazon, cc salicylat, aspirin cng tng tc vi tolbutamid v cc sulfamid
chng i tho ng cng theo c ch ny v d gy chong do lm h glucose mu.
1.2.3. Ngn cn chuyn ha
Mt s thuc chnh, nh INH, iproniazid, cloramphenicol, cimetidin, quercetin,
levodopa,
enoxacin,
disulfiram,
erythromycin,
allopurinol,
ciprofloxacin,
dextropropoxyphen, clarithromycin, fluconazol, fluoxetin, ketoconazol, diltiazem,
verapamil, metronidazol, phenylbutazon, miconazol, itraconazol, nefazodon, paroxetin,
ritonavir... c ch c enzym microsom gan (CYP v /hoc UDP - glucuronyl transferase), lm cho nhiu thuc khc kh chuyn ha qua gan, nn ko di tc d ng
(v tng c tnh). V d cimetidin (Tagamet) lm chm chuyn ha (v lm chm thanh
lc) qua gan ca warfarin, diazepam, clordiazepoxid (Librium), phenytoin, theophylin,
carbamazepin, lidocain, metronidazol... Thuc c ch MAO, furazolidon, c ch c
enzym MAO, gy tch ly tyramin khng c chuyn ha, lm tng huyt p t ngt.
16
Cn c bit lu khi k n vi cc nhm thuc sau ( trnh tng tc

bt li nghim trng):
- Thuc c phm vi an ton hp
Thuc chng lon nhp tim (v d: quinidin), thuc chng ung th (nh
methotrexat), digoxin, lithium, theophylin, warfarin...
- Thuc chuyn ha mnh qua enzym gan
Alprazolam, astemizol, amitriptylin, carbamazepin, cisaprid, clozapin, corticoid,
cyclosporin, desipramin, diazepam, imipramin, phenytoin, theophylin, triazolam, warfarin.
- Thuc c ch mnh enzym gan ( nu trn).
- Thuc gy cm ng mnh enzym gan (nu cc phn sau).
o thi chm,
Tng tch lu, Tng
tc dng, Tng c
tnh
Bng 3. Mt s v d v Tng tc do c ch enzym chuyn ha thuc

Thuc
enzym
ch
Clopropamid,
disulfiram,
latamoxef,
metronidazol
Metronidazol,
phenylbutazon,
cloramphenicol,
sulphinpyrazon, cimetidin
Thuc b c ch
Ru ethylic
Ung thuc chng

ng mu
Allopurinol (do c
Azathioprin,
ch xanthin -oxydase)
mercaptopurin
Erythromycin, TAO
17
Corticoid
Hu qu lm sng
Phn ng "ging
disulfiram" do tng nng
acetaldehyd
D chy mu
Tng c tnh ca
azathioprin
v
ca
mercaptopurin, cn gim
1/3-1/4 liu thng dng
Tng tc dng v c
tnh ca corticoid
INH,
cloramphenicol, cimetidin,
cumarin
Phenytoin
Tng tc dng v c
tnh ca phenytoin
Cloramphenicol,
phenylbutazon, cumarin
Tolbutamid
Gim ng huyt
t ngt
Thuc c ch MAO
Nefazodon,
clarithromycin,
erythromycin, itraconazol,
ketoconazol v.v...
Tyramin
(trong thc n)
Astemizol, cisaprid
Cn tng huyt p do
tch ly tyramin (khng
chuyn ha c qua
MAO)
c vi tim (xon
nh, lon nhp tht)
Ritonavir
Thuc chng lon

Tng c tnh, cn
nhp
tim,
astemizol, theo di cht v iu chnh
cisaprid, benzodiazepin
liu
Erythromycin
Carbamazepin,
theophylin
Ciprofloxacin,
enoxacin, grepafloxacin,
cimetidin
Cimetidin
Nc qu bi
Tng c tnh
Tng c tnh
Theophylin
Diazepam,
propranolol, metoprolol
Tc dng tng v ko
di
Felodipin,
nifedipin,
Tng sinh kh dng,
cyclosporin,
mt
s tng tc dng v c tnh
benzodiazepin
(nh
triazolam)
1.2.4. Gim o thi qua thn

Kim ha nc tiu lm tng ti hp thu cc thuc l kim yu qua on thng
(pars recta) ca ng ln gn. Acid ha nc tiu lm tng ti hp thu qua ng thn
ca cc thuc l acid yu.
V d:
Kim ha nc tiu bng natri bicarbonat, acetazolamid, thuc li niu nhm
thiazid, hoc ung thuc chng toan (liu cao, dng di ngy) s lm gim thi tr (tc
dng hip ng), lm tng tc dng v c tnh ca cc thuc l kim nh (nh
amphetamin, phenylbutazon, oxyphenbutazon, indomethacin, sulfinpyrazon).
C khi c c ch tng tc nm khu o thi tch cc qua ng thn (active
tubular transport) qua cnh tranh cng cht vn chuyn (carrier), thuc no chim
c carrier s b o thi, lm cho thuc kia quay tr li dch k ca c th tng
tch ly v pht huy tc dng bn, c khi tng c tnh.
18
Probenecid cnh tranh trn cng carrier ng thn vi penicilin G, ampicilin,

carbenicilin, cephalosporin, nn probenecid y ngc nhng thuc ny tr li d ch k
v lm chm o thi tch cc ca chng (li ch iu tr ca khng sinh -lactam).
Probenecid cng lm chm thi dapson, rifampicin, nitrofurantoin, methotrexat, salicylat,
clorpropamid, acid nalidixic, indomethacin qua ng ln, cng theo c ch cnh tranh
cng carrier.
Cc salicylat v mt s thuc chng vim khng steroid (nh ketoprophen) cnh
tranh vi methotrexat cng carrier ng thn, lm tng c tnh ca methotrexat, c th
gy t vong do tng tc c hi.
Quinidin cng lm tng nng digoxin trong huyt thanh, mt phn do c ch
cnh tranh ti carrier ng thn.
2. Tng tc dc lc hc
Tng tc dc lc hc l khi thuc A gy nh hng ti p ng sinh hc ca
thuc B hoc ti nhy cm ca m trong c th khi dng cng thuc B. Nhng
thuc gp tng tc ny s c tc dng i khng hoc hip ng vi nhau, nhiu khi
c hu qu lm sng tai hi. V d, bnh nhn tng huyt p thng phi dng thuc
h p sut i: Nu dng cng mt s thuc chng lon nhp hoc chng au tht
ngc c th gy trng thi gim huyt p qu mc, gy ri ro (nh khi li xe, vn hnh
my mc); khi ung ru s c tc dng m tnh vo bnh tng huyt p v gy t t
huyt p khng kim sot ni; thuc trm cm 3 vng i khng vi tc d ng h p
ca guanethidin, - methyldopa, clonidin; Nhiu thuc tc ng trn h thn kinh trung
ng cng tc ng ln huyt p.
2.1. Tng tc i khng

2.1.1. C cnh tranh:
Cht ch vn (agonist) v cht i khng (antagonist) cnh tranh vi nhau cng
mt ni ca th th (receptor; R), v d khi xt cc cht ch vn - cht i khng sau
y:
Pilocarpin - atropin (th th M), histamin - phenergan (th th H 1), histamin cimetidin (th th H2), aldosteron - spironolacton (th th cn cho trao i Na+/K+ ng
ln xa), isoproterenol - propranolol (th th ):
R = Th th
C khi s dng kiu tng tc ny gii c thuc. V d:

chng c hoc cai nghin morphin (hoc heroin, cc opiat khc), ta dng
naloxon (tim) hoc naltrexon (ung) i khng th th morphinic:
19
Th th
Morphin
Morphin
(Cht ch vn)
Naltrexon
(Cht i khng)
Morphin v th th ca morphin
L din phng k nc gn vi nhn thm ca opiat, phi
hp vi mt v tr gn chc phenol;
L khoang thu nhn nhn phenanthren ca opiat;
L v tr anion, lin kt vi chc amin ca cu trc.
Morphin coi nh cha kha m kha (th th), cn naloxon, naltrexon l bn

tay bt cht l kha.
2.1.2. Khng cnh tranh
Cht i khng c th tc ng ln th th v tr khc vi cht ch vn; cht i
khng lm cho th th bin dng (th th d dng), qua , th th s gim i lc vi
cht ch vn.
V d, mt s cht khng histamin th th H1 (nh astemizol):
R = Th th
V d khc v tc dng i khng khng cnh tranh th th:

Thuc li niu nhm thiazid lm tng glucose mu, nn lm gim tc dng h
ng huyt ca insulin v ca thuc chng tiu ng (ung), khi cn iu chnh
liu lng.
20
Tc dng khng sinh ca thuc khng sinh nhm -lactam l pha phn bo ca
vi khun (c ch s tng hp vch t bo vi khun), tc dng ny b hn ch mt phn
nu dng penicilin phi hp vi tetracyclin, sulfamid, cloramphenicol, v nhng thuc
sau l km khun, lm chm s phn bo.
Bng 4. Mt s v d v Tng tc dc lc hc, to tc dng i khng
Thuc tng tc
Vitamin K
Thuc
nh hng
chu
Ung
chng ng
thuc
tc
Cafein, theophylin, c
Thuc ng, an
ph, nc ch
thn
Corticoid
Kt qu ca tng
Thuc
glucose mu
Thuc chng ri lon

Levodopa,
tm thn (loi c tc dng carbidopa
ph gy Parkinson)
Tc dng chng ng
b nh hng
Gim bun ng
Gim tc dng chng
tiu ng
Gim tc dng chng
Parkinson
2.2. Tng tc hip ng

2.2.1. Hip ng cng th th
V d khi dng khng sinh cng nhm aminoglycosid vi nhau. Trong thc t,
khng dng cch phi hp ny.
2.2.2. Hip ng trc tip, nhng khc th th
Dng thuc m cng thuc gin c cura, khi tnh vn ng ca c cng b c ch
bi thuc m (c ch trung ng) v bi cura trn bn vn ng (c ch ngoi bin).
Propranolol hip ng trc tip cng quinidin chng lon nhp tim, nhng khc
th th: propranolol phong b , thuc kia lm n nh mng t bo c tim. Phi hp
thuc h huyt p vi thuc li niu cha tng huyt p cng l hip ng trc tip,
nhng khc th th. Aspirin dng cng dn xut coumarin (nh warfarin) lm tng tc
dng chng ng mu: aspirin chng kt dnh tiu cu, cn warfarin c ch tng hp
cc yu t ng mu.
Clopromazin (aminazin) l v d rt in hnh ca tc dng hip ng tr c ti p:
aminazin khng cha ng tc dng ca nhng thuc khc, nhng li lm tng rt r
tim lc ca chng (potentiation), v d khi phi hp aminazin vi thuc m, thuc gim
au, ru, thuc t, cura, thuc ng, an thn, chng ng kinh ..., hu qu ca tng
tc ny c khi rt nghim trng!
2.2.3. Hip ng vt mc (tng tc c li)
Acid folic l coenzym gip to nn cc base purin, thymin v cc acid amin c n
cho tng hp DNA, RNA v protein l nhng nguyn liu cn cho vi khun pht tri n.
Sulfamid cng vi trimethoprim (hoc pyrimethamin) c ch hai loi enzym khc nhau
hai khu khc nhau, nhng trong cng mt qu trnh tng hp acid tetrahydrofolic. Hai
loi thuc dng chung s hip ng vt mc, tng tc c li (ch khng phi mt
php cng thng thng), mnh hn hn khi dng n c tng loi. l nguyn tc
21
to nn cng thc thuc khng khun nh Bactrim (co-trimoxazol; Biseptol; tc l

sulfamethoxazol + trimethoprim) hoc chng st rt nh Fansidar (sulfadoxin +
pyrimethamin) c hiu lc cao:
Sulfamethoxazol; sulfadoxin
Trimethoprim; pyrimethamin
Trong mt s trng hp cn thit nht nh, phi hp (nhng khng trn ln) cc
khng sinh -lactam vi aminoglycosid (nh streptomycin, gentamicin...) cng cho tc
dng hip ng vt mc: ngoi tc dng khng sinh ca chnh n, th
-lactam (do ngn cn tng hp vch vi khun) cn to iu kin aminoglycosid d
xm nhp vo bn trong t bo vi khun tiu dit vi khun ngay tn "so huyt".
Tuy nhin khi phi hp thuc nhm cephalosporin vi thuc nhm aminoglycosid
cho tc dng hip ng vt mc, nhng gy tng tc mc 4 (phi hp nguy
him), do ch s dng phi hp ny trong mt s trng hp nhim khun nng do
Klebsiella spp, Enterobacter spp, Proteus spp, Providencia spp, Serratia spp,
Pseudomonas aeruginosa, Haemophilus influerzae v cn theo di chc nng thn ca
ngi bnh (lng nc tiu, creatinin mu)
Acid clavulanic v sulbactam l hai phn t -lactam, tuy c tc dng khng sinh
rt yu nhng li c i lc mnh vi -lactamase. Kt hp mt -lactam vi acid
clavulanic hoc sulbactam cho tc dng h tr c li v enzym -lactamase b c ch
to iu kin cho -lactam c bn vng pht huy tc dng. V d:
Acid clavulanic + amoxicilin = Augmentin
Acid clavulanic + ticarcilin = Timentin
Sulbactam + ampicilin = Unasyn.
22
Phi hp rifampicin vi isoniazid cng l hip ng vt mc: tng tc ny va

c li (lm tng kh nng dit trc khun lao), va d gy phn ng c hi (gy r i
lon chc nng gan).
Bng 5. Mt s v d v Tng tc dc lc hc, to tc dng hip ng
Cch phi hp
Kt qu ca tng tc
Khng cholinergic + khng

Tng tc dng khng cholinergic; t
cholinergic (thuc chng Parkinson, qu khi gp nng hoc m; Rut co bp,
butyrophenon, phenothiazin, chng bnh tm thn do ng c, kh ming hng
trm cm ba vng...)
rng, nhn m, st... (cn c bit trnh
dng ngi cao tui)
Thuc h huyt p + thuc gy
Tng tc dng lm h huyt p; Gim
gim huyt p (thuc gin mch, huyt p t th ng
phenothiazin, chng au tht ngc)
Thuc c ch TKT + thuc c
Lm gim k nng tm thn - vn
ch TKT (ru, thuc chng nn, ng, gim tnh to, bun ng, sng s, suy
khng histamin, thuc an thn gy h hp, hn m, mt mi, t vong. c bit,
ng, gii lo, gim au, chng lon trnh dng cho ngi cao tui.
thn...)
Methotrexat + co-trimoxazol
To nguyn hng cu khng l ty

xng do i khng acid folic
Thuc c vi thn + Thuc

c vi thn (gentamicin hoc
streptomycin, hoc tobramycin dng
cng cephalothin)
Thuc phong b thn kinh - c +
thuc c tc dng phong b thn kinh
- c (nh khng sinh aminoglycosid)
Tng c tnh vi thn
Tng phong b thn kinh - c; Chm

bnh phc; Ko di s ngng th
Thuc cha K+ + thuc li niu

gi K (spironolacton, triamteren)
Tng r K+/mu
Gia cc thuc chng vim

khng steroid vi nhau
Tng tc dng khng mong mun

(nh lot d dy - t trng)
Thuc li niu quai (furosemid,

Tng c tnh vi tai (do thuc li niu
acid etacrynic) + aminoglycosid.
lm thay i thnh phn in gii ca ni
dch tai trong).
Thuc lm tng calci mu (hoc
Tng hiu lc v c tnh ca glycosid
lm gim kali mu) + glycosid tr tim
tr tim
II. TNG TC THUC - THC N

1.1. Thc n lm thay i pH ca d dy
23
Khi i (sng sm), d dy cha t dch, pH rt acid (1,7 - 1,8); Khi no, pH d dy
tng n 3 ty thuc ch n. Thuc s thay i hp thu ty thuc pH: trong ba
n no, aspirin phn cc nhiu hn lc i, nn gim hp thu d dy.
S tho sch ca d dy c nh hng ti tc di chuyn thuc: khi no, thuc
mt 1 - 4 gi cng thc n thot khi d dy, nhng lc i, thi gian ny ch l 10 30 pht.
Khi no, thuc s nm lu d dy, hu qu xu hay nh hng tt ty loi
thuc:
Vi thuc t hp thu d dy, th nm lu d dy s lm chm hp thu rut
non. Thuc no kt hp c vi nhng thnh phn ca thc n d dy to phc
kh tan, th s gim cng hp thu rut, v d cc tetracyclin to chelat vi cation
calci (Ca2+) trong sa hoc vi magnesi (Mg2+), st (Fe3+), nhm (Al3+) v vi cc cation
ha tr 2 v 3 khc nm trong thc n.
Vi thuc m kch thc cc ht c nh hng ti cng hp thu (nh
griseofulvin, nitrofurantoin, spironolacton...), th nn dng trong ba n, v lc d dy
tng tit dch v khi lng thc n nho nn gip nhng ht thuc c trn u.
Thuc no tan mnh trong lipid v do hp thu tt hn, th nn dng trong ba
n giu lipid, v d sulfamid, phenytoin, griseofulvin...
Thuc no m tan km (nh propoxyphen) th s tan tt hn khi n no.
Dng vin bao tan trong rut s bt li khi ung lc no.
Thuc no t bn pH acid (nh ampicilin, erythromycin...) s d b hy trong ba
n, v nm lu d dy.
1.2. Ch n
Ch n thiu protid, lipid v nng lng s lm gim hot tnh cytochrom P450.
Ngc li, ch n giu protid lm tng chuyn ha thuc qua gan, do lm tng tng
hp enzym chuyn ha thuc. Ba n s lm tng lu lng mu qua gan, tc lm tng
lng thuc qua gan v tng chuyn ha ban u (first - pass metabolism) nh vi
morphin, nhiu hormon, thuc phong b beta... Ba n c th hy hoi vi khun rut,
lm nh hung ti chuyn ha ca mt s thuc qua ng tiu ha.
Ch n thiu mt s khong nh thiu km (Zn2+), calci (Ca2+), magnesi (Mg2+)
cng cn tr chuyn ha thuc. Thiu vitamin C lm gim hot tnh ca enzym chuyn
ha thuc (t l cao nhng tc dng khng mong mun ca thuc ngi bnh cao
tui c th c lin quan ti s hao ht vitamin C trong c th).
Nhiu thuc c nh hng ti s thm n, lm tng (hoc gim) glucose mu,
tng (hoc gim) lipid mu, gim chuyn ha protid, gim hp thu thc n:
Tng thm n: Insulin, hormon steroid, hormon gip trng, sulfonylurea (chng
tiu ng), khng histamin H1, mt s thuc tm thn.
Gim thm n: Glucagon, indomethacin, morphin, cyclophosphamid, glycosid tr
tim...
Tng glucose mu: Cc opiat, phenothiazin, li niu thiazid, probenecid,
phenytoin...
24
Gim glucose mu: Sulfamid, aspirin, thuc phong b beta, phenylbutazon,

barbiturat...
Gim lipid mu: Aspirin, L-asparaginase, colchicin, dextran, fenfluramin, glucagon,
phenindion, sulfinpyrazon...
Tng lipid mu: Thuc ung nga thai (loi estrogen - progestogen), hormon v
thng thn, aminazin, ru ethylic, thiouracil, vitamin D...
Gim chuyn ha protid: Tetracyclin, cloramphenicol...
Gim hp thu thc n: Clortetracyclin, phenindion, indomethacin, methotrexat...
1.3. Nhiu thuc cn c tng tc vi chuyn ha vitamin v kim loi trong
c th
Nhiu thuc khi dng phi kim tra lng Na +, K+ trong ch n, nh dng li
niu, corticoid, lithi, glycosid tr tim.
Thuc li niu (c bit nhm thiazid) v corticoid gy thiu ht K +, s lm tng
nguy c lon nhp tim nu dng glycosid tr tim. Ung di ngy thuc nhun trng cng
gy hao ht K+. Cortisol, aldosteron, desoxycorticosteron, thuc ung nga thai (cha
estrogen-progesteron), phenylbutazon gy tch nc v Na+.
Sulfonylurea chng tiu ng, phenylbutazon, cobalt, lithi cn tr s xut nhp
iod tuyn gip. Thuc ung nga thai lm gim hm lng Zn 2+ v tng Cu2+ trong
huyt tng. Dng corticoid di ngy c th gy long xng.
Ru ethylic cn tr hp thu vitamin B1. Isoniazid l cht i khng vi vitamin B6
v PP. Ru ethylic, thuc ung nga thai c ch hp thu acid folic. Nhiu ngi bnh
dng di ngy thuc chng ng kinh (phenytoin, phenobarbital, primidon, cc
phenothiazin...) s c hm lng thp acid folic trong huyt thanh v trong hng cu, c
th b thiu mu hng cu to.
Colchicin, ru ethylic, thuc ung nga thai cn tr hp thu vitamin B12 qua ng
tiu ha. Thuc chng ng mu loi coumarin lm hao ht vitamin D.
Phi hp thc n cha nhiu tyramin (pho-mt, ru vang , chui, bia, gan g,
gan ngng...) vi thuc c ch mono amino oxydase (MAOI) s lm cho tyramin khng
ging ha c, gy tng tit catecholamin lm co mch t ngt, ln cn tng huyt
p kch pht, c th t vong ("hi chng ph -mt", "cheese syndrome").
2. nh hng ca thc ung ti ng hc, tc dng v c tnh ca thuc
2.1. Nc (H2O)
Nc gip thuc chng ti t trng l ni thuc d hp thu. Nc lm tng tan r
dng bo ch, tng tan hot cht, thc y sinh kh dng ca thuc, nh vi
amoxicilin, theophylin.
Thuc ch lu li ti thc qun 5 giy nu ung km 100mL nc; nhng nu
ung thuc vi qu t nc hoc khng dng nc, th thuc lu ti thc qun, c th
gy lot ti ch, lm thay i ng hc ca thuc. Ngoi ra, cn mt s nguyn nhn
thun li, nh c cn tr lu thng trong thc qun (khi u, hp thc qun, thc qun
b chn p t ngoi, thc qun tr tr li co bp). Cn dn d ngi bnh ung thuc
25
vi 100 mL nc, t th ng trong 10 pht, nht l vi nhng thuc d gy lot thc

qun, nh cc tetracyclin (k c doxycyclin, minocyclin), ch phm cha st (Fe3+),
cha kali, aspirin, thuc chng vim steroid v khng steroid, clindamycin, theophylin,
cc biphosphonat (alendronat, risedronat...) v.v...
Nc ung cn l v b tr khng th thiu c trong nhiu trng hp iu tr,
nh cha gt, nhim khun ng tit niu hoc gip tng thi thuc qua nc tiu
(sulfamid, cyclophosphamid...).
Mt s thuc khc cn ung vi nhiu nc l amoxicilin, penicilin V,
erythromycin (ethylsuccinat, propionat), ketoconazol...
2.2. Sa
Sa cha calci caseinat, to c phc hp, do lm gim tc dng ca nhiu
thuc, nh tetracyclin (k c doxycyclin, minocyclin), cefalexin, Augmentin, lincomycin,
clindamycin, mui Fe, atenolol...
Sa cha nhiu lipid gip cc thuc a lipid d tan, nhng lm chm khuch tn
ca nhng thuc no c h s phn tn du /nc cao. Sa lm gim sinh kh dng
ca penicilin V, theophylin, mt s cephalosporin. Sa c pH kh cao, nn lm gim s
kch ng d dy ca mt s thuc acid.
2.3. C ph, nc ch, cacao, chocolat
C ph, nc ch, cacao, chocolat cha cafein, theophylin, gy hng phn thn
kinh trung ng, nn c tng tc (hip ng hoc i khng) vi nhiu thuc khc.
Thuc h st gim au (aspirin, paracetamol...) tng tc dng khi ung cng c ph,
nc ch. Do li niu, nn c ph, nc ch gip nhiu cht tng o thi qua nc tiu.
C ph, nc ch lm gim hp thu v gim tc dng ca alendronat.
C thuc, nh aminazin, haloperidol, trn ln vi c ph, nc ch s c tng
k kt ta, nn gim hp thu khi ung. Mt khc, nhiu thuc lm tng c tnh ca c
ph v theophylin: Phi hp c ph, nc ch vi thuc c ch mono amino oxydase
(MAOI) gy nhc u, tng huyt p. Cimetidin, ung thuc nga thai s c ch
chuyn ha cafein v theophylin gan, lm tng c tnh ca c ph, nc ch (mt
ng, bn chn, m sng...).
2.4. Ru ethylic
Liu cao ru gy co tht h v, lm chm s tho sch d dy, nn lm gim tc
hp thu, gim sinh kh dng ca diazepam, penicilin V, cc vitamin rut. Ngc
li, khi ung cng ru, c thuc (nh glycerin trinitrat, mt s benzodiazepin...) li tng
hp th v tng ha tan v lu lng mu rut tng ln sau khi ung ru.
Ru kch ng ng tiu ha, lm tng tnh thm ca mt s thuc m lc
thng rt kh thm, nh khng sinh aminoglycosid, thuc chng giun sn.
ngi nghin ru, albumin huyt tng st km lm cho nhiu thuc kh gn
vo albumin huyt tng, do tng phn b vo cc m. Ru lm thay i tnh thm
ca mng, gip mt s thuc d khuch tn, nh thuc thn kinh trung ng
(benzodiazepin, levodopa, methaqualon) c th gy ri lon tm thn. Khi , lu lng
tim tng ln do ung ru, lm cho thuc cng d khuch tn, c tnh cng tng.
26
Nghin ru gy cm ng enzym chuyn ha thuc gan, lm tng chuyn ha

v gim tc dng ca nhiu thuc khc, nh barbiturat, phenytoin, carbamazepin,
meprobamat, tolbutamid, propranolol...
Nhng nu thnh thong ung ru, th ru li c ch chuyn ha v lm tng
tc dng (tng c tnh) ca mt s thuc khc, nh diazepam, clordiazepoxid,
phenytoin, carbamazepin, meprobamat, propoxyphen, phenobarbital, tolbutamid v d n
xut sulfonylur, thuc khng vitamin K, tetracyclin, INH...
Nhng thuc sau y cng khng c ung cng ru, v s gy tng tc c hi:
Ketoconazol, hydralazin, prazosin, captopril, enalapril, ramipril, atenolol, bisoprolol,
labetalol, sotalol, oxprenolol, acebutol, lithi, levodopa, dn xut biguanid chng tiu
ng, thuc khng acid...
III. TNG TC THUC - TRNG THI BNH L

Mt s trng thi bnh l, mt s thuc chnh cm dng hoc phi dng thn
trng.
1. Mang thai
Ba thng u ca thai k hoc ngi nghi c thai: Thuc chng gin phn
(cyclophosphamid, methotrexat, vinblastin, busulfan, clorambucil...), nhiu thuc chng
nn (cyclizin, meclozin, dimenhydrinat...), thuc chng ng kinh, chng st rt, thuc
nhun trng cha podophylin, penicilamin, thalidomid, thuc chng trm cm loi ba
vng, lithium, furosemid, rifampicin, trimethoprim (trong co-trimoxazol), pyrimethamin,
thuc chng tiu ng ...
Trong sut thai k: Khng sinh nhm aminoglycosid, khng gip trng tng hp,
hormon sinh dc, cht lm ng ha protein, iod liu cao hoc dng lu, cc tetracyclin,
vitamin A liu cao, vaccin ...
Trong ba thng cui ca thai k (nht l khi sp chuyn d): Thuc gy m, thuc
ng, khng vitamin K, indomethacin, aspirin, thuc an thn gii lo, ch phm thuc phin,
thuc gy metHb hoc gy vng da tr s sinh ...
2. Suy mch vnh
Thuc lm tng cng nng tim: Loi adrenergic, amphetamin, thuc chng cao
huyt p, cc xanthin (cafein, theophylin), hormon gip trng (liu cao), levodopa,
ketamin, mt s thuc gin mch ...
Thuc gy gim oxygen c tim: Thuc lit hch, thuc gim glucose mu (liu
cao) ...
3. Suy tim
Propranolol, verapamil, thuc lm h calci/mu (mithramycin...), thuc gy m,
dch truyn lm tng p lc thm thu, thuc cha ion Na +, thuc gy tch ly nc v
Na+, thuc ng, an thn gii lo (khi lu lng tim rt thp), corticoid, ACTH, dn xut
phenylbutazon, thuc c vi c tim, thuc tng tc vi iu tr suy tim (tim tnh
mch calci, thuc gy h kali mu, Li+...).
4. Ngi theo ch n khng mui
27
Thuc cha Li+, truyn tnh mch thuc cha Na+, thuc long m cha natri
(natri benzoat, natri citrat...), thuc khng acid ng tiu ha cha natri bicarbonat
hoc dinatri phosphat ...
5. Tng huyt p
Mt s thuc gy m, thuc lm tng huyt p cp tnh, nh khi bt u dng loi
adrenergic, reserpin, -methyldopa (Aldomet) hoc dng clonidin khi kt thc iu tr
mn (nh thuc ung nga thai, corticoid, ACTH), thuc cha natri, sulpirid, lithi...
6. Suy gan
Thuc ng, an thn gii lo, thuc an thn kinh, khng histamin H1, thuc d lm
chy mu (aspirin, salicylat, khng vitamin K, heparin, loi tiu fibrin); thuc gy lot ng
tiu ha (thuc chng vim, reserpin); thuc c vi gan (thuc chng gin phn,
halothan, thuc c ch MAO, INH dng cng rifampicin, ethionamid, Aldomet, vitamin A
liu cao) ...
7. Vim hoc lot ng tiu ha
Acid ethacrynic, thuc chng vim, thuc d lm chy mu (aspirin, salicylat,
indomethacin, thuc chng ng, loi tiu fibrin, reserpin...).
8. ng kinh
Thuc hi sc h hp (nikethamid, long no, cardiazol, doxapram ...), amphetamin
v dn xut, thuc t (liu cao), dn xut phenothiazin khng H1, thuc lm chy mu
(c th gy chn thng s), thuc chng co git, chng ng kinh c tng tc vi
in no (nh barbiturat, benzodiazepin...), thuc an thn kinh, liu cao penicilin
(tim tnh mch), reserpin, liu cao theophylin, thuc chng trm cm loi ba vng,
strychnin ...
9. Nghin ru
Thuc ng, an thn gii lo, an thn kinh, thuc khng histamin H 1, thuc chng
trm cm loi ba vng, thuc ng gy ri lon tm thn (glutethimid, methaqualon,
meclaqualon), thuc gy thiu vitamin (nh ethionamid, INH, protionamid, dihydralazin,
piperazin lm gim vitamin B6 gy co git); thuc lm thiu vitamin B 1 lm trm trng
mt s bnh thn kinh ngoi bin ngi nghin ru, ung khng sinh ph rng
(tetracyclin, cloramphenicol, ampicilin, sulfamid), thuc gy thiu acid folic lm thiu mu
nguyn hng cu khng l (nh methotrexat, thuc chng ng kinh, pyrimethamin,
trimethoprim, triamteren), thuc gy phn ng vn mch (clopropamid, metronidazol,
tolbutamid, cephalosporin...) hoc gy nhim acid lactic (nh phenformin), thuc m
chuyn ha b thay i bi ru ethylic.
ngi nghin ru, cn trnh mi thuc nguy him cho ngi ng kinh, suy
gan, ngi lot d dy - t trng.
10. Suy thn
Khng sinh aminoglycosid, penicilin G, carbenicilin (liu cao tim tnh mch), khng
sinh polypeptid, thuc st khun ng tit niu (nh nitrofurantoin), EACA, thuc gy t,
cloramphenicol, thiamphenicol, glycosid tr tim, acid ethacrynic, furosemid, thuc c ch
trao i ng ln xa (nh spironolacton, triamteren), thuc lm tng K + mu, thuc lm
gim glucose mu (sulfamid chng tiu ng), lm nhim acid lactic (biguanid), dn
28
xut thy ngn (Hg), mithramycin, ch phm bismuth (Bi), dn xut phenacetin, sulfamid
km khun, succinylcholin ...
11. Tiu ng
Thuc mang thm ose (glucose, fructose), thuc lm tng glucose mu (corticoid,
ACTH, ung thuc nga thai, thuc li niu thiazid, furosemid, phenytoin, mt s thuc
chng gin phn), thuc gy nhim acid chuyn ha (thuc c ch , thuc c ch
MAO, sulfamid, perhexilin), thuc khng sinh nh cc tetracyclin, ampicilin,
cloramphenicol; corticoid v ACTH, thuc c ch min dch.
Thuc tng tc vi iu tr i tho ng lm tng tim lc tc dng gim
glucose mu, nh:
Vi insulin: Khng dng thuc c ch , thuc c ch MAO, sulfamid, perhexilin.
Vi sulfamid chng tiu ng: Ngoi nhng thuc k trn vi insulin, khng dng
phenylbutazon, aspirin, salicylat, thuc khng vitamin K.
12. Suy h hp
Thuc c ch trung tm h hp (ch phm thuc phin, nalorphin, barbiturat,
thuc an thn gii lo); thuc ngn cn dn truyn thn kinh c (khng sinh
aminoglycosid, d-tubocurarin, colistin, polymyxin B, cc tetracyclin, aminazin,
trimethadion, penicilamin, succinylcholin...); thuc dng lu gy x ha phi (thuc
chng gin phn, mecamylamin, nitrofurantoin, oxy (O2) nng cao dng lu,
phenytoin, cao tuyn yn nh mi...), thuc lm co ph qun, nht l ngi hen v
vim ph qun (loi c ch , kch thch , cholinergic, N-acetylcystein, loi gii phng
histamin) ...
13. Ngi b i
nam gii: Cc androgen v loi ng ha protein.
c hai gii: Loi khng cholinergic (atropin v cng loi, thuc chng Parkinson
loi khng cholinergic trung ng, thuc khng histamin H1, thuc an thn kinh (nh loi
phenothiazin), chng trm cm ba vng, thuc lit hch (nh Arfonad)...
14. Glocom
ngi glocom mn: Corticoid, ACTH.
ngi glocom gc mng mt - gic mc ng: Atropin (nh mt hoc ton
thn), thuc khng cholinergic, thuc lit hch Arfonad..., loi adrenergic (ti ch v
ton thn), dn xut amphetamin ...
15. Ngi ngoi nng nhiu, nhit cao, ang st
Tip xc nhiu vi nh nng: Thuc c c tnh khi gp nh sng (nh ban
ni ca thn th tip xc vi nh sng).
Thuc bi ngoi: Thuc st khun cha halogen (hexaclorphen, bithionol...), dn
xut hc n (benzen, toluen, anthracen...), mt s cht mu (eosin, xanh methylen,
fluorescein...), mt s thuc chng nm, mt s thuc khng histamin (promethazin,
diphenhydramin...).
29
Thuc dng bn trong c th: Doxycylin, dn xut phenothiazin, thuc khng

histamin H1, thuc an thn kinh, khng vitamin K, amiodaron, sulfamid, acid nalidixic...
Thuc gy d ng do nh sng (nhy cm vi nh sng): Sulfamid, dn xut
phenothiazin, thuc st khun cha halogen, mt s cht mu, griseofulvin, quinin ...
Thuc gy qu ti sc t melanin: Ung thuc nga thai.
Tip xc vi nhit cao: Thuc khng cholinergic (loi atropin), thuc li niu,
thuc lm tng thn nhit (loi amphetamin, thuc hi sc h hp, thuc chng trm
cm loi ba vng, aspirin, salicylat, cinchophen, thuc c ch MAO, thuc an thn kinh,
theophylin, ch (Pb) (v khi Pb hp thu khng ng lc, gy ng c).
Ngi ang st: Mi thuc gy ri lon thn kinh - tm thn.
H Ni, thng 7 nm 2006
GS.TSKH Hong Tch Huyn
Phn hai
NI DUNG TNG TC THUC V CH KHI CH NH
ACAMPROSAT
Thuc c tnh tit acid gamma amino butyric,
dng trong cai ru
CC THUC TRONG NHM

ACAMPROSAT vin nn bc 333mg
Aotal vin nn bc 333mg
CH KHI CH NHTHUC
Cn theo di: mc 1
tr.
Thi k cho con b: Cha c d liu chnh xc, khng cho con b trong khi iu
Thi k mang thai: Cha c d liu chnh xc, khng dng thuc ny trong ba
thng u thai k.
ACETORPHAN
Thuc chng tiu chy, chng tit dch rut do c ch enkephalinase.
Cc enkephalin c tc dng chng tit dch thun tu rut. Acetorphan
30
c dng trong iu tr triu chng cc trng hp tiu chy cp tnh

ngi trng thnh. Trnh dng thuc qu mt tun l
CC THUC TRONG NHM

ACETORPHAN nang 100mg
Tiorfan nang 100mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b, tr cn b, tr em, ngi mang thai : Thn trng vi mt
thuc mi cn thiu cc d liu trong y vn.
31
ACICLOVIR
Thuc khng virus
CC THUC TRONG NHM

ACICLOVIR vin nn 200 mg; kem bi da 5%; 3%; thuc m 5% tup 5 g
Acyclovir Denk vin 200 mg
Acyclovir Stada kem bi 50mg/g
Acyclovir Stada vin nn 200mg, 400mg; 800mg
Avircrem 5% kem bi da
Cyclovax kem bi da v vin nn 200mg, 400mg, 800mg
Cyclovir 3% kem da tup 5 g
Cyclovir vin nn 200 mg
Hacyclor kem bi da 50mg/g
Herperax vin nn 200mg
Herperax 5% thuc m tup 5 g
Herpevir vin nn 200mg
Herpex vin nn 200mg
Herpex 5% kem bi
Lovir vin nn 400mg
Mediclovir m tra mt
Medovir 200 mg vin
Medovir kem bi 5%
Napharax kem bi 5%
Sudo Acyclovir thuc m 50mg/g
Vacrax thuc m 50mg/g
Virucid vin nn 800mg
Zoraxin vin nn 200mg
Zovirax vin nn 200mg; 800mg, m tra mt 3%
CH KHI CH NH THUC
Thn trng: mc 2
32
Ngi cao tui: Liu lng phi thch ng vi ngi cao tui. Phi theo di chc
nng to mu v thn.
Cn theo di: mc 1
Thi k cho con b: Aciclovir qua c sa m. Cha hon ton chng minh
c tnh khng c ca thuc i vi tr em b sa m.
Thi k mang thai: Aciclovir qua nhau thai. c dng cho ngi mang thai,
c bit n mc hecpet ng sinh dc, gim nguy c ly nhim i vi tr. Cn
phi khng nh thm tnh khng c ca thuc.
Cc trng hp khc: C tin s qu mn cm vi aciclovir.
TNG TC THUC
Tng tc cn thn trng: mc 2
Acid valproic
Phn tch: Nng trong huyt thanh ca acid valproic c th gim, lm gim tc
dng. Tng tc mun. C ch cha r.
X l: Cn gim st ngi bnh v tc dng iu tr ca acid valproic khi bt u
hoc ngng iu tr acyclovir. iu chnh liu acid valproic khi cn.
Hydantoin (phenytoin)
Phn tch: Nng trong huyt thanh ca phenytoin c th b gim, lm gim tc
dng. Tng tc xy ra mun. C ch cha r.
X l: Gim st cn thn ngi bnh v thay i tc dng ca phenytoin khi bt
u hoc ngng iu tr acyclovir. iu chnh liu ca phenytoin khi cn.
Theophylin
Phn tch: Nng trong huyt tng ca theophylin c th tng, lm tng tc
dng dc l v tc dng khng mong mun. Tng tc chm. C ch c kh nng c
ch chuyn ho oxy - ho ca theophylin.
X l: Gim st cn thn nng trong huyt tng ca theophylin v theo di
cc tc dng c hi trong khi phi hp vi acyclovir. iu chnh liu theophylin nu cn.
Zidovudin
Phn tch: Tc dng khng mong mun, nh ng lm v suy nhc do mt c ch
cn cha bit.
Tng tc cn theo di: mc 1
Probenecid
Phn tch: Probenecid c th lm tng nng ca acyclovir trong huyt thanh, lm
tng tc dng iu tr v tc dng khng mong mun. Tng tc xy ra nhanh. C ch
Probenecid c th cn tr bi tit acyclovir qua ng thn.
X l: Liu lng ca acyclovir v valacyclovir c th cn phi gim nu xut
hin nhim c acyclovir.
33
ACID ASCORBIC
Acid ascorbic v natri ascorbat c ch nh d phng v iu tr thiu ht
vitamin C. Thiu ht ny do thiu dinh dng v c th gy bnh scorbut giai on cui.
Acid ascorbic tham gia mnh vo cc phn ng oxy ho - kh t bo
CC THUC TRONG NHM

ACID ASCORBIC
Acti-5
Aronamin
Ascormin ng tim 500mg/5mL
Ascortonyl ng ung 5mL (km K v Mg aspartat)
Aspirin C
Aspirin UPSA-Vitamin C
ASS+ C Pharmavit
Ca-C 1000 Sandoz vin si
Calcium Corbire C 1000 DPP
Calcium Corbire Vitamin
Cal-C-vita vin si
Callimon vin si
Cegrovit vin si
Celaskon vin si
Ceelin-thuc git ung 100mg/1mL; siro 100mg/5mL
Cevita ng tim 500mg/5mL
Cevita ng tim 100mg/2mL
C-Vitamin Pharmavit vin si
Cyclo 3 forte vin
Effemol gi thuc
Fervex cm
Gluco C vin nn
Igatan nang
34
Laroscorbine ng tim 1000mg/5mL

Laroscorbine vin si 1g
My vita vitamin C vin nn si 75mg
Plusssz-vitamin C vin nn si 60mg
Polytonyl enfant dung dch ung
Rutin C vin nn
Soda C gi bt
Solucetyl vin si
Upsa C vin nn si 1 g
Vita C vin nn 100mg
Vita-Cal C vin si
Vitamin C dung dch tim 10 % ng 5 mL; 500 mg/5mL
Vitamin C ng tim dung dch 5 % ng 2 mL
Vitamin C Oberlin cm pha dung dch, gi 1000 mg
Vitamin C Oberlin vin nn
Vitamin C vin nn 100 mg; 500 mg
Vitamin C vin si bt 1000 mg
Vitamin C Bil dung dch tim
Dng phi hp
Ca-C 1000 Sandoz-vin nn si
Calcium Corbire vitamin ng ung 5mL
Gluco C vin nn ngm
Rutin C vin nn
Upsa C-calcium vin nn si
Phi hp trong cc dng cha nhiu vitamin
Astymin forte v Astymin Liquid
Brivita (vin si v cam)
Cebitex-C 300
Centovit
Enervon C
Homtamin
My Vita multivitamin vin si
Orange multivitamin vin si
35
Opssi multivitamin vin si

Plusssz multivitamin vin si
Phi hp vi thuc gim au
Ameflu + C
Efferalgan-vitamin C
CH KHI CH NHTHUC
Cn nhc nguy c/li ch: mc 3
Thiu ht G6PD: i vi ngi bnh thiu ht G6PD, c nguy c tan mu.
Si thn: Trnh dng vitamin C liu hng ngy vt qu 1g khi c si thn (lm
gim pH thn).
TNG TC THUC
Phi hp nguy him: mc 4
Alopurinol hoc dn cht
Phn tch: Dng acid ascorbic thng xuyn vi liu cao lm acid ho nc tiu
v c th lm kt ta tinh th urat thn.
X l: ngi b gt, nn trnh lm acid ho nc tiu v thng c khuyn
co dng nc khong kim to thun li cho cc tinh th urat c ho tan.
Cc cht kim ho nc tiu
Phn tch: Acid ascorbic l thuc acid ho nc tiu. Khi dng cc thuc kim ho
nc tiu, pH nc tiu s b trung ho khi dng vitamin C liu cao (trn 2g).
X l: Trong mt s trng hp iu tr, c th cn phi theo di pH nc tiu
bng giy th acid-base. Nu cn kim ho nc tiu, cn trnh phi hp vi vitamin
C.
Sulfamid khng khun
Phn tch: Nguy c kt ta ng tit niu khi dng vitamin C liu cao (trn 2g,
tng tc l - ho v l thuyt, cn phi chng minh trn thc t).
X l: Theo di pH nc tiu (o pH bng giy ch th). Nu cn kim ho nc
tiu, trnh k n cng vi vitamin C. Thng bo cho ngi bnh bit nguy c ny v
yu cu tm ngng dng vitamin C liu cao trong khi iu tr bng sulfamid.
Barbituric
Phn tch: Dng ng thi thuc ny vi vitamin C s tng o thi acid ascorbic.
X l: Nhu cu vitamin C ngi bnh iu tr lu di bng barbituric (th d:
ng kinh) tng ln, nn c th k n b sung vitamin C. Cn lu ngi bnh hay t
dng vitamin C, do k n hay pht thuc phi lu iu ny.
36
Deferoxamin
Phn tch: Dng acid ascorbic hng ngy vi liu cao hn 250 mg cng vi
deferoxamin c th lm h hi kh nng to phc ca deferoxamin, t lm tng
c tnh ca st i vi m, c bit m tim, c th dn ti tim mt b.
X l: Khng k n dng ng thi vitamin C i vi ngi bnh iu tr bng
deferoxamin. Khuyn khng t dng vitamin C. Ch ngi bnh cao tui i u tr
bng deferoxamin.
Primidon hoc dn cht
Phn tch: Dng cc thuc ny ng thi vi acid ascorbic lm tng thi acid
ascorbic.
X l: Nhu cu vitamin C ngi bnh iu tr lu di bng nhng thuc ny (th
d ngi ng kinh) tng ln, nn c th b sung vitamin C. Cn nh ngi bnh hay
t dng vitamin C.
Thuc chn beta (propranolol)
Phn tch: Tc dng dc l ca propranolol c th b gim. C ch c th do
gim hp thu propranolol.
X l: Gim st p ng lm sng ca ngi bnh v iu chnh liu khi cn.
Fluphenazin
Phn tch: Tc dng dc l v iu tr ca fluphenazin c th b gim. Tng tc
xy ra mun. C ch cha r.
X l: Khng cn phi x l. Gim dn liu fluphenazin nu cn.
Thuc ung nga thai
Phn tch: Acid ascorbic lm tng nng trong huyt thanh ca estrogen cha
trong vin thuc, c th gy ra cc tc dng khng mong mun. Tng tc xy ra
mun. C ch tng kh dng sinh hc ca thuc ung nga thai do acid ascorbic lm
tn hi n chuyn ho thuc nga thai.
X l: Nu c tc dng c hi xy ra, c lin quan n estrogen, nn ngh n
kh nng do phi hp vi acid ascorbic.
Warfarin
Phn tch: Tc dng chng ng mu ca warfarin c th b gim. C ch cha
r.
X l: Khng cn can thip tr khi ngi bnh dng mt liu ln (>5-10g/ ngy)
acid ascorbic.
ACID CHENODESOXYCHOLIC HOC DN CHT
37
Acid ny l thnh phn cu to bnh thng ca mt. Khi ung,

thuc c th lm tan si cholesterol ti mt vi iu kin
l si trong sut vi tia X (si khng vi ho)
CC THUC TRONG NHM
ACID CHENODESOXYCHOLIC vin nn bc 250mg
Chenodex vin nn bc 250mg
ACID URSODESOXYCHOLIC nang 200mg
Ursolvan nang 200mg
Bio-clean (phi hp) vin bao ng
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai: Do thy c tnh vi gan ca thai kh Rhesus.
Cn nhc nguy c/ li ch: mc 3
Bnh i trng: Acid chenodesoxycholic d hp thu rut non. C th c phn
khng c hp thu, s gy bi tit nc v cc cht in gii i trng. Khi
thng xy ra tiu chy, nn chng ch nh dng thuc ny nhng ng i c bnh
i trng. Tuy nhin, acid ursodesoxycholic khng kch ng nim mc i trng nn c
th dng c.
Suy gan: S to thnh acid lithocholic do cc vi khun rut c th dn n tng
va phi v nht thi cc transaminase.
Cc trng hp khc: Chng ch nh dng loi ny khi c bnh tn thng
thc th rut do nguy c tiu chy.
Cn theo di: mc 1
Thi k cho con b: Do thn trng
TNG TC THUC
Cn nhc nguy c / li ch: mc 3
Aminosid ung; cholestyramin; estrogen hoc thuc nga thai
estroprogestogen; fibrat; progestogen hoc dn cht; thuc khng acid ng
ung hoc than hot
Phn tch: Acid ursochenodesoxycholic lm tng t l acid mt/ cholesterol. Khi
lp li cn bng gia cc thnh phn ca mt, thuc c th gp phn lm thoi tri n
nhng si mt cholesterol. To phc vi acid ursodesoxycholic (khi dng cng vi
cholestyramin v cc khng acid), hoc lm tng s bo ho ca mt (khi dng cng
vi estrogen, progestogen, fibrat, neomycin ung) s lm gim hot tnh ca acid
ursodesoxycholic.
38
X l: iu tr bng acid ursodesoxycholic phi di ngy (t 6 thng n 1 nm).

Cn trnh khng phi hp vi nhng thuc lm gim tc dng ca acid
ursodesoxycholic (nh cholestyramin, cc khng acid, estrogen, progestrogen, fibrat,
neomycin ung), tr khi thuc phi hp ch dng trong thi gian rt ngn trnh tht
bi trong iu tr.
Ciclosporin
Phn tch: Acid ursodesoxycholic lm tng hp thu v tng nng trong huyt
thanh ca ciclosporin mt s ngi bnh, nhng khng d on trc c. Acid
ursodesoxycholic c v khng tng tc vi ciclosporin.
X l: Thng tin cn hn ch. Cn thn trng gim st tc dng khi thm hoc
ngng acid ursodesoxycholic ngi ang iu tr bng ciclosporin, iu chnh liu
ciclosporin khi cn.
Ciprofloxacin
Phn tch: Nng trong huyt thanh ca ciprofloxacin c th b gim khi phi
hp vi acid ursodesoxycholic. C ch cha r.
X l: Tuy thng tin cn t (mt trng hp c bo co), nhng cn phi gim
st tng tc ny vi bt c mt khng sinh quinolon no khi phi hp.
39
ACID CROMOGLYCIC HOC THUC TNG T

Tc dng chng d ng bng cch c ch s mt ht
cc dng bo v cc bch cu a base
CC THUC TRONG NHM
ACID CROMOGLYCIC dung dch nh mt 2%; dung dch phun mi 2,8mg/1,4ml
Cromal
Opticron dung dch nh mt 2%
Stadaglicin (nh mt) 20mg/mL
Stadaglicin (xt mi)
NEDOCROMIL bt bm ht 2mg/l
Tilade bt bm ht 2mg/l
CH KHI CH NH THUC
Cn theo di: mc 1
Thi k mang thai: V thn trng, khng dng trong ba thng u ca thai k.
ACID FOLIC HOC DN CHT

Vitamin chng thiu mu thuc nhm vitamin B
CC THUC TRONG NHM

ACID FOLIC
Tardyferon B9 vin nn bc 35mg (phi hp vi st sulfat v vitamin C) Az-vital
Adofex (nang phi hp)
Apo-Folic (vin nn 5mg)
Astymin fort (nang phi hp)
Astymin liquid (siro phi hp)
Biofer (vin nn nhai phi hp)
Centrivit (vin phi hp)
Femaxx (nang phi hp)
40
Cn nhc nguy c/ li ch
+++
Ferlin (thuc git v siro phi hp)

Ferovit (nang phi hp)
Hepatoglobine
Homtamin (nang phi hp)
Moriamin forte (nang phi hp)
Natalvit
Obimin (vin nn phi hp)
Oramin
Plenyl
Plussz junior
Plussz Multivitamin
Polyamine forte
Promin
Previt (vin si phi hp)
Revigin Ginseng plus
Saferon
Siderfol
Siderplex
Tardiferon B9 (vin bao ng phi hp)
Tropic (vin nn si bt phi hp)
Vitacap (nang phi hp)
ACID FOLINIC nang 15mg; dung dch tim 3mg/ 1mL; 30 mg / 3 mL; 5 mg/5 mL
Calcium folinat Ebewe nang 15mg
Calcium folinat Ebewe dung dch tim 3mg/ 1mL
Calcium folinat Ebewe dung dch tim 30mg/3mL
Leucovorin dung dch tim 3mg/ 1mL
Leucovorin dung dch tim 5mg/ 5mL
TNG TC THUC
Methotrexat
Phn tch: Methotrexat l cht i khng ca acid folic, do c ch dihydrofolat
reductase. Tng tc cng c ngha nu dng liu cao v iu tr di ngy.
41
+++
X l: p dng tng tc ny trong trng hp qu liu methotrexat, dng acid

folinic (calci folinat) thay cho acid folic.
Barbituric; primidon hoc dn cht
Phn tch: Nguy c lm gim nng thuc chng ng kinh trong huyt thanh
khi b sung acid folic. Dng ng thi cc thuc ny vi acid folic c th lm gim tc
dng chng co git, do gim tc dng ca thuc chng ng kinh trn h thn kinh
trung ng.
X l: Tng cng theo di lm sng v sinh hc khi iu tr ng kinh ngi
bnh dng b sung acid folic. iu chnh liu lng thuc chng ng kinh nu cn,
trong v sau khi ngng acid folic.
Natri valproat hoc dn cht
Phn tch: Ngoi tnh cht c ch h thn kinh trung ng, y c s phi hp
acid folic vi mt thuc c hot tnh khng folic (do c ch dihydrofolat reductase).
X l: Kim tra huyt u n, v khi cn, iu tr bng b sung acid folinic,
c bit vi ngi bnh dng natri valproat hoc dn cht vi liu cao hoc di ngy.
Phenytoin
Phn tch: Phi hp acid folic vi phenytoin gy nguy c gim nng phenytoin
trong huyt thanh, lm gim tc dng chng co git, do lm gim tc dng ca
phenytoin h thn kinh trung ng.
X l: Tng cng theo di lm sng v sinh hc trong iu tr chng ng kinh
ngi bnh c dng b sung acid folic. iu chnh liu lng ca phenytoin khi cn,
trong v sau khi ngng b sung acid folic.
Pyrimethamin hoc trimethoprim
Phn tch: Tc dng i khng vi acid folic, do c ch dihydrofolat reductase.
Tng tc cng quan trng nu liu dng cng cao v iu tr cng ko di.
X l: Kim tra huyt thng xuyn. Khi cn, b sung acid folinic (calci folinat),
c bit i vi ngi bnh dng pyrimethamin- trimethoprim liu cao hoc iu tr di
ngy.
Thuc li tiu gi kali
Phn tch: Ch triamteren trong h thuc li tiu gi kali l c tnh i khng vi
acid folic, do c ch dihydrofolat reductase. Tng tc ny cng quan trng nu li u
dng cng cao v iu tr cng di ngy.
X l: Kim tra huyt v khi cn, cho dng b sung acid folinic (calci folinat),
c bit vi ngi bnh dng triamteren liu cao hoc iu tr di ngy, nht l trong
thi k mang thai.
Sulfasalazin hoc dn cht
Phn tch: Salazosulfapyridin (sulfasalazin) lm gim hp thu acid folic (khong
mt phn ba). Thiu ht folat biu hin nng folat trong huyt thanh h thp, thiu
42
mu nguyn hng cu khng l, chng i hng cu v chng tng hng cu li. C

kh nng do c ch hp thu folat rut.
X l: Khi thy thiu ht folat v lm sng hoc sinh hc, cn b sung acid folinic
cho ngi bnh.
Fluoro - 5 - uracil
Phn tch: Dng ng thi vi acid folinic di dng calci folinat c th lm tng
tc dng iu tr v c tnh ca fluoro - 5 - uracil.
X l: C th dng ng thi hai thuc ny, nhng nu cn th hiu chnh li liu
lng. Ch k n kt hp ny c s chuyn khoa cng vi theo di u n huyt
.
ACID FUSIDIC
Khng sinh dit khun v km khun, tc dng trn s tng hp protein
v thng c dng ch yu chng t cu
CC THUC TRONG NHM

ACID FUSIDIC kem bi da 2%; thuc m 2%; gel tra mt 1%
Foban kem bi da 2%
Fucidin kem bi da 2%
Fucidin thuc m 2%
Fucidin vin nn 250mg natri fusidat
Fucicort kem bi da 2% (phi hp vi betamethason)
Fucithalmic gel tra mt 1%
Fudikin thuc m 2%
CH KHI CH NHTHUC
Chng ch nh: mc 4
Trnh dng acid fusidic theo ng ung trong nhim t cu khun ng tit
niu, v acid fusidic khng thi qua nc tiu.
Suy gan: V c nguy c vng da, nn cn theo di gan nhng ngi bnh dng
thuc ny.
Thn trng: mc 2
43
+++
Thi k cho con b: Mt lng thp thuc bi tit qua sa m.

Thi k mang thai: Cha chng minh c tnh khng c ngi mang thai.
Cn theo di: Mc 1
Tr em: Nguy c vng da nhn no tr cn b, do nguy c cnh tranh gia acid
fusidic v bilirubin gn vo albumin.
ACID HO NC TIU ( CC CHT)

Thuc c tc dng lm h thp pH nc tiu
CC THUC TRONG NHM

AMONI CLORID
Chlorammonic vin nn bc 500 mg
Atussin (phi hp) siro
Benadryl (phi hp)
Komix (phi hp)
Zedex (phi hp)
ACID PHOSPHORIC dung dch ung 2,7 mg/90 mL
Phosoforme dung dch ung 2,7 mg/90 mL
CH KHI CH NH
Chng ch nh: mc 4
Lot d dy - t trng; vim d dy: Do tnh acid ca cc cht ny.
Trng hp khc: Chng ch nh dng mt cht acid ho nc tiu tt c
nhng trng hp nhim acid hoc si urat.
Cn theo di: mc 1
Suy gan: Khi suy gan nng, ion amoni (+NH4) b sung s khng c chuyn
ho, v dn n nguy c tng amoniac mu.
Suy thn: Do ion amoni mt phn c thi qua thn, nn c nguy c qu ti
gan v trng thi nhim acid tng clor mu do thn.
44
+++
TNG TC THUC
Sulfamid khng khun
Phn tch: Phn ng ho - l cho php gii thch nguy c kt tinh sulfamid trong
ng thn, ko theo tn thng thn thc th. Kt ta cng r khi pH khong 5. Tng
tc ny c thng bo trong y vn khi phi hp vi hexamin.
X l: Trnh phi hp hai thuc ny. Nu cn phi hp, phi theo di pH nc
tiu bng giy ch th.
Phn tch: Dng thng xuyn cc thuc acid ho nc tiu liu cao c th dn
n kt ta cc tinh th urat thn.
X l: Trnh acid ho nc tiu ngi bnh thng phong (gt). Tng bi niu
bng cho ung nc kim tnh to iu kin ho tan tinh th urat. Cn lu n
vitamin C m ngi bnh hay t dng. Thng bo cho ngi bnh thng phong dng
alopurinol bit nguy c vitamin C gy ta urat. Nguy c ch xut hin vi li u vitamin C
dng hng ngy vt qu 2g.
Amphetamin hoc dn cht
Phn tch: Gim ti hp thu amphetamin ng thn. Cc cht acid ho nc tiu
lm tng thi amphetamin (pH khong 5) qua thn. Amphetamin l mt base thi qua
nc tiu. Trong mi trng acid, t gp thuc ny dng khng phn cc.
X l: Tng tc c li: Acid ho nc tiu nhm to iu kin thi nhanh
amphetamin khi dng qu liu. Tng tc c hi cn trnh: Khi iu tr bng
amphetamin, c th tht bi do thi thuc qu nhanh (nu acid ho nc tiu) hoc c
th b lon tm thn do thuc (nu kim ho nc tiu).
Barbituric
Phn tch: Tng ti hp thu ng thn, c th ko di tc dng ca barbituric v
lm xut hin c tnh do qu liu.
X l: Nu cn phi hp hai thuc ny, phi hiu chnh liu dng. Nu ngi
bnh c biu hin ng g khi dng hai thuc ny, c khi phi gim liu barbituric sau
khi o pH nc tiu bng giy ch th.
Mexiletin
Phn tch: Acid ho nc tiu c th lm tng thi mexiletin qua thn. Tng tc
ny, nu trong cc ti liu, cho thy c nhng bin i v ngha lm sng khi phi hp
thuc.
X l: Nu cn phi hp thuc, phi theo di cc tc dng trn lm sng, v lun
lun thc l c th c nhng bin i tc dng dc l ca mexiletin.
Primidon hoc dn cht
45
Phn tch: Lm tng ti hp thu ng thn.

X l: Tc dng dc l ca hai thuc tng ln, nn khi cn phi hp hai thuc th
phi hiu chnh liu lng. o pH bng giy ch th bit c cn hiu chnh liu lng
hay khng.
Salicylat
Phn tch: Nng salicylat trong huyt tng tng do gim bi tit qua nc tiu
khi phi hp vi cc cht acid ho.
X l: Tc dng dc l ca thuc tng ln, nn khi cn phi hp th phi hi u
chnh liu lng. o pH nc tiu bng giy ch th bit c cn hiu chnh liu
lng hay khng.
Thuc chng trm cm ba vng hoc thuc tng t
Phn tch: Thuc chng trm cm ba vng l base, nn cc thuc acid ho nc
tiu c th lm tng bi tit cc thuc qua nc tiu. Ngc li cc thuc kim ho
nc tiu li c tc dng lm gim bi tit (to iu kin ti hp thu ng thn).
X l: Mc du tng tc ny c th xy ra theo c ch l - ho, nhng hnh nh
khng c nhng biu hin lm sng ng k.
Thuc kim ho nc tiu
Phn tch: Trung ho v mt l ho.
X l: Phi hp hai loi thuc ny c th hp l hay khng hp l tu theo mc
ch iu tr. o pH nc tiu bng giy ch th.
46
ACTINOMYCIN D
Khng sinh km t bo
CC THUC TRONG NHM

DACTINOMYCIN l bt pha tim 0,5mg
Cosmegen l bt pha tim 0,5mg
CH KHI CH NH THUC
Cc trng thi khc: Ngi bnh ung th: Phi cn nhc k tu theo trng thi
sinh l - bnh l ca ngi bnh, theo kh nng theo di ti ch, v theo mc tiu iu
tr do nh chuyn mn n nh.
TNG TC THUC
Cc cht c ch HMG - CoA reductase
Phn tch: Dng ng thi vi cc cht c ch min dch lm tng nguy c xut
hin tiu c vn v suy thn.
X l: Mc du cc trng hp thng bo ch lin quan n lovastatin, nhng
nguy c vn c kh nng xy ra vi simvastatin, pravastatin v cc statin khc. Nn
trnh phi hp.
Doxorubicin hoc dn cht
Phn tch: Mt mt, c nguy c tng c tnh vi mu do c ch tu xng, do
cc tc dng hip ng, c th dn n mt bch cu ht. Mt khc, c nh ng
thng bo v cc trng hp bnh c tim.
X l: Nu cn phi hp, th vi mi thuc phi dng liu thp; theo di
cht ch huyt . Khuyn ngh l tng liu doxorubicin khng vt qu
450 mg/m2 din tch c th.
Vaccin sng gim c lc
Phn tch: Nguy c pht trin nhim khun tng ng vi vaccin dng, do c
ch min dch ca thuc phi hp.
X l: Hai loi thuc ny phi dng cch nhau khong 3 thng n mt nm, tu
thuc mc c ch min dch.
47
+++
Alopurinol hoc dn cht; colchicin hoc dn cht

Phn tch: Dactinomycin c nguy c lm tng nng acid uric trong huyt tng.
X l: Cn phi hiu chnh liu lng ca thuc thng phong km hm s tng
nng acid uric trong mu.
Carmustin hoc dn cht; cisplatin
methotrexat; vincristin v cc cht tng t
hoc
dn
cht;
ganciclovir;
Phn tch: Nguy c tng c tnh vi mu do c ch tu xng, do nhng tc

dng hip ng, c th dn ti mt bch cu ht.
X l: Nu cn phi phi zhp thuc, nn dng liu thp vi mi cht. Theo di
cht ch huyt .
Clozapin
Phn tch: Nguy c tng c tnh vi mu do c ch tu xng, v do nhng tc
dng hip ng, c th dn ti mt bch cu ht. Ch ring i vi clozapin c th
gy mt bch cu ht nng, thm ch t vong (c tnh min dch).
X l: Trnh phi hp. Nu cn phi hp, phi dng liu thp vi mi thuc. Vi
clozapin, khng c g cho php d bo xut hin mt bch cu ht. Cho nn d ph i
hp hay khng, u phi theo di cht ch huyt (nh i vi bt c mi thuc km
t bo). Thng bo cho ngi bnh khi ch st nh, vim hng hay lot mi ng l phi
ngng dng thuc.
Cyclophosphamid hoc thuc tng t; fluoro-5-uracil; interferon alpha ti
t hp; levamisol; procarbazin; thiotepa; thuc chng ung th: Azathioprin
Phn tch: Nguy c tng c tnh vi mu do c ch tu xng, do cc tc dng
hip ng, c th gy mt bch cu ht.
X l: Nu c th, trnh phi hp. Nu cn phi phi hp, nn gim liu mi cht
v theo di cht ch huyt . Ch nhng thy thuc chuyn khoa mi k phi h p
nhng thuc ny, v thng phc iu tr c quy nh.
Cyclosporin
Phn tch: Phi hp gia hai thuc u c tc dng c ch min dch. Do c ch
min dch qu mnh, c nguy c xut hin u lympho gi.
X l: Phi hp hai thuc c ch min dch l iu phi suy ngh, tng quan
gia nguy c/ li ch phi cn nhc tu theo mc ch iu tr. S phi hp ny ch
c thc hin c s chuyn khoa v c theo di ngi bnh tht cn thn.
Dantrolen
Phn tch: Phi hp cc thuc c tim nng c vi gan (hip ng cc tc dng
khng mong mun).
X l: Khi phi hp hai thuc c vi gan, hoc phi theo di cht ch chc nng
gan (ASAT, ALAT, phosphatase kim, bilirubin), hoc nu c th, hon 1 trong 2 thuc
. Cn bo m l ngi bnh khng thng xuyn ung ru, v khng c tin s
vim gan virus. Cc triu chng lm sng ch yu khng c hiu: bun nn, vng
da Vic kt hp xut hin ban ngoi da, nga, hch to bin minh cho cn nguyn do
48
thuc. Da vo kt qu cc test sinh hc, cn phn bit nguy c xut hi n vim gan
hu t bo khng hi phc v vim gan mt hi phc c sau khi ngng iu tr.
Glycosid tr tim
Phn tch: Phi hp vi mt cht km t bo s ko theo km hp thu digitalis
khong 50%, do thng tn nim mc rut c th hi phc.
X l: Theo di cn thn nng digitalis trong huyt thanh trong sut thi gian
iu tr.
Interleukin 2 ti t hp
Phn tch: Phi hp hai thuc c ch tu xng.
X l: Ch c dng Interleukin 2 ti t hp c s chuyn khoa do bnh nng.
Cc tng tc thuc phi c cn nhc v tt c cc chc nng ca c th cn phi
theo di thng xuyn. Bt buc phi theo di huyt .
Mercaptopurin; pentostatin
Phn tch: S dng ng thi hai cht c ch tu xng c th gy cc ri lon
v mu nghim trng, tu thuc thi gian iu tr.
X l: Phi hp ny phi c theo di v mt huyt hc.
Penicilamin hoc thuc tng t

Phn tch: Dng ng thi hai cht c ch tu xng c th dn n nhng ri
lon v mu nghim trng, tu thuc thi gian iu tr. Cng cn phi theo di chc
nng thn.
X l: Phi hp ny phi c theo di v mt huyt hc v chc nng thn.
Phenicol
Phn tch: Nguy c tng c tnh vi mu do c ch tu xng, do tc dng hip
ng, c th dn n mt bch cu ht. Ch ring i vi phenicol c th dn n
mt bch cu ht nghim trng, thm ch t vong (c tnh min dch).
X l: Nu cn phi hp, dng liu thp vi mi thuc. Khng th on tr c
xut hin mt bch cu ht do cc phenicol. Theo di cn thn huyt , thc hin nh
thng l vi mt cht km t bo, vn c gi tr. Thng bo cho ngi bnh l khi ch
st nh, vim hng hay lot ming l phi ngng iu tr vi cc phenicol.
Zidovudin
Phn tch: Phi hp zidovudin vi cc thuc c khc vi tu i hi phi rt thn
trng. C nguy c thiu mu hay cc ri lon khc v mu.
liu.
49
X l: Nu cn phi hp, phi theo di cn thn huyt v nu cn, phi gim
ALOPURIOL HOC DN CHT

Thuc chng bnh thng phong (gt),
thuc c ch tng hp acid uric
CC THUC TRONG NHM

ALOPURINOL vin nn 100mg; 300mg
Apo-Allopurinol vin nn 100mg; 200mg; 300mg
Domedol vin nn 300mg
Milurit vin nn 100mg; 300mg
Zyloric vin nn 100mg
CH KHI CH NH THUC
Thi k cho con b: Alopurinol tham gia qu trnh chuyn ho (c ch tng hp
purin, v gy nhng bt thng trong chuyn ho cc pyrimidin) nn trnh dng su t
trong thi k cho con b.
Thi k mang thai: Alopurinol tham gia qu trnh chuyn ho (c ch tng hp
purin, v gy nhng bt thng trong chuyn ho pyrimidin) nn trnh dng trong thi
k mang thai.
Thn trng khi dng: mc 2
Suy gan hoc thn: 3% s trng hp dng thuc, c tai bin ngoi da nh
nga, ban v him hn l my ay hay phn ng ngoi da c trc mnh; cc tai bin
ny thng gp ngi bnh suy gan.
Tng tc thuc
Acid ascorbic
Phn tch: Dng u n acid ascorbic liu cao, do lm acid ho nc tiu, c th
lm kt ta urat thn.
X l: Vi ngi bnh thng phong (gt), cn trnh lm acid ho nc tiu, v
khuyn nn tng lng nuc tiu bi tit bng ung c tnh kim, to iu kin cho s
ho tan cc tinh th urat. Ngi bnh hay t dng vitamin C, nn phi cnh bo ngi
bnh thng phong iu tr bng alopurinol v nguy c ny , n ch xut hin vi nhng
liu vitamin C thng ngy vt qu 2g (c s thay i ng k pH ca nc tiu).
50
Penicilin
Phn tch: Nguy c cao c phn ng ngoi da, c bit vi nhng penicilin nhm
A (ampicilin). Nguy c ny c bit quan trng i vi ng i bnh gt. Tuy v y ch a
xc nh c nguyn nhn ca hin tng ny l do alopurinol, hay l do nng acid
uric cao trong mu.
X l: Nn trnh phi hp thuc ny. Nn tm mt khng sinh loi khc c hot
ph tng t i vi chng khun gy nhim.
Vidarabin
Phn tch: Nguy c ri lon thn kinh, kiu run, hay ri lon trong hnh thnh
ngh. Nguy c c vi thn kinh v cc tc dng c hi khc, nh: thiu mu, bun nn,
au, nga.
X l: Nu phi hp thuc tuyt i cn thit, phi theo di lm sng.
Asparaginase
Phn tch: Asparaginase lm tng nng acid uric trong mu.
X l: S phi hp thuc ch c thc hin ti bnh vin. Kim tra liu lng
thuc chng gt. trnh bnh si urat, ngi ta a dng alopurinol hn l cc thuc
gy acid uric niu, chng c th gy bnh thn do urat.
Azathioprin hoc mercaptopurin
Phn tch: Alopurinol c ch chuyn ho oxy ho ca azathioprin, v
mercaptopurin (do tc dng c ch xanthin oxydase, l enzym ging ho cc purin
thnh acid uric) gy nguy c tch lu cc cht khng chuyn ho, gm nhng base
puric.
X l: Nu cn phi hp thuc, ngi k n phi gim liu cht khng chuyn
ho xung 25 n 30%.
Cyclophosphamid hoc thuc tng t
Phn tch: S dng ng thi alopurinol vi cyclophosphamid c th lm tng tc
dng c ch tu xng.
X l: Nu cn phi hp thuc, cn nhn mnh phi theo di huyt mt cch
cht ch.
Dactinomycin
Phn tch: Nguy c lm tng nng acid uric trong huyt tng.
X l: C th phi hiu chnh liu thuc chng gt khc phc s tng acid uric
trong mu.
Doxorubicin hoc dn cht - melphalan
Phn tch: Dng ng thi mt thuc km t bo vi mt thuc chng gt lm
tng nng acid uric. Ngoi ra, tng nguy c gim bch cu v gim tiu cu do hip
ng nhng tc dng c hi ca cc thuc.
51
X l: Nn trnh phi hp cc thuc ny, nu khng, c th tht bi trong li u

php cha thng phong.
Pentostatin
Phn tch: Pentostatin c th lm tng nng acid uric. C th phi hiu chnh
liu alopurinol khng ch tng acid uric trong mu.
X l: Nn dng alopurinol (cht c ch tng hp acid uric) thay cho nhng cht
gy urat niu trnh nguy c bnh thn v urat.
Sulfamid h glucose mu
Phn tch: Alopurinol c th c ch bi tit clorpropamid qua ng thn, do c
th gy nguy c h glucose mu nng, v lm tng ng k na i ca clorpropamid.
X l: Cn c bit cnh gic vi ngi suy thn dng hai thuc ny. Theo di
cht ch glucose mu khi bt u, trong thi gian v khi ngng iu tr vi alopurinol.
Tng tc ny mi ch c m t vi clorpropamid, cn vi cc sulfamid h glucose
mu khc th cha c ni ti. Tt hn ht l ghi n dng mt thuc khc chng tiu
ng.
Theophylin hoc dn cht
Phn tch: Dng alopurinol liu cao (t nht 600mg/ngy) cng vi theophylin s
ko theo gim thanh lc theophylin thn v lm tng nng cht ny trong huyt
thanh.
X l: Phi theo di cht ch nng theophylin trong huyt thanh, v iu chnh
liu lng theo kt qu theo di. Cc du hiu ng c theophylin gm bun nn, nn,
au vng thng v, nhc u, kch thch, mt ng, nhp tim nhanh. Hin tng co git
ni chung c coi l du hiu chc chn do nhim c, v c th l du hiu u tin
(c bit tr em). Cn nh l theophylin c ranh gii iu tr thp.
Thuc acid ho nc tiu
Phn tch: Dng thng xuyn cc thuc acid ho nc tiu vi liu cao c th
gy kt ta cc tinh th urat thn.
X l: Vi ngi bnh thng phong (gt), cn trnh acid ho nc tiu. Ngi
bnh hay t dng vitamin C, nn phi cnh bo ngi bnh gt iu tr bng alopurinol
v nguy c kt ta urat thn, nguy c ny ch xut hin khi dng vitamin C hng ngy
vi liu trn 2g (lm tng pH nc tiu ng k). Nn dng ung tnh kim tng
lng nc tiu bi tit v to iu kin ho tan cc tinh th urat.
Thuc li tiu thi kali; furosemid hoc thuc tng t
Phn tch: Cc cht ny lm tng nng acid uric trong mu v lm gi m tc
dng ca liu php chng bnh thng phong (gt).
X l: Tt nht nn trnh s kt hp cc thuc ny v c th lm cho li u php
cha thng phong tht bi.
Thuc ung chng ng mu khng vitamin K
Phn tch: Tng na i ca thuc chng ng mu, do c ch chuyn ho thuc
gan (tng tc dc ng hc v chuyn ho gan).
52
X l: Nu cn phi hp thuc, phi theo di u n hn thi gian Quick v t

l chun quc t (INR) ngi bnh khi bt u, trong qu trnh v khi kt thc iu tr
bng alopurinol. Sau khi hiu chnh liu lng, khuyn ngi bnh dng thuc u
n, vo gi nht nh. Khng ngng iu tr t ngt hoc thay i cch iu tr m
khng c kin ca bc s.
Thuc ung khng acid hoc than hot tnh
Phn tch: Lm gim hp thu alopurinol theo ng tiu ho, nn lm gi m tc
dng ca thuc ny.
X l: Cn mt khong thi gian t mt n hai gi gia lc ung thuc khng
acid v alopurinol. Nn nhc li l thng thng thuc khng acid c dng 1 gi 30
pht sau ba n, khi m n l nguyn nhn ca s tng tit dch d dy. Tng tc
ny vi alopurinol cn cn c khng nh.
ALPROSTADIL
Prostaglandin E1 c tc dng ch yu
trn c trn ng ng mch
CC THUC TRONG NHM

ALPROSTADIN ng tim 10 mg; 20 mg; 0,5 mg/ 1 mL
Caverject ng tim 10 mg; 20 mg
Edex A ng tim 0,5 mg/ 1 mL
CH KHI CH NH THUC
Chng ch nh: mc 4
Cc trng thi khc: Khng tim thuc ny trc tip vo tnh mch.
Cn theo di: mc 1
Tr em: Dng thn trng cho tr s sinh c nguy c chy mu. Trnh dng cho
tr s sinh suy h hp.
TNG TC THUC
Thuc chng tng huyt p: Tc dng gim huyt p tng. Cn theo di huyt p.
53
AMANTADIN HOC THUC TNG T

Chng Parkinson v khng virus
CC THUC TRONG NHM

AMANTADIN nang 50 mg; 100 mg
Mantadix nang 100 mg
Contenton nang 50 mg; 100 mg
CH KHI CH NH THUC
Thi k cho con b: Do thn trng, khi cha c d liu.
Thi k mang thai: Nguy c sinh qui thai ng k.
Thn trng: mc 2
Trm cm: Amantadin c th gy ri lon thn kinh tm thn: l ln km theo o
gic v th gic v thnh gic, ch yu vo chiu ti.
ng kinh: Amantadin h thp ngng co git, v c th gy cn ng kinh.
Cn theo di: mc 1
Suy tim: Nguy c h huyt p t th ng.
Suy thn: Nguy c tch lu, do amantadin t b chuyn ho, nn c mt gn nh
ton b trong nc tiu di dng cn hot tnh.
TNG TC THUC
Thuc c ch MAO khng c hiu; procarbazin
Phn tch: Tng tc c th gy tng huyt p khng thng xuyn sau khi dng
thm thuc c ch MAO, do mt c ch cha c bit.
X l: Nu k n phi hp thuc, cn thn trng xc nh liu l ng v cn
thng bo cho Trung tm cnh gic thuc tt c nhng iu bt thng cho php
khng nh mt s nhn xt.
Ru
Phn tch: Tng tc dng c ch h thn kinh trung ng, ko theo tng tc dng
an thn gy bun ng. Mt s tc dng tm thn vn ng c th thy, c bit trong
tun iu tr u tin. Tng tc kiu dc lc.
54
X l: Tt hn l khng nn phi hp, v ngi k n khng th m bo ngi

bnh khng ung ru. Nguy c an thn gy bun ng c bit nguy him vi ng i
li xe v ngi ng my. Khuyn ngi bnh khng dng cc ch phm c ru.
Cafein; theophylin hoc dn cht
Phn tch: Thn trng trong phi hp amantadin vi thuc kch thch tm thn,
nhm trnh nhng tc dng hng thn nh d b kch thch, mt ng, v c n lon
nhp tim.
X l: Vic phi hp thuc ny i hi phi thn trng v cnh gic. Nhng tc
dng khng mong mun xut hin cn c chuyn v Trung tm cnh gic thuc.
Khng histamin khng H1 c tc dng an thn; thuc chng trm cm ba
vng hoc thuc tng t
Phn tch: Amantadin to iu kin xut hin cc tc dng l ln v o gic ca
cc thuc khng cholinergic. Ch cht ketotifen (Zaditen*) v oxadomid (Tinset*) hnh
nh khng c tc dng cholinergic.
X l: Nu nghi ng tng tc gy cc tc dng khng mong mun, iu chnh li
liu cc cht khng cholinergic trong khi dng phi hp vi amantadin. Bo cho ng i
bnh bit nhng tc dng khng mong mun c th xy ra.
Levodopa
Phn tch: C th s dng phi hp thuc ny trong iu tr bnh Parkinson,
nhng li cn trnh dng cho ngi bnh tm thn hay c tin s bnh tm thn.
X l: Trnh dng phi hp thuc ny cho ngi bnh c tin s bnh tm thn
v phi hi ngi bnh hay nhng ngi xung quanh.
Phenothiazin
Phn tch: Amantadin to iu kin xut hin cc trng thi l ln v o gic ca
cc thuc c tc dng khng cholinergic ( y l tc dng khng cholinergic ca cc
thuc an thn dn cht ca phenothiazin).
X l: Nu nghi ng tng tc gy tc dng khng mong mun, iu chnh li u
cc thuc khng cholinergic khi iu tr ng thi vi amantadin. Thng bo cho ng i
bnh bit nhng tc dng khng mong mun c th xy ra.
Quinin hoc dn cht (quinidin)
Phn tch: Nng trong huyt thanh ca amantadin c th tng nam, nhng
khng tng n. Nguy c nhim c amantadin (nh tht iu, l ln) c th tng.
Tng tc xy ra nhanh. C ch: Cc dn cht quinin c th c ch thanh lc ca
amantadin thn nam gii.
X l: Cn gim st cc tc dng c hi v thn kinh khi dng phi hp.
Thuc cng giao cm alpha - beta; thuc cng giao cm beta
Phn tch: Tng cng cc tc dng hng thn, ko theo tnh d b kch thch,
mt ng v him thy hn l co git v lon nhp tim.
X l: Khi dng cc thuc cng giao cm, phi theo di lm sng.
55
Thuc li tiu gi kali; thuc li tiu thi kali

Phn tch: Cc thiazid li tiu thi kali v triamteren li tiu gi kali c tc dng
lm gim thanh lc ca amantadin thn, do mt c ch cn cha bit, nn c th
lm tng c tnh ca amantadin.
X l: Khi phi hp thuc, phi iu chnh liu amantadin cho thch hp. Tng
tc ny cn cn c xc minh.
Thuc c ch MAO typ B
Phn tch: S c ch c hiu monoamin oxydase typ B dn ti ko di tc dng
ca levodopa, gii thch vic k n ng thi thuc c ch MAO typ B vi levodopa.
Nh vy, cc tng tc ging nh cc tng tc ca levodopa, nn ngh xem mc
h thuc levodopa. S phi hp thuc ny c th c s dng trong iu tr bnh
Parkinson, nhng ngi bnh tm thn, hoc c tin s bnh tm thn th khng nn
dng.
X l: V cn trnh phi hp thuc ny i vi ngi bnh c tin s bnh tm
thn, nn cn phi hi ngi bnh hoc hi nhng ngi xung quanh.
Trimethoprim; trimethoprim sulfamethoxazol
Phn tch: Dng ng thi cc thuc c th lm l ln cp tnh. Tng tc xy
ra mun. C ch Amantadin v trimethoprim c th c ch thanh lc ca c hai
thuc, lm tng nng huyt thanh ca c hai thuc.
X l: Cn gim st cc tc dng c hi v thn kinh khi dng phi hp.
Phn tch: Tuy cha c trng hp no c thng bo, nh sn xut khuyn nn
thn trng trong vic phi hp amantadin vi cht kch thch tm thn, nhm trnh
nhng tc dng hng thn nh tnh d kch thch, mt ng, v c th c lon nhp tim.
X l: Phi hp thuc ny i hi phi thn trng v cnh gic, v nu cn, cc
tc dng phi c bo v Trung tm cnh gic thuc.
Thuc khng cholinergic
Phn tch: Do hip ng cc tc dng khng mong mun, nn cc tc dng khng
cholinergic tng, lm tng nguy c b tiu tin, kh ming, to bn.
X l: Cn ghi nhn nhng nhc im ca loi thuc ny. Nu cn phi hp
thuc, phi thng bo cho ngi bnh bit cc nhc im . Trnh dng cho ngi
b ph i tuyn tin lit v ngi tng nhn p.
56
AMINEPTIN
Thuc chng trm cm ba vng, khng phi dn cht ca imipramin, khng phi
thuc c ch MAO, ch yu c tc dng dopaminergic (tc dng ging dopamin).
CC THUC TRONG NHM
AMINEPTIN vin nn 100mg
Survector vin nn 100mg
CH KHI CH NH THUC
n ung - Ru: Trnh ung ru khi iu tr.
Suy gan: Nguy c vim gan do c ch min dch d ng.
Cc trng thi khc: Chng ma git Huntington.
Cn theo di: mc 1
Thi k cho con b: Bi tit vi lng thp vo sa.
ng kinh: Nguy c h thp ngng gy ng kinh.
Thi k mang thai: V cha c nhng d liu chnh xc.
TNG TC THUC
Thuc c ch MAO khng chn lc
Phn tch: Nguy c cn tng huyt p c th gy t vong, bnh v no, co git,
st cao, t vong.
X l: Chng ch nh phi hp thuc, ngay c khi mt s chuyn gia mun dng
cho mt s ngi bnh khng li cc liu php khc ti c s chuyn khoa.
Procarbazin
Phn tch: Nguy c ri lon huyt p nghim trng do tc dng c ch MAO ca
procarbazin.
X l: Ch bt u dng amineptin sau khi ngng dng procarbazin t nht 15
ngy. Nu ngc li, ch bt u dng procarbazin sau khi ngng dng amineptin
hai ngy.
Tng tc cn thn trng khi dng: mc 2
Carmustin hoc dn cht; dantrolen; estrogen hoc thuc trnh thai estroprogestogen; griseofulvin; isoniazid hoc thuc tng t; macrolid; methotrexat;
natri valproat hoc dn cht; progabid; rifampicin; thuc gy m bay hi cha
halogen
57

khng mong mun).
X l: Khi cn iu tr bng hai thuc c vi gan, th hoc phi theo di cht ch
chc nng gan (ASAT, ALAT, phosphatase kim, bilirubin) hoc hon dng mt trong
hai thuc nu c th. Phi m bo l ngi bnh khng thng xuyn ung ru
v khng c tin s vim gan virus. Nhng triu chng lm sng chnh khng c hi u
l bun nn, st, vng da... Nu b ban ngoi da, nga v hch to th c nhiu kh
nng l do thuc. Tu theo kt qu test sinh hc, cn phn bit nguy c xut hin vim
gan tiu t bo khng hi phc vi nguy c vim gan mt hi phc c sau khi
ngng iu tr.
Gluthetimid hoc thuc tng t; fluoxetin; interferon alpha ti t hp;
khng histamin khng H1 c tc dng an thn; medifoxamin; reserpin; thuc
chng trm cm ba vng hoc cc cht tng t; thuc ch vn ca morphin.
Phn tch: Tng cc tc dng c ch h thn kinh trung ng, c ch h hp v
h huyt p. Ngoi ra, nu b ph thuc thuc th phi hp hai thuc c th lm tng
thm nguy c ph thuc thuc.
X l: Phi tnh n nguy c ny iu chnh liu lng hai thuc cho thch
hp, nu cn phi hp hai thuc, phi ngh n gim tnh to ngi li xe v ng i
ng my. Khuyn ngi bnh khng ung ru v dng cc ch phm c ru.
Phn tch: Mc tiu chnh l iu tr ung th tuyn thn (adenocarcinoma).
Interleukin cng c tnh c vi gan, nn y l s phi hp hai thuc c tim nng c
vi gan.
X l: Ch c thc hin kt hp ny c s iu tr chuyn khoa. Dng
interleukin 2 i hi phi theo di thng xuyn. Nh vy, trong trng hp ny, mi
th phi quyt nh theo trng thi chung ca ngi bnh. Khi phi hp hai th thuc
c vi gan, phi, hoc theo di cht ch chc nng gan (ASAT, ALAT, phosphatase
kim, bilirubin), hoc hon dng mt trong hai thuc nu c th.
Oxaflozan
an thn gy bun ng (tng tc dc lc).
X l: Phi tnh n nguy c trn hiu chnh liu lng ca hai thuc. Phi
ngh n gim tnh to ngi li xe, ngi ng my. Khuyn khng ung ru v
dng cc ch phm c ru.
Thuc chng nm dn xut imidazol
Phn tch: Phi hp hai thuc c tim nng c vi gan.
X l: Amineptin dng mt mnh, c th gy phn ng min dch d ng gan,
hi phc c sau khi ngng iu tr. Vi cc thuc chng nm dn cht ca imidazol,
hoc phi theo di cht ch chc nng gan (ASAT, ALAT, phosphatase kim, bilirubin),
c bit vi ketoconazol, hoc nu c th, hon dng mt trong hai thuc. Phi m
bo l ngi bnh khng thng xuyn ung ru v khng c tin s vim gan virus.
Cc triu chng lm sng chnh trn khng c hiu l bun nn, st, vng da... S
xut hin ban ngoi da, nga v hch to ni ln c nhiu kh nng do thuc.Cn c
58
cc test th sinh hc, phn bit r nguy c xut hin vim gan tiu t bo khng h i
phc vi vim gan mt hi phc c sau khi ngng iu tr.
Viloxazin
Phn tch: Tng c ch h thn kinh trung ng, ko theo tng tc dng an thn
gy bun ng (tng tc dc lc).
X l: Phi tnh n nguy c ny iu chnh liu lng hai cht cho thch hp,
nu cn s kt hp ny. Phi ngh n gim tnh to ngi li xe v ngi ng my.
Khuyn khng ung ru v dng cc ch phm c ru.
Phn tch: Tc dng i khng: c th lm tng tnh hung hn ngi nghin
amphetamin.
X l: Tnh n tng tc dc lc ny nh ra mc ch iu tr chnh.
Khuyn gp li thy thuc nu thy iu tr km kt qu.
Methadon
Phn tch: Tng tc dng c ch h thn kinh trung ng gy an thn bun ng
mnh, c hi c bit vi ngi li xe hay ng my.
X l: Phi tnh n tng cng tc dng an thn bun ng khi k n thuc v
phi c li khuyn thch hp.
AMINOGLYCOSID (NHM KHNG SINH)

(ng ton thn hoc ti ch)
Khng sinh ch yu km khun
Ch : S hp thu aminoglycosid (aminosid) dng ti ch c th trong mt s
hon cnh (liu cao, tn thng thc th) gy nn nhng nguy c tng tc tng t
nh khi dng aminoglycosid ng tim.
CC THUC TRONG NHM
AMIKACIN l tim 500 mg/2mL; 250 mg/2mL; 500 mg/4mL; 1000 mg/2mL
Acemycin l bt pha tim 500 mg/2mL
Amikacin l bt pha tim 250 mg/2mL
Amikacin dung dch tim 250mg/mL
Amikaye l bt pha tim 250 mg/2mL
Amiklin l bt pha tim 50mg/1mL; 250mg/2mL v 500 mg/4mL
Biodacyna l bt pha tim 250mg/2mL; 500mg/2mL; 1g/4mL
59
Kupramickin ng tim 500mg/2mL

Likacin dung dch tim truyn 250mg/2mL; 500mg/2mL
Mikin l bt pha tim 500 mg/2mL
Minakin l bt pha tim 500 mg/2mL
Opekacin l bt pha tim 100mg/2mL; 500mg/2mL
Selemycin 250mg/mL
FRAMYCETIN thuc nh mt 31500 IU; dung dch nh mi 1,25%
Frakidex thuc nh mt 31500 IU
Soframycin dung dch nh mi 1,25% framycetin phi hp vi Naphazolin
GENTAMICIN ng tim 80 mg/2mL; 40 mg/2mL; thuc m tra mt 3%; dung dch
nh mt 3 mg/10 mL
Betnovate-GM-kem bi 0,1% gentamicin sulfat + betamethason v miconazol
Genoptic liquifilm dung dch nh mt 0,03%
Gentacyne 40 ng tim 40 mg/2mL
Gentacyne 80 ng tim 80 mg/2mL
Gentagram ng tim 40 mg/2mL
Gentamycin sulfat ng tim 40 mg/2mL; 80 mg/2mL
Gentamycin thuc m tra mt 3%
Gentamycin thuc nh mt dung dch 0,3%
Gentamycin B.J. ng tim 40 mg/1mL; 80 mg/2mL
Gentamycin 80 uphace
Gentamycin FI Pharma ng tim 80mg/2mL, thuc nh mt 3%/5mL
Progara ng tim 80 mg/2mL
Infectoflam: thuc nh mt 15mg gentamicin + fluorometholon/ l 5mL
m tra mt 15mg gentamicin + fluorometholon/ tup 4g
Servigenta 80 ng tim 80 mg/2mL
NEOMYCIN m tra mt 340.000 IU/100 g
Cbmycine m tra mt 5 g (Neomycin 3.400 IU/1g)
Cbmycine dung dch nh mt l 10 mL (Neomycin 340.000 IU/100 mL)
Dicortineff dch nh mt, nh tai 25mg neomycin sulfat
Flucort - N kem bi da 15g (5mg neomycin sulfat/1g)
Izac vin ngm 2,5mg (phi hp)
Lobacin vin ngm 2,5mg (phi hp)
Lorinden-N kem bi da 15g (5mg neomycin sulfat/1g)
60
Neodexa thuc nh mt, nh mi (neomycin 17.000 IU/5mL)

Nemydexan thuc nh mt, nh mi, nh tai (neomycin 17.000 IU/5mL)
Neo-Zergynan vin t m o 65000 IU/vin (phi hp)
Neomycin Diamant dung dch nh mt 3500 IU/mL
Neomycinum m tra mt 0,5% (tup 3g)
Neo-Tergynan vin t m o (neomycin sulfat 65000 IU/vin)
Polydexa thuc nh tai 1% neomycin sulfat l 5mL; 10mL
Polydexa nasal (thuc nh mi)
Polygynax vin t m o (neomycin sulfat 35000 IU/vin)
NETILMICIN dung dch tim 100 mg/ 2mL
Netromycin dung dch tim 100 mg/ 2mL
Nelticin ng tim 100mg/2mL
Uninetil ng tim 100mg/2mL
SPECTINOMYCIN l 2 g
Kirin l bt pha dung dch tim 2g
Togocide l bt pha dung dch tim 2g
Trobicin l bt pha dung dch tim 2g
Spectinomycin l 2g
STREPTOMYCIN l 1g
Streptomycin Panpharma l bt pha tim 1g
Streptomycin Sedapharm l 1g
Streptomycin sulfat l bt pha tim 1g
TOBRAMYCIN dung dch nh mt 1 mg/1 mL; m tra mt 1 mg/g
Brulamycin dung dch tim 80mg/2mL; dung dch nh mt 15mg/5mL
Dex-Tobrin dch treo nh mt 3mg/mL km dexamethason
Gentobra dch treo tim 80mg/2mL
Mytob dung dch tim 80mg/2mL
Tobrabact dung dch nh mt 0,3%
Tobramycin dung dch tim 40mg/1mL
Tobramicina IBI dung dch tim 150mg/2mL
Tobradex dch treo v m tra mt 3mg/1mL; 3mg/g
Tobrex dch treo v m tra mt 1mg/1mL
Toracin dung dch nh mt 3mg/1mL
61
Tobrin dch treo nh mt 3mg/mL

Union-topracin Inj dung dch tim 80mg/2mL
CH KHI CH NH THUC
Nhc c: Aminosid lm gim dn truyn thn kinh - c, thng qua c ch gii
phng acetylcholin v nh vy lm tng cc triu chng nhc c.
Thn trng: mc 2
Thi k mang thai: Aminosid c coi l nguyn nhn gy ic bm sinh hay
gy tn thng thn kinh th gic do c tnh ca thuc nhm ny.
Suy thn: Aminosid thi qua thn di dng cn hot tnh. Khi suy thn, c th
c nng thuc qu cao trong huyt thanh, v do c tnh vi thn v vi tai, nn c
th lm bnh thn nng ln v lm ic vnh vin. Cn hiu chnh liu lng thch hp.
Cn theo di: mc 1
Thi k cho con b: Aminosid c th qua sa m.
Ngi cao tui: Tui tc l yu t d gy c vi tai (tn thng tin nh v c
tai) v c vi thn. Vi ngi cao tui, cn theo di cht ch chc nng thn v thnh
gic, ngay trong trng hp hiu chnh liu lng cn thn
TNG TC THUC
Cc cephalosporin hoc thuc tng t
Phn tch: Phi hp vi cefalotin lm tng nguy c c vi thn. Nguy c ny hy
cn bn ci v c th ch hn ch cht ny.
X l: Cn theo di chc nng thn, nu phi iu tr theo ng tim di ngy.
Bacitracin; capreomycin; khng sinh polypeptid (colistin, tyrothricin...)
Phn tch: Tng c tnh vi tai v vi thn do phi hp hai thuc c vi thn.
C hip ng cc tc dng khng mong mun. S phi hp ny c th c ch trong mt
s trng hp.
X l: Phi hp thuc ny thng p dng ti bnh vin. Mc du cch dng
thuc mt liu duy nht cho aminosid mi ngy s hn ch c tnh vi tai v vi thn,
song khi cn phi hp thuc, phi hiu chnh liu lng thuc theo thanh lc
creatinin (p dng cng thc Cockroft v Gault). Cn c bit theo di khi dng thuc
ngi cao tui.
Carmustin hoc dn cht; foscarnet; lincosamid; methotrexat; penicilamin
hoc dn cht
Phn tch: Tng nguy c c vi thn do phi hp hai thuc c tim nng c vi
thn. Hip ng tc dng khng mong mun.
62
+++
X l: Phi hp thuc ny thng thy, nht l ti bnh vin. Mc du cch dng

aminosid mt liu duy nht mi ngy s hn ch c tnh vi thn v tai, song khi cn
phi hp thuc, phi hiu chnh liu lng thuc theo thanh lc creatinin (p dng
cng thc Cockroft v Gault). Cn c bit theo di s dng ngi cao tui.
Digoxin
Phn tch: Tc hp thu digoxin b gim i, lm gim tc dng dc l ca
thuc. Tuy nhin, li c mt t l thp s ngi bnh (di 10%) c hin tng gim
chuyn ho digoxin khi dng kt hp vi neomycin. C ch gim hp thu digoxin khi
dng cng vi aminosid cn cha r. Cn vn gim s chuyn ho ca digoxin c
th do neomycin dit cc tp khun rut, c vai tr trong s to thnh cc sn phm
ca digoxin kh ho, l mt bc trong s chuyn ho ca cht ny.
X l: Phn ln cc ngi bnh cha xc nh c liu digoxin m dng mt
liu n nht neomycin khng cn s chm sc g c bit. Nhng i vi ngi bnh
cha xc nh c liu digoxin trong iu tr duy tr hay ngi bnh dng neomycin
nhiu ln lin tip hay dng lu di, th phi theo di s thay i nng digoxin trong
mu tm ra mt liu lng thuc thch hp.
c t Clostridium botulinum
Phn tch: Nguy c tng tc dng "ging cura" ca cc aminosid v ng c li.
c t Clostridium botulinum phong b acetylcholin ch ni thn kinh - c, v gy lit
c.
X l: K n c t Clostridium botulinum dnh ring cho nhng chuyn gia,
trong mt s ch nh chnh xc him gp. Nu iu tr bng khng sinh aminosid, phi
tnh ti nguy c ny khi chn liu c t Clostridium botulinum.
Phenicol
Phn tch: Tc dng km khun ca cc phenicol c th i khng tc dng dit
khun ca nhm thuc phi hp. Tc dng dit khun biu hin trn cc vi khun trong
giai on pht trin theo hm m. Tnh i khng ny c th c hi trong iu tr vim
mng no m ta cn can thip sm v mnh.
X l: Phi tnh ti nguy c ny theo bi cnh sinh bnh hc c th. Vic phi
hp thuc c th c thc hin tu thuc loi thuc, v vi khun gy bnh (cn ch
n nng c ch ti thiu; MIC).
Thuc chng vim khng steroid
Phn tch: Thuc chng vim khng steroid lm gim tc thanh lc ca cu
thn, gy tch lu aminosid, do lm tng nng cc thuc ny trong huyt t ng,
c bit tr s sinh thiu thng.
X l: Rt bt liu aminosid, ri mi dng thuc chng vim khng steroid. Sau
, hiu chnh li liu dng da vo chc nng thn v nng aminosid trong huyt
thanh.
Thuc gy th doi c khng kh cc
Phn tch: Do tc dng hip ng v dc l, tc dng ca cc thuc gy th
doi c s c tng cng, gy suy h hp.
63
X l: Ch dng kt hp thuc ny khi tht cn, v phi tm liu thch hp thuc

gy th doi c thng qua p ng thn kinh - c. Chun b h tr h hp nu cn.
Furosemid hoc thuc tng t; thuc li tiu thi kali
Phn tch: c tnh vi tai ca cc aminosid v cc thuc li tiu quai c th tng
ln nu dng phi hp hai thuc. C th mt thnh lc mc khc nhau, i khi
khng hi phc c. C ch cha r, c th do tc dng hip ng v c tnh vi
tai. Nguy c tng khi dng thuc theo ng tnh mch, khi suy thn.
X l nu cn phi hp thuc, phi theo di u n thnh lc. i vi ngi suy
thn, cn gim liu mt trong hai thuc hoc c hai thuc.
Phn tch: Interleukin ch c dng ti c s chuyn khoa. Nguy c hip ng
tc dng c vi thn ca hai thuc.
X l: iu tr bng interleukin ch c thc hin nhng c s chuyn khoa, do
thuc c ch nh cho nhng trng hp nng. Khi , cc tng tc nng nh tu
theo tnh trng chung ca ngi bnh. Nu khng hon dng c mt trong hai thuc,
cn theo di cn thn ion v thanh lc creatinin.
Mui vng
Phn tch: Tng creatinin niu. Hip ng tc dng c vi thn.
X l: Loi phi hp thuc ny hay gp, nht l ti bnh vin. Mc du cch
dng aminosid mt liu duy nht mi ngy s hn ch c tnh vi tai v vi thn,
nhng nu cn phi hp thuc ny, phi hiu chnh liu lng cho thch hp theo
thanh lc creatinin (cng thc Cockroft v Gault). Cn theo di thng xuyn chc nng
thn. Cn c bit theo di khi dng ngi bnh cao tui.
Penicilin cc loi (ampicilin, mezlocilin, nafcilin, oxacilin, penicilin G,
piperacilin, ticarcilin)
Phn tch: Tnh hip ng ca cc khng sinh ny c xc nh. Tuy vy,
mt s aminoglycosid b mt tc dng do mt s penicilin. Mt tc dng nhiu nht khi
phi hp in vitro. Khi tim vo c th, thuc b pha long nn lm gim bt tnh t ng
k l ho. Tobramycin v gentamicin mt tc dng do cc loi penicilin nhiu hn so
vi netilmicin hoc amikacin. Gentamicin c th b mt tc dng nhiu hn vi ticarcilin
so vi mezlocilin hoc piperacilin. C ch: Cha r.
X l: Khng trn ln aminoglycosid vi cc loi penicilin tim vo trong cng mt
dung dch. Gim st nng aminoglycosid v chc nng thn. iu chnh liu khi cn.
hi)
Thuc gy m khc (ngoi thuc gy m barbituric v thuc gy m bay
Phn tch: Tng tc tu thuc tnh cht phong b ch ni thn kinh - c (phong
b dn truyn thn kinh c) ca aminosid.
X l: Nu ngi bnh phi qua phu thut, khuyn h thng bo cho thy thuc
gy m tt c cc thuc v ang dng.
Thuc gy m bay hi cha halogen
64
Phn tch: Nguy c phong b thn kinh - c tng ln, c th gy nhc c v c

ch h hp, thm ch gy lit, c bit vi cht enfluran v isofluran.
X l: Ngi gy m phi trnh nguy c ny, phi chun b cc thuc khng
cholinesterase v cc mui calci tim gii to s phong b thn kinh - c. Nguy c
ny gim thiu khi c h tr h hp. Phi ch khi ngi bnh tnh li.
Thuc loi cura
Phn tch: Nguy c phong b thn kinh - c tng, c th ko theo nhc c, suy
h hp, thm ch lit. Ch , nguy c phong b ny c th g p vi cc thuc gy m
halogen ho bay hi v mt s thuc gim au h thuc phin, nhng mc nh
hn.
X l: Thy thuc gy m phi trnh nguy c ny, phi chun b cc thuc khng
cholinesterase v cc mui calci tim gii to s phong b thn kinh - c. Nu ngi
bnh c h tr h hp th nguy c ny mt i.
Salicylat
Phn tch: Salicylat, khi dng lu di v vi liu cao, c th c vi tai, do , c
tnh ny s tng khi ngi bnh c iu tr bng mt aminosid vi liu cao.
X l: Phi chc chn l ngi bnh khng dng thng xuyn cc salicylat
(c iu tr hay t iu tr). Tu theo s cn thit, iu tr phi hp phi thng k
kim tra thnh lc.
Vancomycin
Phn tch: Mi thuc u c vi thn. Nguy c c cho thn c th tng khi phi
hp 2 thuc. Tng tc xy ra mun.
C ch cn cha r.
X l: Gim st chc nng thn v nng huyt thanh ca thuc. iu chnh
liu aminoglycosid hoc vancomycin nu cn.
Zalcitabin
Phn tch: Tng nng zalcitabin trong huyt tng, km theo tng nguy c
nhim c.
X l: Theo di cc tc dng khng mong mun ca zalcitabin, v nu cn, gim
thp liu dng.
Amphotericin B; ciclosporin; cisplatin hoc dn cht
Phn tch: Tng nguy c c vi thn, do phi hp hai thuc c tim nng c vi
thn. Hip ng nhng tc dng c hi.
X l: Phi hp ny hay gp, nht l ti bnh vin. Mc du cch dng aminosid
mt liu duy nht mi ngy hn ch c c tnh vi tai v thn, nhng nu cn phi
hp thuc th phi iu chnh liu thuc cho thch hp theo thanh lc creatinin (cng
thc Cockroft v Gault). Cn theo di u n chc nng thn. Cn theo di c bit
khi dng ngi bnh cao tui.
65
Tacrolimus
thn. Hip ng nhng tc dng khng mong mun.
X l: Nhng phi hp ny hay gp, nht l ti bnh vin. Mc d u cch dng
aminosid mt liu duy nht mi ngy c th hn ch c c tnh vi tai v th n,
nhng nu cn phi hp thuc phi iu chnh liu thuc cho thch hp theo thanh
lc creatinin (cng thc Cockroft v Gault). Cn theo di c bit khi dng ngi bnh
cao tui.
AMIOGLYCOSID NG UNG
Khng sinh ng tiu ho, km khun, khng b hp thu
CC THUC TRONG NHM

NEOMYCIN vin nn
Izac vin ngm 2,5mg
Lobacin vin ngm 2,5mg
Neomycine Diamant vin nn
STREPTOMYCIN
Strep-Berin nang 125mg (75mg streptomycin sulfat + 50mg berberin)
CH KHI CH NH THUC
Cn theo di: mc 1
Suy thn: Mc du bnh thng aminosid c hp thu qua rut rt t, nhng
vn nn thn trng khi nim mc ng tiu ho ngi suy thn b tn thng.
TNG TC THUC
Acid chenodesoxycholic hoc dn cht
Phn tch: Acid ursochenodesoxycholic gp phn lm tng t l acid mt /
cholesterol. Nh tc dng lm cn bng cc thnh phn t o nn mt, cho nn acid
ursochenodesoxycholic c th gp phn lm gim khi lng cc si mt
cholesterolic. Khi to phc vi acid ursodesoxycholic (nh cholestyramin, cc khng
acid), hoc khi lm tng bo ho ca mt (nh neomycin ng ung, estrogen,
progesteron, fibrat), th hot tnh ca acid ursodesoxycholic b gim.
X l: Vic iu tr vi acid ursodesoxycholic l di hn (t 6 thng n 1 nm).
Cn trnh tht bi trong iu tr, v vy khng dng kt hp vi cc thuc khc lm
gim hiu qu ca n, tr trng hp vic dng kt hp ny ch thc hin trong mt
thi gian rt ngn.
66
Cc phenicol
Phn tch: Tc dng km khun ca cc phenicol i khng vi tc dng dit
khun ca cc aminosid ung, c tc dng trn cc vi khun ang giai on pht
trin theo hm m. S i khng gy hi trong vic iu tr vim mng no, cn phi c
mt tc dng nhanh v mnh.
X l: Ch ti nguy c ny trong tnh trng sinh l bnh hc c th. S kt hp
c th thc hin vi mt vi thuc c th, i vi mt s chng khun c th (ch
n nng c ch ti thiu; MIC).
Methotrexat
Phn tch: C th c hin tng gim hp thu methotrexat, gim cc tp khun
rut c tc dng chuyn ho methotrexat v gim p ng vi methotrexat.
X l: Ch dng kt hp methotrexat vi aminosid ng ung c s chuyn
khoa v phi rt thn trng.
Glycosid tr tim
Phn tch: c bit khi kt hp vi neomycin. Khng sinh ny lm chm s hp
thu ca digoxin, ngay khi digoxin c ung trc 6 gi. C th l neomycin tiu dit
cc tp khun rut, lm ko di tc dng ca cc thuc digitalis thng qua c ch s
thoi bin digoxin.
X l: Khi kt hp thuc, phi theo di nng digoxin trong huyt thanh. Mt s
du hiu nhim c cc thuc digitalis l bun nn, nn v ri lon th gic (nhn mu).
Phn tch: C s tng hiu qu khng vitamin K, c th do tc dng ca aminosid
(cn nm trong khoang rut) trn tp khun rut sn sinh vitamin K, hay do lm gim
s hp thu vitamin K.
X l: Nu kt hp thuc, phi tng cng theo di liu php khng vitamin K
thng qua t l chun quc t (INR) hay thi gian prothrombin. Hiu chnh liu lc bt
u v lc kt thc iu tr vi aminosid, nu thy cn.
AMIODARON
Thuc chng au tht ngc khng phi nitrat, chng lon nhp loi III
ca Vaughan - Williams (ko di th tc dng ca c tim)
CC THUC TRONG NHM

AMIODARON vin nn 200 mg; ng tim 150 mg/3 mL
Amiodaron vin nn 200 mg
67
Cordaron vin nn 200 mg

Cordaron ng tim 150 mg/3 mL
Sedacoron vin nn 200 mg
Sedacoron ng tim 150 mg/3 mL
CH KHI CH NH THUC
Cn nhc nguy c /li ch: mc 3
Thi k mang thai: Iod cha trong phn t amiodaron tch lu trong m m c
tim v cc c khc khi dng thuc di hn. Cc trng hp ri lon tuyn gip gp
c th l tng nng hay gim nng tuyn gip. Nh vy s c nguy c cho tuyn gip
ca thai nhi, do chng ch nh dng amiodaron khi mang thai.
Tng nng tuyn gip: Trc khi bt u iu tr bng amiodaron, phi tm hiu
k xem ngi bnh c b tng nng gip khng?
Thn trng: mc 2
Suy tim: Do amiodaron gy gim nhp tim.
Cn theo di: mc 1
nng.
Suy h hp; hen: Tc dng lm chm nhp tim s mnh hn khi suy h hp
Ngi cao tui: Tc dng lm chm nhp tim s mnh hn i vi ngi bnh
cao tui.
TNG TC THUC
Benzamid
Phn tch: Trong cc benzamid, ch sultoprid (Garnetil) l gy nguy c khi kt hp
vi amiodaron. Tt c cc cht gy co c m tnh (lm chm nhp tim) u c th lm
tng nguy c gy lon nhp tht, c bit l xon nh do c b sung thm tnh cht
in sinh l ca sultoprid.
X l: Chng ch nh vic kt hp thuc ny.
Bepridil; bretylium; disopyramide; lidocain hoc thuc tng t; quinidin hoc
dn cht; vincamin
Phn tch: Tng nguy c xon nh do hip ng tc dng. Hin tng h kali mu,
nhp tim chm v khong QT di c t trc (ch nhn bit c trn in tm ) l
nhng yu t to iu kin cho s xut hin xon nh.
X l: Kt hp ny c kh nng gy t vong v phi chng ch nh.
Macrolid
Phn tch: Tng nguy c xon nh do tc dng hip ng (ch gp vi
erythromycin tim tnh mch). Hin tng h kali mu, nhp tim chm, v khong QT
di (ch nhn bit c trn in tm ) l nhng yu t to iu kin cho s xut
hin xon nh. Trong nhm macrolid, ch c erythromycin, c bit l d ng tim tnh
68
+++
mch l c th gy lon nhp tim (ko di khong QT, ngoi tm thu tht, xon nh,
bloc nh - tht).
X l: Kt hp c th gy t vong, phi chng ch nh. Ngay vi erythromycin tim
tnh mch dng ring, cng c th gy ri lon nhp tim, v vy khng c tim nhanh,
m phi tim truyn tnh mch, tim lin tc hay ngt qung, lng thuc cho mt ln
dng phi truyn trong t nht l 60 pht.
Ritonavir
Phn tch: Ritonavir c i lc mnh vi isoenzym 3A4 ca cc cytochrom P450, nn
lm gim s chuyn ho cc thuc b chuyn ho nh cytochrom P 450, do nng
cc thuc ny trong huyt tng tng ln, ko theo tng c tnh. Nguy c gy lo n
nhp tim. Tng tc dc ng hc giai on chuyn ho.
X l: Khng phi hp thuc v suy ngh v nhng thuc thay th.
Sparfloxacin
Phn tch: Tng nguy c xon nh.
X l: Chng ch nh phi hp thuc. Chn mt thuc chng lon nhp khc.
Thuc khng histamin khng H1 khng an thn
Phn tch: Tng tc ch c ni ti vi mt khng histamin khng H 1 l
astemizol (Hismanal). Tng nguy c xut hin xon nh.
X l: Phi hp nguy him. Chn mt khng histamin khng an thn khc, khng
gy xon nh (cetirezin, loratadin).
Corticoid - khong; halofantrin; pentamidin
Phn tch: C nguy c xut hin xon nh khi phi hp thuc. S gim kali mu,
nhp tim chm v khong QT di c t trc (ch nhn bit c trn in tm ) l
nhng yu t thun li cho s xut hin xon nh.
X l: Kt hp thuc nn trnh. Dng nhng thuc khng gy xon nh. Nu cn
phi hp thuc, phi theo di lin tc khong QT v kim tra u n nng kali
trong mu.
Sotalol
Phn tch: Amiodaron c th tng cng thm tc dng lm chm nhp tim ca
thuc chn beta. C th xut hin ri lon nhp xoang v bloc nh-tht, nht l nhng
ngi bnh c tin s ri lon nhp xoang.
X l: Nu cn phi kt hp thuc, cn phi gim liu v theo di in tm .
Cn ch l amiodaron c na i l 28 ngy, nn tc dng ca tng tc thuc cn
c th biu hin nhiu tun l sau khi ngng iu tr.
Diltiazem; thuc chn beta; verapamil
Phn tch: Amiodaron tng cng thm tc dng lm chm nhp tim ca thuc
chn beta (ngay khi dng di dng thuc nh mt), diltiazem, verapamil. C th xut
hin nhng ri lon nhp xoang hay nhp blc nh - tht, nht l ngi bnh c tin s
ri lon nhp xoang.
69
X l: Nu cn phi hp thuc, iu quan trng l phi gim liu v theo di in

tm . Cn nh l amiodaron c na i l 28 ngy, nn tc dng ca tng tc gy
ra vn c th biu hin nhiu tun l sau khi ngng iu tr.
Thuc khng gip tng hp
Phn tch: y khng phi l mt tng tc thuc tht s, v hin tng gim
nng hay tng nng tuyn gip c th xut hin sau khi iu tr vi amiodaron. y l
nhng tc dng khng mong mun do s c mt ca iod trong phn t amiodaron. Mt
liu php vi nhng thuc khng gip c th b nhiu do amiodaron, ko theo lon nng
tuyn gip khi dng thuc ngn hn, trung hn, hay di hn.
X l: Nu cn kt hp thuc, phi ch kh nng kh gi chc nng tuyn gip
c cn bng. Hin tng tng nng hay gim nng tuyn gip c th xut hi n
mt ngi bnh ch dng ring amiodaron. Thy thuc k n phi cn nhc gia l i
ch v nguy c. Nhng trong mi trng hp, chng ch nh amiodaron cho ngi tng
nng tuyn gip. Cn nh l amiodaron c na i l 28 ngy, nn nhng hiu qu ca
tng tc vn c th biu hin nhiu tun l sau khi ngng iu tr.
Thuc nhun trng lm trn; thuc nhun trng kch thch
Phn tch: C nguy c xut hin xon nh khi phi hp thuc. Hin tng gim
kali - mu, nhp tim chm v khong QT di c trc (ch nhn bi t c trn
in tm ) l nhng yu t to iu kin cho vic xut hin cc xon nh.
X l: Nn ngng dng thuc nhun trng. Nu cn kt hp thuc, cn d phng
h kali - mu bng cch tng cng theo di, v kim tra in tm . Khi xut hin
xon nh, khng dng cc thuc chng lon nhp.

Amphotericin B
Phn tch: C nguy c xon nh khi kt hp amphotericin B tim vi amiodaron.
Hin tng gim kali mu, nhp tim chm v khong QT di c t trc (ch nhn
bit c trn in tm ) l nhng yu t to thun li cho vic xut hin cc xon
nh.
X l: Nu cn kt hp thuc, phi d phng h kali mu nh tng cng theo
di v kim tra in tm thng xuyn. Khi xut hin xon nh, khng dng cc
thuc chng lon nhp.
Glycosid tr tim
Phn tch: Tng nguy c nhp tim chm. Ngoi ra, amiodaron cn lm tng nng
digoxin trong huyt thanh.
X l: Khi bt u liu php vi amiodaron, liu lng cc thuc digitalis phi gim
i 50%. Theo di cht ch nng cc thuc trong huyt thanh trong v sau iu tr.
Ch l amiodaron c na i l 28 ngy, nn nhng h qu ca tng tc cn c th
biu hin nhiu tun sau khi ngng dng thuc.
70
Glucocorticoid; furosemid hoc thuc tng t; tetracosactid; thuc li

niu thi kali
Phn tch: Nguy c xon nh do h kali mu. Hin tng h kali mu, nhp tim
chm v khong QT di c t trc (ch nhn bit c trn in tm ) l nhng
yu t to thun li cho vic xut hin cc xon nh.
X l: Nu cn kt hp gia amiodaron vi cc thuc h kali mu th phi d
phng h kali mu nh tng cng theo di v kim tra thng xuyn in tm . Khi
xut hin xon nh, khng dng cc thuc chng lon nhp.
Mexiletin
Phn tch: C nguy c xut hin xon nh. Trn in tm , khong QT di ra.
X l: Phi hp thuc cn c theo di c bit (in tm ). Ni chung, s
phi hp vi cc thuc chng lon nhp loi I ca Vaugang - Williams l nn trnh, do
s ko di thi gian dn truyn tim.
Phenytoin
Phn tch: Tng nng phenytoin trong huyt thanh, dn n qu liu.
X l: Gim liu phenytoin theo nng thuc trong huyt thanh.
Phn tch: Nguy c h huyt p thm, nguy c khng hin tng nhp tim chm
do atropin gy ra.
X l: Tt c ph thuc vo mc tiu chnh ca vic iu tr v thi gian dng
tng th thuc di hay ngn. C th phi hp thuc gy tht bi trong iu tr.
Phn tch: Vi cc dn cht coumarin, thi gian Quick c th tng gp i, thm
ch gp ba. Tng tc ny c m t vi acenocoumarol (Sintrom*) v warfarin
(Coumadine*).
X l: Gim liu thuc khng vitamin K t 30 n 50%, theo di t l chun quc
t (INR) v thi gian Quick nhiu tun sau khi ngng dng amiodaron.
71
AMPHETAMIN HOC DN CHT

Thuc gy tnh to c tnh cng giao cm gin tip. Cc thuc gy chn n
c tc dng kch thch h thn kinh trung ng t hn. S dung np thuc tt
c th ko theo tng liu, lm tng cc tc dng khng mong mun
v nguy c ph thuc thuc
CC THUC TRONG NHM
Anorex nang mm
Dinintel nang mm
Fenproporex vin nn 20mg
Incital vin nn 40mg
Isomeride nang mm 15mg
Moderatan nang mm
Ortenal vin nn
Prefamone chronules nang mm 75mg
Tenuate dospan vin nn 75mg
CH KHI CH NH THUC
Tng nhn p: Nh cc thuc cng giao cm khc, amphetamin gy gin ng
t, c th gy ra mt cn tng nhn p cp tnh nhng ngi c gc mng mt - gic
mc hp.
Tng huyt p: Thng qua kch thch cc th th alpha v gii phng noradrenalin, nn cc amphetamin gy tng huyt p.
Tng nng tuyn gip: Do tc dng tng nhp tim ca amphetamin.
Suy tim: Amphetamin gy hi hp v ri lon nhp tim do tc dng kch thch
alpha v beta.
Thn trng: mc 2
Trm cm: Cc amphetamin c th gy ri lon tm thn (lo u, l ln, o gic,
mun t vn...), lm cho trng thi trm cm c t trc nng thm.
ng kinh: Cc amphetamin l nhng cht kch thch h thn kinh trung ng,
nn c th gy kch ng, mt ng, co git. Tuy nhin trong mt s bit d c ch ng
ng kinh, li c amphetamin nhm lm gim tc dng gy bun ng ca thuc chng
co git (nh barbituric).
Thi k mang thai: Amphetamin gy d tt tim, hp cc ng mt v gan.
Cn theo di: mc 1
72
Thc n - ru: Amphetamin tng cng s sn sinh cc catecholamin. C th

c cc s c do tng huyt p khi dng ch n ung giu tyramin v histamin. Cc
ung kch thch (nh ch, c ph) v ru cng cn trnh.
TNG TC THUC
Thuc c ch MAO typ B
Phn tch: Nguy c lon nhp tim nghim trng. S c ch monoamin oxydase typ
B lm ko di tc dng ca amphetamin.
X l: Chn mt chin lc iu tr khc, do nguy c c th xy ra.
Cht c ch enzym chuyn i; diazoxyd; guanethidin hoc thuc tng
t; methyldopa; Thuc chng tng huyt p gin mch; thuc li tiu gi kali;
thuc li tiu thi kali
Phn tch: Amphetamin l thuc cng giao cm, nn c tc dng lm tng huyt
p. Vic kt hp vi cc thuc chng tng huyt p dn n s i khng tc dng v
gy kh khn t c cn bng v huyt p.
X l: Ngi bnh tng huyt p khng nn dng amphetamin.
Levodopa
Phn tch: Lm tng nguy c lon nhp tim.
X l: Gim liu amphetamin.
Thuc acid ho nc tiu
Phn tch: Lm gim s ti hp thu amphetamin ng thn. Cc thuc acid ho
nc tiu lm tng s bi tit cc amphetamin (pH gn bng 5). Amphetamin l mt
base, c bi tit qua thn, n t tn ti di dng khng ion ho mi trng acid.
X l: Trong trng hp dng amphetamin qu liu, vic acid ho nc tiu l c
ch nhm to iu kin o thi thuc ny. Trong trng hp ny, tng tc l c li.
Ngc li, khi dng liu php vi amphetamin, c th tht bi trong iu tr do o thi
thuc qu nhanh (acid ho nc tiu) hoc gy ra nhng bnh tm thn do thuc,
kh o thi (kim ho nc tiu).
Thuc gy m
Phn tch: Tng tc ph thuc vo tc dng cng giao cm ca amphetamin.
X l: Vic chuyn khoa ho cao trong gy m, ng thi vi vic cc thuc gy
m ch c dng khoa phu thut, nn y ch nu ra cc h thuc c th gy
nguy c theo loi thuc gy m dng.
Phn tch: Halothan, enfluran, isofluran, methoxyfluran lm c tim nhy cm vi
cc thuc cng giao cm, nn lm tng nguy c xut hin lon nhp tht nghim
trng.
73
X l: Thy thuc gy m hoc nh chuyn khoa phi yu cu bnh nhn ngng

dng amphetamin, t nht l hai ngy trc khi phu thut hoc l phi ch iu chnh
liu cho thch hp.
Thuc kim ho nc tiu
Phn tch: Khi dng cc thuc kim ho nc tiu vi liu c tc dng, s
lm tng s ti hp thu amphetamin ng thn. Cc thuc acid ho nc tiu lm tng
o thi amphetamin (pH gn bng 5). Amphetamin l mt base, c bi tit qua thn.
N t tn ti di dng khng ion ho mi trng acid. Ngc li, cc thuc kim ho
nc tiu (pH gn bng 8) lm gim rt nhiu s bi tit amphetamin qua nc tiu.
Do s tch lu amphetamin ngi bnh c nc tiu kim tnh, s xy ra cc bnh v
tm thn, v tnh hnh ny nhiu ln c cp trong y vn (tng tc c
khng nh).
X l: Vic acid ho nc tiu l c ch khi dng amphetamin qu liu nhm to
iu kin o thi cht ny. Nh vy tng tc trong trng hp ny l c ch. Ngc
li, khi iu tr bng amphetamin, c th tht bi do o thi thuc qu nhanh (acid ho
nc tiu) hoc s gy ra bnh l v tm thn do thuc (kim ho nc tiu).
Amantadin hoc thuc tng t
Phn tch: Tuy cha c bo co no v tng tc ny, nh sn xut vn khuyn
nn thn trng trong phi hp amantadin vi cc thuc kch thch tm thn, nhm trnh
cc tc dng hng thn, nh d kch ng, mt ng, lon nhp tim.
Amineptin; barbituric; benzamid; benzodiazepin; buspiron; butyrophenon;
carbamat hoc thuc tng t; carbamazepin; cht ch vn ca morphin;
clonidin hoc thuc tng t; cht c ch thn kinh trung ng; dantrolen;
dextropropoxyphen; fluoxetin; fluvoxamin; gluthetimid hoc thuc tng t;
khng histamin H1 c tc dng an thn; interferon alpha ti t hp; manserin;
medifoxamin; natri valproat hoc dn cht; oxaflozan; phenothiazin; primidon
hoc dn cht; procarbazin; thuc an thn kinh; thuc chng ng kinh khng
barbituric; thuc chng trm cm ba vng hoc thuc tng t; thuc c ch
MAO khng chn lc; viloxazin
Phn tch: Tc dng i khng. C kh nng lm tng tnh hung hn ngi
nghin amphetamin.
X l: Tnh n tng tc dc lc ny khi xc nh mc ch iu tr chnh.
Lithium
Phn tch: Tng tc dc lc: Lithium i khng vi cc tc dng kch thch h
thn kinh trung ng ca amphetamin.
X l: Ch n tc dng ny xc nh (hoc xc nh li) chin lc iu tr
theo mc ch iu tr chnh.
Sotalol
Phn tch: Tng tc dc lc, lm tng tc dng alpha - adrenergic v cc hu
qu ca n, nh tng huyt p, nhp tim chm, v kh nng c blc tim.
74
X l: Hiu chnh liu v theo di cht ch huyt p.

Thuc chn beta
Phn tch: Tng tc dc lc, lm tng tc dng alpha adrenergic v cc hu
qu ca n, nh tng huyt p, nhp tim chm, c th blc tim. Nguy c ny nh hn
i vi labetolol (Trandate*) l cht chn beta c nht c ng thi tc d ng chn
alpha.
X l: Hiu chnh liu lng v theo di huyt p cn thn.
Thuc cng giao cm alpha, beta
Phn tch: Lm tng cng tc dng kch thch h thn kinh trung ng (d kch
ng, mt ng, nguy c co git v lan nhp tim)
X l: Ch n nguy c ny, thng bo cho ngi bnh hiu chnh liu, theo di
cn thn trn lm sng.
Thuc cng giao cm beta
Phn tch: Tng tc dc lc. Amphetamin l nhng amin cng giao cm nn
lm tng tc dng hng thn, nh d kch ng, mt ng v i khi c co git v lon
nhp tim.
X l: Theo di lm sng: cc tc dng ni trn mnh hay yu l tu vo t ng
cht cng giao cm beta dng (cc thuc cha hen). Thay i chin lc iu tr
nu cn, hoc hiu chnh liu lng.
75
AMPHOTERICIN B
Khng sinh chng nm
Ch : Ngi k n v ngi pht thuc cn nh gi ng nhng nguy c

tng tc theo ng dng thuc; Amphotericin B b hp thu rt t khi dng ti ch hay
ng ung.
CC THUC TRONG NHM
AMPHOTERICIN B vin nn 50 mg; 250 mg; nang 250 mg; hn dch 100 mg; vin
t m o 50 mg; lotio 3%
Amphocyclin vin nn 50 mg
Fungizon nang 250 mg; hn dch 100 mg
Fungizon vin t m o 50 mg
Fungizon lotio 3%
CH KHI CH NH THUC
Suy thn: Amphotericin B c vi thn, gy nguy c gy tr niu khng km
protein niu. C nitrogen mu cao, nhim acid chuyn ho do hin tng co mch
cc tiu huyt qun thn, v gy tn thng ng ln xa ca thn, nn nh hng ti
s ti hp thu nc (H20) bi ADH ti y, c th lm tng lng nc tiu.
TNG TC THUC
Bepridil; halofantrin; vincamin
Phn tch: Phi hp cc thuc ny vi amphotericin B dng tim c nguy c gy
xon nh. Hin tng h kali mu, nhp tim chm, v khong QT di c t tr c
(ch nhn bit c trn in tm ) l nhng yu t c th to iu kin cho s xut
hin xon nh.
X l: Phi hp cn trnh. Dng nhng thuc khng gy xon nh. Nu phi hp
ny l cn, phi theo di lin tc khong QT v thng xuyn kim tra nng kali
trong mu.
Khng histamin H1 khng an thn
Phn tch: Tng tc ch c ghi nhn vi mt khng histamin khng an thn l
astemizol (Hismanal). Amphotericin B dng ng tim gy tc dng h kali mu. Hin
tng h kali mu (v c nhng trng hp tiu chy dai dng gy mt in gii) l
yu t thun li cho s xut hin cc xon nh. Nguy c ny li tng ln khi thuc gy
h kali mu li kt hp vi cc thuc khc c th to xon nh.
76
X l: Kt hp thuc l cn trnh v nn thay i chin lc iu tr v chn

nhng thuc khng gy xon nh. Nu s phi hp thuc ny l cn, theo di nng
kali trong mu v nu cn th b sung kali.
Pentamidin
Phn tch: C hai nguy c: 1/ Nguy c xon nh khi phi hp vi amphotericin B
dng tim. Hin tng h kali mu, nhp tim chm v khong QT di c t trc (ch
nhn bit c trn in tm ) l nhng yu t thun li cho s xut hin xon nh.
Xon nh l mt dng ring bit ca nhp tht, c th xut hin thnh cn r t ng n
(vi giy, mt thu, c cm gic ngt, nhng khng mt tri gic). 2/ Kt hp
amphotericin B dng tim vi cc thuc c vi tu khc i hi phi rt thn trng. C
nguy c thiu mu hay nhng ri lon khc v mu.
X l: Phi hp thuc cn trnh. Dng cc thuc khng gy xon nh. Nu cn
phi hp thuc, phi theo di lin tc khong QT v phi kim tra thng xuyn nng
kali mu.
Sparfloxacin
Phn tch: Tng tc ny ch th hin mt fluoroquinolon l sparfloxacin
(Zagam). Nguy c xut hin xon nh tng khi kt hp vi amphotericin B dng tim.
Hin tng h kali mu, nhp tim chm, khong QT di c t trc (ch nhn bit
c trn in tm ) l nhng yu t to thun li cho s xut hin xon nh, i
khi tin trin thnh rung tht.
X l: Tng tc cn trnh. Dng cc thuc khng gy xon nh. Nu cn phi
hp thuc, phi theo di lin tc khong QT v phi kim tra thng xuyn nng kali
trong mu.
Amiodaron; disopyramid; quinidin hoc dn cht; sotalol
Phn tch: Nguy c gy xon nh khi kt hp cc thuc ny vi amphotericin B
dng tim. Hin tng h kali mu, nhp tim chm v khong QT di c t trc (ch
nhn bit c trn in tm ) l nhng yu t thun li cho s xut hin xon nh.
X l: Nu cn phi hp thuc trn vi amphotericin B, cn phi d phng h kali
mu nh tng cng theo di v kim tra in tm . Khi xut hin xon nh, khng
iu tr bng thuc chng lon nhp.
Azathioprin; carmustin hoc dn cht; clozapin; cyclophosphamid hoc
thuc tng t; doxorubicin hoc dn cht; fluoro - 5 - uracil; ganciclovir;
interferon alpha ti t hp; levamisol; melphalan; mercaptopurin; methotrexat;
penicilamin hoc thuc tng t; phenicol; procarbazin; pyrazol; quinin hoc
thuc tng t; thiotepa; thuc chng ung th; vincristin hoc thuc tng t;
vng; zidovudin.
Phn tch: Vic kt hp amphotericin B dng tim vi mt s thuc c vi tu
khc phi rt thn trng. C nguy c thiu mu v cc ri khc v mu.
X l: Nu cn phi hp thuc, phi theo di cht ch huyt . Nu cn phi
gim liu dng.
Cisplatin hoc dn cht
77
Phn tch: S kt hp vi amphotericin B dng tim vi mt s thuc c vi tu

khc phi rt thn trng. C nguy c thiu mu hoc nhng ri lon khc v mu.
Ngoi ra y cn l s phi hp gia hai thuc c vi thn.
X l: Nu cn phi hp thuc, phi theo di cht ch huyt , ion v
thanh lc creatinin. Nu cn, phi gim liu dng.
Foscarnet
Phn tch: C nguy c tng thm tc dng c vi thn.
K n: Nu khng ngng dng mt trong hai thuc, phi theo di cn thn ion
v thanh lc creatinin.
Corticoid-khong; furosemid hoc thuc tng t; glucocorticoid;
tetracosactid; thuc li tiu thi kali; thuc nhun trng kch ng
Phn tch: Dng kt hp vi amphotericin B s lm tng tc dng h kali mu
ca cc thuc ni trn. Amphotericin B rt t hp thu theo ng ung, hay dng ti ch
trong iu kin bnh thng.
X l: Theo di kali mu v phi nh gi nguy c tng tc thuc theo ng
dng amphotericin B.
Glycosid tr tim
Phn tch: Amphotericin B dng ng tim lm h kali mu, gy nhc c, c
kh nng lm tng cng tc dng ca cc thuc cura khng kh cc (l nhng cht
phong b mi ni thn kinh - c) v tng cng c tnh thuc digitalis. Cc glycosid tr
tim c ch Na+/K+ ATPase c chc nng chuyn vn cc ion Na+ v K+ qua mng t bo
c tim. C ch chnh xc cha c lm r hon ton. Khng c nhng cng b trong y
vn chng t gi thuyt dc l ny l ng. S h kali mu mnh (d i hoc bng
3mEq/lt) c th gy ngoi tm thu tht hay nh, nhp tht hay nh nhanh, cng nh
nhng ri lon trong s dn truyn nh tht. Ngi bnh dng thuc digitalis, th c
nhng ri lon tng t khi hin tng h kali mu cha mc nng nh trn.
X l: Trc khi kt hp thuc, cn tin hnh nh lng kali trong huyt thanh,
cha hin tng h kali mu nu cn, v theo di u n nng
kali trong mu. Tng tc ny da trn nhng l lun dc l hc. Nu thc hin kt
hp thuc, cn ch quan st trn lm sng v tm nhng bng chng ni ln gi
thuyt trn l ng. Ch v mt lm sng, s h kali mu u tin th hi n hi n
tng
nhc
c,
co
cng
c,
sau
n nhng triu chng nng hn nh lon nhp tim, lit h hp. Phi cnh gic v i
nhng trng hp h kali mu do m hi qu nhiu hay tiu chy dai dng.
Phn tch: Interleukin ch c dng ti nhng c s chuyn khoa. C nguy c
hip ng nhng tc dng c vi thn ca hai thuc.
X l: Vic iu tr vi interleukin ch c thc hin c s chuyn khoa do mc
nghim trng ca vic ch nh dng thuc. Khi cc tng tc thuc cn phi
xem xt theo trng thi chung ca ngi bnh. Nu khng th ng ng mt trong hai
thuc, th phi theo di cht ch ion v thanh lc creatinin.
Thuc cura
78
Phn tch: C nguy c tng cng phong b thn kinh - c do gim nng kali
trong mu, nht l vi cc thuc cura khng kh cc. Ch ring amphotericin B d ng
tim c th l nguyn nhn h kali mu.
X l: C th cn phi nh lng kali trc khi dng thuc cura khng kh cc.
Thuc chng nm dn xut t imidazol
Phn tch: C th c i khng trong tc dng chng nm, c ni ti vi cc
thuc ketoconazol v miconazol; c ch cha r.
X l: Trong tnh hnh hiu bit hin nay, nn trnh phi hp ny.
Zalcitabin
Phn tch: Tng nng zalcitabin trong huyt tng khi kt hp thuc v c
nguy c nhim c.
X l: Theo di cc tc dng c hi ca zalcitabin. Gim liu nu cn.
Aminosid dng ng ung hay ti ch
Phn tch: Nguy c tng c tnh vi thn khi phi hp hai thuc u c c tnh
vi thn. C hip ng cc tc dng khng mong mun.
X l: Nhng phi hp thuc ny hay gp, nht l ti bnh vin. Mc du nu ch
dng mt ln mt ngy s lm gim c tnh vi tai v thn, nhng khi cn phi hp
thuc, phi hiu chnh liu theo thanh lc creatinin (cng thc Cockroft v Gault).
Theo di k khi dng ngi bnh cao tui.
Cyclosporin
Phn tch: Tng creatin niu. Tc dng hip ng gy c vi thn.
X l: Nu cn kt hp hai thuc, phi quan tm n tng tc ny. Tng cng
theo di thanh lc creatinin v ion .
ANTIMON (Hp cht)

Dn xut t antimon c hot tnh trn cc bnh leishmania. Hp cht antimon
ho tr ba (anthiolimin) khng cn c dng v hp cht antimon ho tr nm
c dung np tt hn (Meglumin antimoniat, natri stibogluconat)
CC THUC TRONG NHM
MEGLUMIN ANTIMONIAT ng tim 1,5 g
Glucantime ng tim 1,5 g
CH KHI CH NH THUC
Thi k mang thai: Nguy c c vi thai.
79
Suy tim: Khi suy tim nng, v cc tc dng ph ca cc thuc ny.

Suy gan / suy thn: V c tnh ca antimon.
Trng hp khc: Lao phi.
80
APOMORPHIN
Dn xut t morphin c cu trc ging dopamin
v hot ng nh mt cht ch vn ca th th dopamin
CC THUC TRONG NHM
APOMORPHIN HYDROCLORID thuc tim 0,5%; 1%
Apokinon thuc tim 0,5%
Apokinon thuc tim 1%
Apomorphin Aguettan thuc tim 0,5%
Apomorphin Aguettan thuc tim 1%
Apomorphin Meram thuc tim 0,5%
CH KHI CH NH THUC
Chng ch nh: mc 4
Suy tim; suy gan: Do chuyn ho ca thuc ny.
Trng hp khc: L ln tm thn v trng thi tm thn.
TNG TC THUC
Memantin
Phn tch: Tc dng ca apomorphin c th tng do memantin.
X l: Cn gim st lm sng
Nitrat
Phn tch: Tng tc dng gim huyt p vi thuc ngm di li.
X l: Cn gim st lm sng.
Thuc chng lon thn
Phn tch: Tc dng i khng
X l: Nn trnh phi hp
Thuc dopominergic khc (entacapon)
Phn tch: Tc dng ca apomorphin c th tng do Entacapon.
X l: Cn gim st lm sng.
81
ASPARAGINASE
Enzym phn t lng ln, thu c t nui cy Escherichia coli v c dng lm
thuc chng ung th (nht l trong bnh bch huyt cp tnh).
CC THUC TRONG NHM
ASPARAGINASE ng tim 10 MIU
Kidrolase ng tim 10 MIU
CH KHI CH NH THUC
Thuc c ch nh do thy thuc chuyn khoa
Chng ch nh: mc 4
Thi k cho con b: Nh i vi tt c cc thuc chng gin phn.
Thi k mang thai: Nguy c c cho thai, d dng quan trng v d thng b
xng.
Suy gan; vim tu.
Thn trng: mc 2
i tho ng: Nguy c tng glucose mu.
Gt/ si thn: Nguy c tng acid uric trong mu.
TNG TC THUC
Vaccin sng gim c lc
Phn tch: Nguy c pht trin nhim khun tng ng vi vaccin v hot tnh gim
min dch ca asparaginase.
X l: Khong cch gia hai thuc t 3 thng ti mt nm tu theo mc gi m
min dch.
Alopurinol hoc dn cht; probenecid
Phn tch: Asparaginase lm tng nng acid uric trong mu.
X l: Phi hp cn thc hin bnh vin. iu chnh liu php chng gt.
trnh si uric, nn dng alopurinol hn l cc thuc gy acid uric niu.
Colchicin hoc dn cht
Phn tch: Dng ng thi mt thuc km t bo v mt thuc chng gt lm tng
nng acid uric. Hn na cn tng nguy c gim bch cu v gim tiu cu do hi p
ng cc tc dng khng mong mun ca cc thuc.
82
X l: Trnh phi hp hai thuc cng mt lc, nu khng, liu php chng gt s
tht bi. Nn dng alopurinol (c ch tng hp acid uric) hn dng cc thuc gy acid
uric niu trnh cc bnh thn.
Corticosteroid: Glucocorticoid; corticoid-khong; tetracosactid
Phn tch: Tng tc dng lm tng glucose mu.
X l: Phi hp do thy thuc chuyn khoa thc hin bnh vin.
c tnh t hn khi dng asparaginase sau khi dng corticoid, so vi dng trc
hoc ng thi.
Didanosin
Phn tch: Hip ng cc tc dng khng mong mun: Tng nguy c vim tu.
X l: Gim st lm sng, v nu cn trong trng hp au bng, xt nghi m
chc nng tu (nng amylase trong mu v trong nc tiu).
Insulin; sulfamid h glucose mu
Phn tch: Asparaginase c th lm ri lon cn bng glucose mu v tnh cht
tng glucose mu.
X l: Gim st glucose mu ngi tiu ng trong v sau khi iu tr bng
asparaginase.
Phenytoin
Phn tch: Nng phenytoin c th gim nhiu trong huyt thanh sau khi dng
liu cao asparaginase (trong mt iu tr phi hp).
X l: Thng tin cn t, cha y . Cn gim st cht nng phenytoin trong
huyt thanh, khi phi hp vi cc thuc chng ung th, trong c asparaginase.
Thuc chng nm dn xut imidazol: Fluconazol; Itraconazol
Phn tch: Phi hp asparaginase nguy c thp lm tng hoc gim nng
itraconazol trong huyt thanh. Phi hp asparaginase dc ng hc ca fluconazol
khng b nh hng.
X l: Nn dng fluconazol.
Vincristin hoc thuc tng t
cu.
Phn tch: Tng c tnh ca vincristin i vi h thn kinh v ri lon to hng
X l: Phi hp phi do thy thuc chuyn khoa thc hin bnh vin. c tnh
t hn khi dng asparaginase sau khi dng vincristin so vi dng trc hoc ng thi.
AZATHIOPRIN
Thuc c ch min dch, tc ng n chuyn ho purin.
Thuc phn gii thnh 6-mercaptopurin
83
CC THUC TRONG NHM

AZATHIOPRIN vin nn 50 mg
Azanin vin nn 50 mg
Imurel vin nn 50 mg
CH KHI CH NH THUC
Thuc do thy thuc chuyn khoa ch nh, tu theo tnh trng ngi bnh.
TNG TC THUC
Alopurinol
Phn tch: Tc dng ca azathioprin v mercaptopurin tng ln r rt khi phi hp
vi alopurinol. Tng tc ny c th khng xy ra khi cc thuc ny (chng ung th )
c tim tnh mch. iu ny cn c xc nhn thm. Alopurinol c ch chuyn ho
oxy ho azathioprin v mercaptopurin bng cch c ch xanthin oxydase, l enzym cn
cho s phn gii purin thnh acid uric, gy nguy c tch lu azathioprin v
mercaptopurin. Tng tc xy ra chm.
X l: Tng tc quan trng v lm sng v c kh nng gy t vong. Liu lng
azathioprin v mercaptopurin phi gim ti khong 1/3 hoc 1/4 khi dng thuc ng
ung gim gy ng c. Phi gim st cht ngi bnh.
Co-trimoxazol hoc trimethoprim
Phn tch: Tng nguy c c ch tu xng ca c hai thuc (c bit ngi
ghp thn khi dng co-trimoxazol lu di).
X l: Nn trnh phi hp, nht l ngi ghp thn, c nguy c gy t vong. C
mt gi nhng cha c kim nghim l c th dng acid folinic iu tr c hiu
qu c ch tu xng m khng nh hng n tc dng khng khun ca cotrimoxazol.
Tacrin
Phn tch: Nguy c tng c vi gan.
X l: Nu cn, tng cng gim st gan. Trnh cc phi hp gy nguy c
ngi cao tui.
Vaccin sng gim c lc
Phn tch: Nguy c pht trin nhim khun tng ng vi vaccin, v tc ng c
X l: Khong cch gia hai thuc khong t 3 thng n mt nm, tu thuc
mc c ch min dch.
Amphotericin B
84
Phn tch: Phi hp amphotericin B tim vi cc thuc khc c c tnh vi tu

xng phi rt thn trng: nguy c thiu mu hoc cc ri lon huyt hc khc.
X l: Nu cn phi hp, phi gim st k huyt v nu cn, phi gim liu.
Cc glycosid tr tim
Phn tch: Gim hp thu cc thuc digitalis khong 50% do tn thng nim mc
rut c th phc hi c, do thuc km t bo gy nn.
X l: Gim st k nng huyt thanh thuc digitalis trong sut liu trnh.
Clozapin
Phn tch: Nguy c tng c ch tu xng, do tc dng hip ng, c th dn
n gim bch cu ht. C th b gim bch cu ht nghim trng, thm ch t vong
khi ch dng n c clozapin (c tnh min dch).
X l: Nu cn phi hp, dng liu thp cho mi thuc. Phi gim st k huyt
. Phi bo cho ngi bnh h b st nh, vim hng v lot ming, phi ngng iu
tr bng clozapin.
Ciclosporin
Phn tch: Phi hp hai thuc c ch min dch mnh, nn c nguy c pht trin
u limpho gi.
X l: Khi phi hp cn cn nhc li/hi tu thuc mc tiu iu tr. Ch c th
tin hnh ti c s chuyn khoa, theo di cht ch ngi bnh.
Colchicin hoc dn xut
Phn tch: Tng nng acid uric huyt thanh. Tng nguy c gim bch cu v
tiu cu do hip ng tc dng khng mong mun ca cc thuc ny.
X l: Nn trnh phi hp hai thuc cng mt lc, nu khng, liu php chng gt
c th tht bi.
Didanosin
Phn tch: Hip ng cc tc dng khng mong mun: tng nguy c vim tu do
thuc.
X l: Gim st lm sng v, nu cn khi au bng, lm xt nghim chc nng
tu (nng amylase trong mu v trong nc tiu).
Ganciclovir; interferon ti t hp; penicilamin
Phn tch: Nguy c c ch tu xng do tc dng hip ng, c th dn n mt
bch cu ht.
X l: Nu c th, trnh phi hp. Nu cn phi hp, dng liu thp cho mi
thuc v gim st k huyt .
Phn tch: Hai thuc c tim nng c vi gan v c ch tu xng.
85
X l: Ch c th tin hnh ti c s chuyn khoa. Dng interleukin cn phi c

gim st lin tc. Khi phi hp, phi gim st cht ch huyt v chc nng gan
(ASAT, ALAT, phosphatase kim, bilirubin), hoc nu c th, hon mt trong hai thuc.
Mesalazin; sulfasalazin
Phn tch: Tng c tnh c ch tu xng ca azathioprin.
X l: Nu phi hp, phi gim st cht ch huyt hc v lc u, nn thn trng
gim liu azathioprin.
Mesalazin l mt cht chuyn ho ca sulfasalazin.
Niridazol
Phn tch: Hai thuc c vi gan. Niridazol cn c vi thn kinh. Nguy c xut
hin co git, ri lon tm thn v c vi gan khi phi hp.
X l: Khi phi hp hai thuc c vi gan, cn gim st cht ch chc nng gan
(ASAT, ALAT, phosphatase kim, bilirubin) hoc nu c th, hon mt trong hai thuc.
Ngi bnh khng c thng xuyn dng ru, v khng c tin s vim gan virus.
Cc triu chng lm sng chnh khng c hiu l bun nn, st, vng da... Nu thy
ng thi ban da, nga v hch to, c th ngh ti do thuc. Cn da vo kt qu th
nghim sinh hc phn bit nguy c vim gan tiu t bo khng phc hi c v i
vim gan mt phc hi c sau khi ngng iu tr.
Phenicol
Phn tch: Nguy c tng c ch tu xng, do hip ng cc tc dng, c th
dn n gim bch cu ht nghim trng, thm ch t vong, khi ch dng n c mt
phenicol (c tnh min dch).
X l: Nu cn phi hp, dng liu thp cho mi thuc. Khng tin on c
gim bch cu ht do dng phenicol, cho nn phi gim st k huyt cng nh mi
khi dng mt thuc km t bo. Nu ngi bnh b st nh, vim hng v lot mi ng,
phi ngng phenicol.
Thuc chng ng warfarin
Phn tch: Tc dng chng ng mu ca warfarin c th b gim. Tng tc xy
ra chm.
X l: Khi phi hp, cn gim st cht ch tc dng ca warfarin trong v sau khi
phi hp chc chn kim sot c tt thi gian prothrombin. C th phi iu
chnh liu ca thuc chng ng.
Thuc chng nm dn xut ca imidazol; vng
Phn tch: Phi hp nhiu thuc c tim nng c vi gan (hip ng cc tc
dng khng mong mun).
X l: Cn gim st cht ch chc nng gan (ASAT, ALAT, phosphatase kim,
bilirubin) hoc nu c th, hon mt trong hai thuc. Ngi bnh khng c thng
xuyn ung ru, v khng c tin s vim gan virus. Cc triu chng lm sng chnh
khng c hiu l bun nn, st, vng da.. Nu thy ng thi ban da, nga v hch to
th c th ngh nhiu n nguyn nhn do thuc. Cn phn bit r, cn c kt qu th
86
nghim sinh hc, nguy c xut hin vim gan tiu t bo khng phc hi c vi vim
gan mt c th phc hi khi ngng thuc.
Thuc chng ung th: Actinomycin D; carmustin; cisplatin; cyclophosphamid;
doxorubicin; fluoro-5-uracil; melphalan; mercaptopurin; methotrexat; pentostatin;
procarbazin; thiotepa; vincristin; thuc chng ung th khc ngoi cc thuc trn
Phn tch: Nguy c c ch tu xng do tc dng hip ng, c th dn n mt
bch cu ht.
X l: Nu c th, trnh phi hp. Nu cn phi hp, dng cc liu thp cho mi
thuc v gim st k huyt .
Thuc gin c khng kh cc: Atracurium, gallamin triethiodid, metocurin
iodid, pancuronium, tubocurarin, vecuronium
Phn tch: Tc dng ca thuc gin c khng kh cc c th b gim hoc o
ngc. Tng tc xy ra nhanh. C th do c ch phosphodiesterase tn cng dy
thn kinh vn ng, nn c tc dng khng cura.
X l: Gim st cht ch chc nng h hp c bit quan trng. C th phi iu
chnh liu khi phi hp.
Zidovudin
Phn tch: Nguy c thiu mu hoc cc ri lon huyt hc khc.
X l: Nu cn phi hp, gim st k huyt v nu cn th gim liu.
Thuc c ch enzym chuyn dng angiotensin v thuc i khng
angiotensin II
Phn tch: Tng nguy c gy thiu mu ( ngi ghp thn), khi dng phi hp vi
captopril hoc enalapril. Tng nguy c gy gim bch cu vi captopril. Thiu mu c th
do
thuc
c
ch
enzym
chuyn
c
ch
erythropoetin.
C ch gim bch cu cha r. Do tc dng hip ng c ch tu xng.
X l: Khi phi hp, cn theo di huyt .
BACLOFEN
Thuc gin c, tc ng ch yu trn tu sng
CC THUC TRONG NHM

BACLOFEN vin nn 10 mg; 25 mg
Lioresal vin nn 10 mg; 25 mg
CH KHI CH NH THUC
87

cng.
Thi k mang thai: Tc dng sinh qui thai khi dng liu cao trn th v chut
Thn trng: mc 2
Thi k cho con b: Baclofen qua c sa m.
Trm cm: Thuc c th lm bc l trm cm.
ng kinh: H ngng gy ng kinh.
Suy gan: Thn trng khi dng.
Suy thn: Nguy c tch lu thuc, phi iu chnh liu.
Suy h hp; hen: Do nhiu tc dng khng mong mun ca thuc.
Ngi cao tui: Do nguy c suy thn v trng thi tm thn nhng ngi bnh
cao tui.
Lot d dy-t trng; vim d dy : Do nhiu tc dng khng mong mun ca
thuc ny.
TNG TC THUC
Dantrolen
Phn tch: Tng tc dng c ch h thn kinh trung ng, dn n tng tc dng
an thn gy bun ng. Tng tc dc lc hc.
X l: Lu nguy c bun ng iu chnh liu ca hai thuc, c bit ngi
li xe v vn hnh my. Khuyn khng ung ru v khng t dng thuc hoc ch
phm c ru.
Dextropropoxyphen
Phn tch: Tng c ch h thn kinh trung ng, dn n tng bun ng. Tng
tc dc lc.
X l: Ch n nguy c ny iu chnh liu ca hai thuc khi cn phi hp.
Ch n gim tnh to ngi li xe hoc vn hnh my.
Ru
tc dc lc.
X l: Nn trnh ung ru. Nu ung, ch n nguy c gim tnh to khi li xe
hoc vn hnh my.
Thuc an thn kinh: Benzamid; butyrophenon; buspiron; benzodiazepin;
carbamat v thuc lin quan; gluthetimid; thuc an thn kinh cc loi khc (th
d nhm thioxanthen)
88
tc dc lc.
X l: Ch n nguy c ny iu chnh liu ca hai thuc khi phi hp. Ch
n gim tnh to ngi li xe hay vn hnh my.
Thuc chng ng kinh: carbamazepin; ethosuximid; phenytoin; primidon
hoc dn cht
tc dc lc.
Thuc chng tng huyt p: Clonidin hoc thuc tng t; guanethidin
hoc thuc tng t; methyldopa; thuc chn beta (sotalol); thuc gin mch
chng tng huyt p; reserpin.
Phn tch: Nguy c tng tc dng lm h huyt p.
X l: Theo di huyt p v iu chnh liu thuc chng tng huyt p trong v
sau khi ngng kt hp. Thn trng c bit ngi bnh cao tui.
Thuc chng trm cm: Medifoxamin; paroxetin; thuc c ch h thn
kinh cc loi khc.
tc dc lc.
Thuc km t bo: Procarbazin; interferon alpha ti t hp
tc dc lc.
X l: Ch n nguy c ny iu chnh liu ca hai thuc khi cn phi hp.
Ch n gim tnh to ngi li xe hoc vn hnh mu.
Thuc li tiu: furosemid; thuc li tiu gi kali; thuc li tiu thi kali
Phn tch: Tng tc dng h huyt p v tng nguy c h huyt p th ng.
X l: Theo di huyt p trong khi phi hp hai thuc. Khi cn, th phi iu chnh
liu ca mt trong hai thuc. Lp mt k hoch ung thuc u n. Khuyn ngi
bnh nu thy chng mt lc bt u iu tr, nn gp li bc s iu tr iu chnh
liu ca mt trong hai thuc, tu trng hp. Tng cng theo di ngi bnh cao
tui (nguy c ng) v khuyn h chuyn dn dn t t th nm hoc ngi sang t th
ng.
Thuc c ch enzym chuyn dng angiotensin
Phn tch: Nguy c tng tc dng h huyt p.
X l: Theo di huyt p v iu chnh liu ca thuc chng tng huyt p trong
v sau khi ngng iu tr bng baclofen. Thn trng c bit ngi bnh cao tui.
89
Verapamil
Phn tch: Nguy c tng tc dng h huyt p v xut hin h huyt p do tc
dng hip ng.
X l: Theo di huyt p v khi cn th iu chnh liu ca verapamil.
Cht ch vn morphin; khng histamin khng H1 an thn; mianserin;
oxaflozan; phenothiazin; viloxazin
Phn tch: Tng c ch h thn kinh trung ng dn n tng tc dng an thn
gy bun ng. Tng tc dc lc.
X l: Lu nguy c ny iu chnh liu ca hai thuc, nu phi hp ch ti
gim tnh to ngi li xe hoc vn hnh my.
Thuc chng trm cm ba vng hoc thuc tng t; barbituric; fluoxetin;
fluvoxamin
Phn tch: Tng c ch h thn kinh trung ng, dn n tng tc dng an thn
X l: Lu nguy c ny iu chnh liu ca hai thuc. Ch ti gim tnh to
ngi li xe hoc vn hnh my.
Levodopa
Phn tch: Nguy c tng cc tc dng khng mong mun, ch yu l l l n, o
gic, vt v.
X l: Theo di lm sng; nu cn phi hp, th phi iu chnh liu d phng
cc tc dng khng mong mun .
Methadon
Phn tch: Tng c ch h thn kinh trung ng, km theo an thn mnh gy bun
ng, c bit c hi i vi nhng ngi li xe v ngi vn hnh my.
X l: Lu nguy c tng tc dng an thn v cho nhng li khuyn thch hp:
trnh li xe hoc vn hnh my; bo cho ngi xung quanh bit mi nguy him.
90
BARBITURIC (dn cht)

Dn cht ca malonylure, gy an thn,
gy ng, gy m, chng ng kinh, chng co git.
CC THUC TRONG NHM

PHENOBARBITAL vin nn 10 mg; 100 mg; ng tim 10%
Gardenal vin nn 0,1 g
Gardenal vin nn 0,01 g
CH KHI CH NH THUC
Thi k mang thai: Nguy c chy mu nghim trng tr s sinh khi m c
iu tr bng phenobarbital, mc du thuc ny c th c s dng ph n ng
kinh tui sinh .
Suy h hp; hen: Cc barbituric c ch cc trung tm h hp hnh no.
Ri lon chuyn ho porphyrin: i tng c c a, c nguy c ri lon
chuyn ho porphyrin do cm ng tng hp ALA-synthetase, dn n tng hp
porphyrin vi au bng, nn, ri lon tm thn v thn kinh (lit mm hai chi di) nht
l khi c ri lon chuyn ho porphyrin cp, tng t.
Thn trng: mc 2
n ung; ru: Ung ru qu nhiu lm tng c tnh barbituric. Ngc li,
ung ru qu mc v ko di (nghin ru) lm tng s phn hu barbituric gan
(nhn barbituric ngi nghin ru). Tuy nhin, ru lm tng tc dng an thn trung
tm ca barbituric.
Suy gan: Phn ln barbituric chuyn ho gan (tr phenobarbital v barbital t b
chuyn ho). Suy gan lm chm chuyn ho v tng c tnh ca barbituric.
Suy thn: Phenobarbital t b chuyn ho v c o thi di dng cn hot
tnh qua thn. Vy suy thn s lm tng c tnh ca barbituric .
Cn theo di: mc 1
Thi k cho con b: Cc barbituric qua c sa m.
Tr em: Nguy c ph thuc thuc v mt th cht v tinh thn, vi nhng phn
ng nghch thng nh kch thch, vt v, trong trng hp k n barbituric lm thuc
ng. Phenobarbital do tnh cm ng enzym lm tng s mt hot tnh ca vitamin D,
gy nguy c ci xng tr em ng kinh.
Suy tim: Do tc dng gim trng lc c v co c tim, barbituric t gy c ch c
tim vi liu gy ng, tr trng hp suy tim.
TNG TC THUC
91
Dextropropoxyphen
an thn gy bun ng. Tng tc dc lc.
X l: Lu nguy c ny iu chnh liu ca hai thuc, nu cn phi phi
hp. Ch n s gim tnh to ngi li xe hoc vn hnh my.
Mifepriston
Phn tch: Nguy c gim hiu lc iu tr, v tng chuyn ho mifepriston, do cm
ng enzym.
X l: u tin phi nh cm ng enzym l mt hin tng chm xut hin (3
tun) v chm kt thc. C th phi tng liu lng.
Ru
an thn. Vi mt s thuc, nht l trong tun l u iu tr, c th thy mt s tc
dng tm thn vn ng. Tng tc dc lc.
X l: Tt nht, khng nn ung ru khi dng barbituric. Nguy c an thn gy
bun ng c bit nguy him ngi li xe hoc vn hnh my.
Saquinavir
Phn tch: Tng chuyn ho saquinavir, dn n gim nng saquinavir trong
huyt tng v do gim hiu qu iu tr.
X l: Tm mt thuc khc thay th khi phi dng saquinavir ng thi. Nu
khng th c, cn tng liu lng saquinavir khng lm gim tc dng chng
virus.
Thuc nga thai (ung): Estrogen hoc
estroprogestogen; progestogen hoc dn cht
cc
thuc
nga
thai
Phn tch: Tng chuyn ho cc estroprogestogen gan, do barbituric gy cm

ng enzym cytochrom P450, do c nguy c th thai.
X l: Trnh dng cc thuc nga thai liu thp; nn dng cc thuc nga thai
liu cao hoc khuyn dng mt bin php nga thai khc, nu phi iu tr bng
barbituric di ngy (th d nh ph n tr ng kinh). Nh rng cm ng enzym
khng bao gi l mt hin tng tc thi.
Acid ascorbic
Phn tch: Tng bi xut acid ascorbic.
X l: Nh vy, nhu cu v vitamin C tng ln ngi bnh iu tr di ngy
bng cc barbituric (th d ngi bnh ng kinh), v do c th phi b sung thm
vitamin C. Cn nh, vitamin C thng c t dng.
Acid folic hoc dn cht
92
Phn tch: Nguy c gim nng thuc tr ng kinh trong huyt thanh, khi b
sung acid folic. Dng ng thi barbituric vi acid folic c th lm gim tc d ng chng
co git, do tc dng i khng trn h thn kinh trung ng.
X l: Tng cng theo di lm sng v sinh hc trong iu tr chng ng kinh
c b sung acid folic. iu chnh liu lng thuc chng ng kinh, nu cn, trong v
sau khi ngng acid folic.
Buspiron
an thn gy bun ng .Vi mt s thuc, c th thy mt s tc dng tm thn vn
ng, nht l trong tun u iu tr. Tng tc dc lc.
X l: Khng nn phi hp hai thuc, v kh kim sot ngi bnh ung ru.
Nguy c bun ng c bit nguy him ngi li xe hoc vn hnh my.
Ciclosporin
Phn tch: Gim nng ciclosporin trong huyt thanh, do tng chuyn ho.
Gim tc dng ciclosporin.
X l: Khi cn phi hp, phi theo di k nng ciclosporin trong huyt thanh v
iu chnh liu khi bt u v khi kt thc iu tr thuc kia. Cn lu nng
ciclosporin c nhng bin ng ln gia cc c th v phi theo di u n.
Cht acid ho nc tiu

Phn tch: Tng ti hp thu barbituric ng thn, do c th ko di tc dng
ca cc barbituric v lm xut hin nhim c do qu liu.
X l: Lu kh nng ni trn khi phi phi hp thuc, v iu chnh liu lng.
Khi thy ngi bnh ng g, do dng phi hp hai thuc, phi tu trng hp m gim
liu
barbituric
sau
khi
o
pH
nc
tiu
bng
giy
ch th.
Corticosteroid: corticoid-khong; glucocorticoid
Phn tch: Tng d ho corticoid bi cc thuc cm ng enzym. Cm ng enzym
ch biu hin t 10 n 12 ngy sau lc bt u iu tr.
X l: Cm ng enzym khng xy ra tc th. iu tr barbituric trong mt thi gian
trung bnh hoc di, bt buc phi ch n gim tc dng ca thuc phi hp. i u
chnh liu corticosteroid trong v sau khi ngng iu tr barbituric.
Phn tch: Tng c tnh ca cyclophosphamid do tng chuyn i thuc ny thnh
sn phm chuyn ho alkyl ho ca cyclophosphamid (cm ng enzym).
X l: Theo di k huyt v cn nhc nguy c gim bch cu do phi hp
thuc. Phi tnh n thi gian iu tr cn thit tng tc ny khng xy ra, v cm
ng enzym xy ra dn dn (t nht mi ngy).
Disopyramid
93
Phn tch: Do cm ng enzym, nn gim nng disopyramid trong huyt thanh

ti nhng nng khng c hiu qu.
X l: Theo di in tm , lm sng, nng thuc chng lon nhp tim trong
huyt thanh v khi cn th iu chnh liu. Tng tc ny cha c xc nh r.
Glycosid tr tim
Phn tch: Tng chuyn ho digitalis gan, do cm ng enzym, dn n gim tc
dng duy nht ca digitoxin (digitalin).
X l: Lu nguy c ny iu chnh liu digitalin (digitoxin) (v digoxin c
o thi qua ng thn), khi cn phi phi hp. iu chnh liu trong v sau khi iu
tr barbituric.
Griseofulvin
Phn tch: Tng chuyn ho gan do cm ng enzym, c th dn n gim hot
tnh ca griseofulvin.
X l: Lu nguy c ny iu chnh liu ca hai thuc, khi cn thit phi phi
hp. Tm quan trng ca tng tc ny cn phi c xc nh.
Guanethidin hoc thuc tng t
Phn tch: Tng nguy c h huyt p th ng.
X l: Thng bo cho ngi bnh. Theo di huyt p trong khi phi hp hai thuc.
Tu theo thuc dng, mc nghim trng ca h huyt p c th khc nhau. Khi cn,
phi iu chnh liu ca mt hoc hai thuc. Tng cng theo di nhng ngi bnh
cao tui (nguy c ng) v khuyn h chuyn dn dn t t th nm hoc t th ng i
sang t th ng.
Hormon tuyn gip
Phn tch: Tng d ho cc thuc ny bi cc thuc cm ng enzym (barbituric).
Cm ng enzym ch biu hin 10 n 12 ngy sau lc bt u iu tr.
X l: Cm ng enzym khng xy ra tc th. Dng barbituric trong mt thi gian
trung bnh hoc di, phi theo di gim tc dng iu tr ca thuc phi hp. iu
chnh liu trong v sau khi ngng thuc barbituric.
Lidocain hoc thuc tng t
Phn tch: Tng chuyn ho lidocain gan, do cm ng enzym, dn n gim
hot tnh ca thuc ny.
X l: Lidocain c dng lm thuc chng lon nhp tim, s phi hp thc hin
ti c s chuyn khoa. Phi tnh n tng tc ny nu dng lidocain thng xuyn, v
cm ng enzym ch n dn dn. Khi , iu chnh liu. Khi cn, phi theo di nng
lidocain trong huyt tng v vn ch theo di khi ngng iu tr.
Mexiletin
Phn tch: Gim nng mexiletin trong huyt tng do cm ng enzym.
X l: iu chnh liu mexiletin tu thuc lm sng v in tm .
94

Phn tch: Natri valproat v cc dn cht lm tng nng barbituric trong huyt
tng, c l do c ch enzym v gim d ho. i vi chuyn ho thuc, y l tng
tc dc ng hc. V mt lm sng, tng nng cc barbituric trong huyt tng s
th hin bng tng cc tc dng khng mong mun (an thn gy bun ng).
X l: Cn theo di lm sng trong 15 ngy iu tr u tin, nh lng nng
barbituric trong huyt tng khi cn, v iu chnh liu ngay khi bt u c d u hiu
bun ng.
Paracetamol
Phn tch: Nu dng barbituric thng xuyn, c th lm tng chuyn ho
paracetamol gan do cm ng enzym, thng xuyn dn n gim hot tnh. Cng c
th tng c tnh vi gan ngi nghin ru hoc ngi c iu tr thng xuyn
bng barbituric.
X l: Theo di lm sng nhng ngi bnh c nguy c. Khi cn, phi theo di
sinh hc nhng ngi bnh bun nn.
Progabid
Phn tch: Cn ch hai tng tc: Tng tc dc ng hc: c th tng
chuyn ho gan do cm ng enzym, dn n gim hot tnh ca progabid; c th c
tng nng phenobarbital hoc primidon trong huyt tng.
X l: Progabid l thuc chng ng kinh dng bc hai, c vi gan. Cn tnh
n nguy c tht bi iu tr. iu chnh liu.
Quinidin hoc dn cht
Phn tch: Tng chuyn ho gan do cm ng enzym, dn n gim hot tnh
ca quinidin (v dn cht).
X l: Lu nguy c ny iu chnh liu hai thuc, nu cn phi phi hp.
Theo di k nu cn, nng trong huyt tng v vn cn ch khi ng ng iu tr.
Ch ti gim tnh to ngi li xe hoc vn hnh my.
Quinin hoc thuc tng t
ca quinin (v thuc tng t).
X l: iu chnh liu. Theo di k, nu cn, nng trong huyt tng v vn
ch khi ngng iu tr. Lu nguy c ny iu chnh liu hai thuc khi phi hp.
Tacrolimus
Phn tch: Tc dng ko di, ch thy ring vi pentobarbital khi iu tr mn tnh
bng tacrolimus, c ch cha r. C l tacrolimus c ch chuyn ho pentobarbital.
X l: Cn gim liu tacrolimus v theo di chc nng thn thng qua nh lng
creatinin mu. Theo di nng tacrolimus trong huyt tng trong v sau khi ng ng
iu tr.
Tetracosactid
95
Phn tch: Tng d ho cc corticoid tuyn thng thn bi cc thuc cm ng

enzym (barbituric).
X l: Cm ng enzym ch biu hin t 10 n 12 ngy sau khi bt u iu tr.
iu tr trong mt thi gian trung bnh hoc di ngy bng mt thuc cm ng enzym
(barbituric) phi tnh n nguy c gim tc dng iu tr ca tetracosactid. iu chnh liu
trong v sau khi ngng iu tr thuc cm ng.
Tetracyclin
Phn tch: Tng d ho ring i vi doxycyclin gan do cm ng enzym. Tuy
vy, vn cn phi thn trng i vi cc tetracyclin khc khng o thi qua ng tit
niu.
X l: Tng tc ny chm xy ra. C nguy c iu tr tht bi, nu cc nng
c ch ti thiu (MIC) ca khng sinh khng cho mt vi khun nht nh. Lu nguy
c ny v nu c th, chn mt khng sinh khc.
Phn tch: Phi hp vi mt thuc cm ng enzym. Tng tc xy ra chm sau
10 n 12 ngy, lm tng chuyn ho theophylin gan, do lm gi m hot tnh v
nng thuc trong huyt tng.
X l: Theo di lm sng. C th iu chnh liu tu thuc vo nng theophylin
trong mu, trong v sau khi ngng iu tr thuc cm ng.
Thuc an thn kinh: Clozapin; gluthetimid hoc thuc tng t; paroxetin
X l: Ch n nguy c ny iu chnh liu ca hai thuc. Ch n gi m
tnh to ngi li xe v ngi vn hnh my.
Phn tch: Gim nng trong huyt tng, c m t vi itraconazol, do
barbituric gy cm ng enzym (gim hiu lc).
X l: Nguy c tht bi iu tr, nu phi hp vi thuc gy cm ng enzym ko
di ti thiu 10 ngy. Khi , cn iu chnh liu lng v nu cn, o cc nng
itraconazol trong huyt tng.
Phn tch: Thuc chng trm cm ba vng h thp ngng gy ng kinh v do
nguy c xut hin li cc cn co git ngi bnh dng thuc chng ng kinh
ny.
X l: Lu nguy c ny v iu chnh liu lng, nu cn.
Phn tch: Cc barbituric l nhng cht gy cm ng enzym, gy tng d ho cc
thuc chng ng gan v lm gim tc dng ca cc thuc ny. Cm ng enzym
khng l mt hin tng tc thi, cho nn iu tr phi bt u t nht trc 10 ngy
khng gy nh hng n tc dng ca thuc chng ng.
96
X l: Phi lu iu ni trn iu chnh liu lng v phi theo di sinh hc

(t l chun quc t INR v t l prothrombin) thng xuyn hn, lc bt u iu tr
bng thuc chng ng, trong v khi ngng barbituric. Kim tra vic theo di u n
ny. Lu gi ng gi gic dng thuc.
Thuc khng acid ung hoc than hot
Phn tch: Thuc khng acid lm gim hp thu barbituric qua ng tiu ho, do
lm gim tc dng ca thuc phi hp.
X l: Dng hai loi thuc cch nhau t nht 1 - 2 gi. Cc thuc khng acid
thng c dng 1gi 30 pht sau ba n, v n ung l nguyn nhn tng tit dch v.
Verapamil
Phn tch: Tng thanh lc ca verapamil (khong 4 ln) v sinh kh dng b
gim khong 5 ln. Tc dng ca verapamil b gim.
X l: Tt c tu thuc mc tiu iu tr chnh v thi gian iu tr bng thuc ny
hay thuc kia. iu tr c th tht bi.
Vitamin nhm D
Phn tch: Khi iu tr di hn, cc thuc cm ng enzym ny c th lm tng
nhanh chuyn ho ca vitamin D, nh vy lm gim tc dng ca vitamin D v lm r i
lon chuyn ho calci.
X l: Phi tnh n thi gian iu tr. Cm ng enzym ch xut hin dn dn. Khi
iu tr di hn bng barbituric, phi iu chnh liu v nu cn, b sung thm vitamin
D.
Zidovudin
Phn tch: Suy rng ra t rifampicin v rifabutin, barbituric lm tng chuyn ho
zidovudin nn lm gim nng zidovudin (cm ng enzym).
X l: Nu thy gim p ng vi zidovudin, phi iu chnh liu ca zidovudin.
Phn tch: i khng tc dng. C th tng tnh gy g nhng ngi nghin
amphetamin.
X l: Tnh n tng tc dc lc ny xc nh mc tiu iu tr chnh.
Khuyn ngi bnh gp li thy thuc iu tr, nu thy iu tr khng n nh.
Carbamazepin
ca carbamazepin.
X l: Lu nguy c ny iu chnh liu hai thuc, nu cn phi phi hp. Theo
di k, nu cn, nng trong huyt thanh v lun lun cnh gic khi ngng iu tr. Ch
ti gim tnh to ngi li xe hoc vn hnh my.
Cht ch vn morphin (7)
97
hp. Ch ti gim tnh to ngi li xe hoc vn hnh my.
Citalopram
Phn tch: Tng tc dng an thn gy bun ng ca thuc c ch ti thu nhn
serotonin.
X l: Thn trng vi vic ung ru trong khi iu tr, nht l i vi ngi li xe
hoc vn hnh my.
Clonidin hoc thuc tng t
an thn gy bun ng. Tng tc dc lc. Vi liu thng thng, rilmenidin khng lm
tng tc dng c ch h thn kinh trung ng ca cc barbituric.
X l: Lu nguy c ny iu chnh liu ca hai thuc, khi cn phi phi hp.
Methadon
Phn tch: Tng tc dng c ch h thn kinh trung ng, an thn mnh gy
bun ng c hi cho ngi li xe hoc vn hnh my.
X l: Phi lu n tng tc dng an thn gy bun ng v khng nn li xe
hoc vn hnh my.
Methotrexat
Phn tch: Tng cc tc dng khng mong mun ca methotrexat, c th do tng
c ch dihydrofolat reductase.
X l: Vn cn lu nguy c ny, tuy methotrexat phn ln c iu tr ti c
s chuyn khoa.
Phenytoin
Phn tch: Ch ti thi im dng cc thuc. Nu dng phenobarbital ngay trc
phenytoin, nng phenytoin s tng trong huyt tng do cnh tranh khu chuyn
ho. Nu dng phenytoin trc phenobarbital, khng lng trc c nhng bin i
ca phenytoin.
X l: Phi ch n thi im dng thuc v tu theo trng hp, iu chnh
liu ca hai thuc khi cn phi phi hp. Ch ti gim tnh to ngi li xe ho c
vn hnh my.
Primidon hoc dn cht
X l: K n tha, do tnh cht dc l v cc ch nh ca hai thuc ny.
Primidon khi vo c th s chuyn thnh phenobarbital, nn phi hp c nguy c nhim
c phenobarbital.
98
Procarbazin; thuc c ch MAO khng chn lc

Phn tch: Thuc c ch MAO c th c ch chuyn ho barbituric gan v ko
di tc dng c ch h thn kinh trung ng. Tng tc xy ra tc th.
X l: Phi ch n tng tc dng bun ng trong v sau iu tr, c bit vi
ngi li xe hoc vn hnh my i hi tnh to.
Thuc chn beta
Phn tch: Tng d ho cc thuc chn beta o thi qua gan, do cm ng enzym
(acebutolol, alprenolol, betaxolol, labetalol, metoprolol, oxprenolol, propranolol, timolol),
nn lm gim tc dng ca cc thuc ny, khi dng barbituric ko di, t nht 3 tun.
X l: Phi thn trng vi ngi ng kinh: Nguy c mt dn tc dng ca thuc
chn beta. Theo di v nh gi thng xuyn v lm sng hiu qu iu tr (au tht
ngc hoc tng huyt p) hoc chn mt thuc chn beta khng b chuyn ho gan.
Thuc chng ng kinh: Ethosuximid;
Thuc khng histamin khng H1 an thn;
Baclofen;
Thuc an thn kinh: Benzamid; benzodiazepin; butyrophenon; carbamat hoc
thuc lin quan; phenothiazin; cc loi khc: thioxanthen;
Thuc chng trm cm: Fluoxetin; fluvoxamin; medifoxamin; Mianserin;
oxaflozan;
Thuc c ch h thn kinh trung ng khc, ngoi cc loi trn:
metaqualon;
Thuc km t bo: Interferon alpha ti t hp;
Thuc chng tng huyt p: Reserpin.
ngi li xe hoc vn hnh my. Khuyn khng ung ru v khng t dng thuc
hoc cc ch phm c ru.
Thuc gy m cc loi (ngoi barbituric v thuc gy m bay cha halogen);
ketamin
Phn tch: Nguy c tng tc dng c ch h thn kinh trung ng.
X l: Nu cn phi hp hai thuc, lu nguy c ny khi gy m v chn liu.
Khuyn ngi bnh sp c phu thut bo cho ngi gy m nhng thuc mnh
dng.
BENZAMID (dn cht)
99
Thuc an thn kinh, trong mt s c nhng c tnh

chng vn ng r rt ng tiu ho
CC THUC TRONG NHM

METOCLOPRAMID ng tim 10mg/2mL; dung dch ung git 260mg/100mL; vin
nn bao 10 mg; vin n 10mg; 20 mg
Elitan ng tim 10mg/2mL
Primperan dung dch ung git 260mg/100mL
Primperan vin nn bao 10 mg
Primperan vin n 10mg; 20 mg
Apo- Metoclop vin nn 10 mg
SULPIRID vin nn 200mg; nang 50mg; dung dch ung 5mg/mL; dung dch tim
100mg/2mL
Dogmatil vin nn 200mg
Dogmatil nang 50mg
Sulpiride nang 50mg
Dogmatil dung dch ung 5mg/mL
Dogmatil dung dch tim 100mg/2mL
Maxdotyl nang 50mg
CH KHI CH NH THUC
U t bo a crom: Cn tng huyt p do sulfirid c m t, i hi phi
kim tra sc kho nghim ngt.
Thn trng: mc 2
ng kinh: C kh nng h ngng gy ng kinh.
Cn theo di: mc 1
Thc phm - ru: Benzamid c th tng tc dng c ch h thn kinh trung
ng ca ru.
Thi k cho con b: Metoclopramid qua c sa m.
Suy tim/suy mch vnh: c bit, nguy c h huyt p trong trng hp bnh
tim mch nng.
Suy thn: V cc benzamid o thi qua thn, cn gim liu v k n thnh
tng t iu tr gin on, i vi ngi suy thn nng.
Ngi cao tui: Thn trng, v tnh nhy cm vi thuc nhng ngi bnh cao
tui (an thn, h huyt p).
100
TNG TC THUC
Amiodaron; bretylium; disopyramid; flecainid hoc thuc tng t; glycosid
tr tim; halofantrin; pentamidin; sotalol; vincamin
Phn tch: Trong nhm benzamid, sultoprid l thuc duy nht c th c nguy c.
Tt c cc thuc gim co c (lm chm nhp tim) c th lm tng nguy c ri lon nhp
tht nht l xon nh, bi cc tnh cht in sinh l cng thm vo ca sultoprid.
X l: Chng ch nh v phi cm phi hp ny.
Bepridil
Phn tch: Tng nguy c xon nh do tc dng hip ng. H kali mu, nhp tim
chm v khong QT di c t trc (ch biu hin trn in tm ) l nhng yu t c
th to thun li cho xut hin xon nh. Ch c sultoprid, thuc duy nht trong nhm
benzamid, do tnh cht ko di khong QT, c th dn n ri lon nhp tht (xo n
nh). Nguy c ny ph thuc vo liu sultoprid.
X l: Chng ch nh v khng c k n phi hp c tim nng gy t vong
ny.
Levodopa
Phn tch: Phi hp levodopa vi mt s thuc c tc dng i khng cng
dopaminergic c th dn n nhng tc dng i khng.
X l: Chng ch nh phi hp ny, tr khi tm kim mt i khng dc l, s
tm kim ny phi c thc hin ti c s chuyn khoa.
Macrolid
Phn tch: Trong nhm macrolid, hin nay ch mi bit duy nht c erythromycin
tim tnh mch c th gy xon nh vi thuc duy nht sultoprid trong nhm benzamid.
X l: Chng ch nh v khng c k n phi hp c bit gy t vong ny.
Ngay c khi dng mt mnh, erythromycin tim tnh mch cng c th dn n ri lon
nhp tim. Khng nn tim thuc t c liu, m phi truyn nh git tnh mch, lin tc
hoc phn on, thi gian cho thuc mi ln truyn ti thiu phi l 60 pht.
Phenothiazin
Phn tch: Vi mt s thuc an thn kinh dn cht ca cc phenothiazin c s
cng hp cc tc dng khng mong mun, biu hin bng nguy c cc tc dng ngoi
thp nng ln. Hn na, tng nguy c ri lon nhp tht, nht l xon nh, do hi p
ng cc tc dng in sinh l, ch c m t ring cho sultoprid.
X l: Khng nn phi hp. Thay i chin lc iu tr. Xin ni r l, trong nhm
benzamid, ch c sultoprid c th tng thm cc nguy c xut hin xon nh.
Sparfloxacin
Phn tch: Tng nguy c xon nh, i khi tin trin thnh rung tht, gy t vong.
X l: Khng nn phi hp. Hoc chn mt fluoroquinolon khc, hoc mt thuc
khc tu theo mc tiu iu tr. Nu nht thit phi phi hp, bt buc phi theo di
lm sng v in tm .
101

Phn tch: Dng ng thi cc thuc ny (nht l vi metoclopramid) c th dn
n i khng tc dng trn nhu ng rut.
X l: Nn trnh phi hp ny v nguy c iu tr tht bi
Thuc khng histamin, khng H1 khng an thn
Phn tch: Tng tc ch c m t vi astemizol, terfenadin. Tng nguy c xut
hin xon nh, i khi tin trin thnh rung tht gy t vong.
X l: Chng ch nh phi hp, nn chn mt khng histamin khng an thn
khng gy xon nh (cetirizin, loratadin).
Thuc c ch MAO typ B
Phn tch: Thuc c ch c hiu monoamin oxydase typ B ko di tc dng ca
levodopa, nn thng c phi hp vi thuc ny. Do , tng tc ging nh tng
tc ca levodopa. S phi hp levodopa vi mt s thuc c nhng tc dng i khng
X l: Chng ch nh phi hp ny, tr khi tm kim mt i khng dc l, s
tm kim ny phi c thc hin ti c s chuyn khoa.
Corticoid-khong; furosemid hoc
tetracosactid; thuc li niu thi kali
thuc
tng
t;
glucocorticoid;
Phn tch: Tng nguy c xon nh khi phi hp vi sultoprid, thuc duy nht
trong nhm benzamid. H kali mu, nhp tim chm v khong QT di c t trc (ch
thy trn in tm ) l nhng yu t thun li cho xut hin xon nh.
X l: Khng nn phi hp. Nu nht thit phi phi hp, phi thng xuyn theo
di khong QT v kim tra u n kali mu.
Dantrolen
Phn tch: Tng c ch h thn kinh trung ng, dn n tng cc tc dng an
thn bun ng. Tng tc dc lc.
X l: Lu nguy c ny iu chnh liu ca hai thuc. Ch n gim tnh
to ngi li xe hoc vn hnh my.
Phn tch: Gim tc dng h huyt p do c ch s ti thu nhn guanethidin ti
nron bi cc benzamid an thn kinh.
X l: Thay i chin lc iu tr bng cch chn mt thuc h huyt p khc.
Khng nn phi hp.
Lithi (mui)
Phn tch: Nhng tai bin c thn kinh kiu hi chng l ln c thng bo
ngi bnh dng phi hp ny.
X l: Khng nn phi hp. Thay i chin lc iu tr, tr khi ngi bnh c
s chuyn khoa.
102
Methyldopa
Phn tch: Cc thuc an thn kinh ni chung c nguy c lm gim tc dng chng
tng huyt p do chn ti thu nhn li cc sn phm chuyn ho ca methyldopa t i
cc nron adrenergic. Ngoi ra, tt c cc thuc an thn kinh cn c thm mt nguy c
lm h huyt p t th ng.
X l: Phi lu nguy c bin ng huyt p ny do cc thuc an thn kinh v
la chn cch iu tr. Nu cn phi phi hp, thng bo cho ngi bnh, ng i
bnh cn phi ung thuc u n vo gi c nh v tng cng t theo di. Nu
khng, thay i chin lc iu tr. Khuyn ngi bnh n khm li nu thy huyt p
bin ng.
Ru
Phn tch: Tng c ch h thn kinh trung ng, dn n tng gy bun ng.
Mt s thuc c th cho mt s tc dng tm thn vn ng, nht l trong tun iu tr
u tin. Tng tc dc lc.
X l: Khng nn ung ru khi iu tr thuc ny. Nguy c bun ng c bit
nguy him ngi li xe hoc vn hnh my.
Succinylcholin/metoclopramid
Phn tch: Tc dng chn thn kinh - c ca succinylcholin c th tng, gy c
ch h hp v ngng th. Tng tc xy ra nhanh. Metoclopramid c th c ch
cholinesterase huyt tng, l enzym cn cho chuyn ho ca succinylcholin.
X l: Cn thn trng khi phi hp. Gim st cht ch chc nng thn kinh c v
khi cn phi h tr h hp bng my th.
Thuc nhun trng kch thch
Phn tch: Nguy c xon nh khi phi hp (c bit vi sultoprid) .
X l: Khng nn phi hp. Dng cc thuc khng gy xon nh. Nu nht thit
phi phi hp, phi theo di thng xuyn khong QT v tin hnh kim tra u n
kali mu. Ch cc du hiu lm sng c th bo hiu h kali mu nh mt mi, y u
c, co cng c...
Carbamat hoc thuc tng t; carbamazepin; baclofen; benzodiazepin;
dextropropoxyphen; thuc chng ng kinh khng barbituric (ethosuximid); thuc
c ch h thn kinh trung ng (metaqualon, ethosuximid).
tc dc lc.
X l: Lu nguy c ny iu chnh liu ca hai thuc nu cn phi hp. Ch
n gim tnh to ngi li xe hoc vn hnh my.
Bromocriptin hoc thuc tng t
Phn tch: V c tnh cht i khng dopaminergic, nn c kh nng tng nng
prolactin v i khng tc dng ca bromocriptin.
103
X l: Tc dng i khng ny c nguy c gy nhiu n mc tiu iu tr chnh.

Cn theo di phi hp hoc thay i thuc phi hp.
Buspiron
Phn tch: Tng c ch h thn kinh trung ng dn n tng bun ng. Vi mt
s thuc c th thy mt s tc dng tm thn vn ng, nht l trong tun iu tr
u tin. Tng tc dc lc.
X l: Khng nn phi hp hai thuc, v khng th cn tr ngi bnh ung ru.
Nguy c bun ng nguy him vi ngi li xe hoc vn hnh my.
Butyrophenon; thuc an thn kinh cc loi (nhm thioxanthen); reserpin
Phn tch: Hip ng cc tc dng khng mong mun lm nng thm cc tc
dng ngoi thp.
X l: Lu nguy c ny iu chnh liu. Theo di lm sng.
Clozapin
Phn tch: Tng nguy c lm gim huyt p nhiu.
X l: Theo di huyt p v iu chnh ngay liu ca thuc thuc nhm benzamid
trong v sau khi ngng iu tr bng clozapin.
Medifoxamin; paroxetin; primidon hoc dn cht; procarbazin
Phn tch: Tng c ch h thn kinh trung ng dn n tng bun ng. Tng
tc dc lc.

Phn tch: Ngoi tng thm tc dng c ch h thn kinh trung ng, natri
valproat v cc dn cht cn lm tng nng benzamid trong huyt tng, c l do
c ch enzym v gim d ho.
X l: Nu cn phi hp, iu chnh v gim liu benzamid. Ch n gim tnh
Phn tch: V thuc khng acid lm gim hp th qua ng tiu ho, nn tc
dng ca thuc phi hp b gim.
X l: Nht thit phi ung hai thuc cch nhau t nht t 1 gi n 2 gi.
Thng ung thuc khng acid 1 gi 30 pht sau ba n, v n ung l ngun gc tng
tit dch v.
Thuc gy m cc loi
Phn tch: Tng cc tc dng c ch h thn kinh trung ng, dn n tng cc
tc dng an thn bun ng. Tng tc dc lc.
104
X l: Ngi bnh trc khi phi phu thut cn bo cho bc s gy m nhng

thuc mnh dng.
Thuc c ch ezym chuyn dng engiotensin
Phn tch: Tng cc tc dng lm h huyt p ca cc thuc c tnh cht an thn
kinh, do gy h huyt p.
X l: Nu cn phi hp, phi tng cng theo di huyt p, trong v sau khi
ngng iu tr mt trong hai thuc. Nu cn th iu chnh liu. Nhn mnh v k
hoch dng thuc v yu cu tun th. c bit ch ngi bnh cao tui.
Phn tch: i khng tc dng. C th lm tng tnh hung hn nhng ngi
nghin amphetamin.
X l: Lu tng tc dc lc ny xc nh mc tiu iu tr chnh. Khuyn
ngi bnh gp li bc s iu tr, nu thy iu tr c v khng n nh.
Barbituric; fluoxetin; fluvoxamin; thuc khng histamin khng H1 an thn; cc
thuc c ch MAO khng chn lc; oxaflozan; viloxazin
Phn tch: Tng c ch h thn kinh trung ng, dn n tng an thn bun ng.
Tng tc dc lc.
X l: Phi tnh n nguy c ny iu chnh liu ca hai thuc. Ch n
gim tnh to ngi li xe hoc vn hnh my.
Cht ch vn morphin
tc dc lc.
X l: Nu cn phi hp, phi lu nguy c ny iu chnh liu ca hai thuc.
Ch n gim tnh to ngi li xe hoc vn hnh my.
thn gy bun ng. Tng tc dc lc. Ghi ch l rilmenidin, vi liu thng thng,
khng tng c ch h thn kinh trung ng ca cc thuc .
X l: Lu nguy c ny iu chnh liu ca hai thuc, nu cn phi hp. Ch
Methadon
Phn tch: Tng c ch h thn kinh trung ng, km theo an thn mnh, c hi
c bit nhng ngi li xe v ngi vn hnh my.
X l: Lu n tng tc dng an thn ny cho nhng li khuyn thch hp
(trnh li xe hoc vn hnh my).
105
Metoclopramid
Phn tch: Nng trong huyt thanh ca mefloquin c th tng lm tng kh
nng gy c cho tim mch, ng tiu ho v h thn kinh trung ng. Tng tc xy
ra nhanh. C th do d dy tng co bp lm tng nhanh hp thu mefloquin rut non.
X l: Cn theo di s tng c tnh ca mefloquin khi phi hp vi
metoclopramid. Nu nghi c tng tc xy ra, cn gim liu mefloquin.
Thuc chng trm cm ba vng hoc tng t
Phn tch: Tng c ch h thn kinh trung ng, c ch h hp v h huyt p.
Hn na, nu b ph thuc thuc, phi hp hai thuc c th li cng tng thm nguy
c ph thuc thuc.
X l: Lu nguy c ny iu chnh liu hai thuc nu cn phi hp. Ch
Thuc gy m barbituric
thn. Tng tc dc lc.
X l: Lu nguy c tng c ch h hp khi gy m.
BENZIMIDAZOL (dn cht)

Cc dn cht benzimidazol c hot tnh trn giun kim, giun a, giun mc,
giun tc v mc t hn trn giun ln
CC THUC TRONG NHM

FLUBENDAZOL vin nn 100 mg
Fluvermal vin nn 100 mg
Vermiflu vin nn 100 mg
MEBENDAZOL vin nn 100 mg; 500 mg; hn dch ung 50 mg/mL
Benda 500 vin nn 500 mg
Fugacar vin nn 500 mg
Fugacar choco hn dch ung 50 mg/mL
Helmintol vin nn 100 mg
Mebendazol vin nn 500 mg
ALBENDAZOL vin nn 200 mg; 400 mg
Al - 400 vin nn 400 mg
Albendazol vin nn 400 mg
106
Miten 400 vin nn 400 mg

Sudo-Albendazole vin nn 400 mg
Ten 400 vin nn 400 mg
Zentel vin nn 200 mg
CH KHI CH NH THUC
Thi k mang thai: V thn trng, trong ba thng u ca thai k: tnh v hi
ngi mang thai cha c xc nh. Kh nng sinh qui thai ng vt c
chng minh.
BENZODIAZEPIN (dn cht)

Thuc an thn, tnh cht gy ng, gii lo, c nh hng ti tr nh, gin c v
chng
co git cc mc khc nhau. Thuc gii c ca nhm thuc ny l flumazenil.
CC THUC TRONG NHM
BROMAZEPAM vin nn 1 mg; 3 mg; 6 mg
Lenitin vin nn 1 mg; 3 mg; 6 mg
Lexomil vin nn 6 mg
DIAZEPAM: vin nn 2 mg, 5 mg, 10 mg; siro 2 mg/5mL; thuc n 5 mg, 10 mg;
ng tim 10 mg/ 2 mL
Seduxen vin nn 5mg; ng tim 10mg/2ml
Valium vin nn 2 mg; 5 mg; 10 mg
Valium thuc tim 10 mg
CH KHI CH NH THUC
Thi k cho con b: Thuc qua c sa m, gy nguy c suy h hp cp v
tc dng an thn, gy ng tr s sinh. Clordiazepoxyd tng tit sa.
Trm cm: Nguy c che lp cc du hiu ca bnh m khng cha c bnh.
Thi k mang thai: Nghi gy qui thai khe vm ming, st mi, i vi
clordiazepoxyd, diazepam, nitrazepam. Nguy c hi chng thm nhim tr s sinh i
vi diazepam khi dng ko di (ri lon gic ng, vt v, c ch h hp v h nhit).
Suy h hp; hen: Benzodiazepin lm suy gim h hp do tc ng ln h thn
kinh trung ng.
Thn trng: mc 2
107
n ung - ru: Tng tc dng an thn bun ng ca cc benzodiazepin (bun

ng, v cm, cc phn x chm li).
Cn theo di: mc 1
Suy gan: Suy gan lm chm s ging ho v o thi benzodiazepin v lm tng
c tnh ca chng.
Suy thn: Suy thn lm chm s o thi ca benzodiazepin v lm tng c
tnh ca chng.
Nhc c: Benzodiazepin lm gin c.
TNG TC THUC
Indinavir
Phn tch: Indinavir c i lc mnh vi isoenzym 3A4 ca cc cytochrom P450, dn
n gim chuyn ho benzodiazepin, l thuc c chuyn ho ch yu bng
isoenzym , (hin tng cnh tranh) v do tng nng trong huyt tng v c
tnh. Nguy c an thn ko di v c ch h hp su (c m t vi midazolam,
triazolam, alprazolam). Tng tc dc ng hc v chuyn ho thuc.
X l: Khng k n phi hp ny. Cn thay th thuc.
Nelfinavir
Phn tch: Nelfinavir c i lc mnh vi isoenzym 3A4 ca cc cytochrom P450, dn
isoenzym (hin tng cnh tranh) v do tng nng trong huyt tng v tng
c tnh. Nguy c an thn ko di v c ch h hp su (c m t vi midazolam,
triazolam, alprazolam). Tng tc dc ng hc v chuyn ho thuc.
Ritonavir
Phn tch: Ritonavir c i lc mnh vi isoenzym 3A4 ca cc cytochrom P450, dn
cytochrom P450 (hin tng cnh tranh) v do tng nng trong huyt tng v
nguy c tng c tnh. Nguy c an thn ko di v c ch h hp su (c m t vi
alprazolam, dikali clorazepat, diazepam). Tng tc dc ng hc v chuyn ho
thuc.
X l: Khng k n phi hp ny. Ngh n thay th thuc.
Buspiron; butyrophenon; carbamat hoc thuc tng t; carbamazepin;
dantrolen; glutethimid hoc thuc tng t; interferon alpha ti t hp;
medifoxamin; paroxetin; phenothiazin; primidon hoc dn cht; procarbazin;
thuc an thn kinh cc loi; thuc c ch h thn kinh trung ng cc loi
Phn tch: Tng c ch thn kinh trung ng, dn n tng tc dng an thn
bun ng. Tng tc dc lc.
108

to ngi li xe hoc vn hnh my. Khuyn khng ung ru v khng t dng
thuc hoc ch phm c ru.
Dextropropoxyphen
Phn tch: Tng c ch thn kinh trung ng, dn n tng tc dng an thn
K n: Lu nguy c ny iu chnh liu hai thuc, nu cn phi phi hp.
Ch n gim tnh to ngi li xe hoc vn hnh my. Khuyn khng ung ru,
v khng t dng thuc hoc ch phm c ru.
Macrolid
Phn tch: Ch c triazolam v midazolam l tng tc dng khi phi hp vi
erythromycin, roxythromycin hoc clarithromycin (c ch enzym).
X l: Khi phi hp vi midazolam cn phi lu n tc dng ph hoc phi
iu chnh liu: cn i vi triazolam, khng nn phi hp (ri lon ng x c
thng bo trong y vn).
Rifamycin
Phn tch: Khi phi hp cc rifamycin (l cht gy cm ng enzym) vi
benzodiazepin, s oxy ho cc benzodiazepin thng qua cytochrom P 450 tng ln, lm
cho tc dng dc l ca cc thuc ny gim.
X l: Theo di p ng trn lm sng vi cc benzodiazepin khi bt u dng v
khi ngng dng rifamycin. Hiu chnh liu khi cn. Nu iu kin cho php, c th dng
temazepam (Restoril) l loi benzodiazepin khng b cytochrom P450 oxy ho, do
khng c tng tc vi rifamycin.
Ru
thn bun ng. Mt s thuc, c th thy gy mt s tc dng tm thn vn ng,
nht l trong tun iu tr u tin. Tng tc dc lc.
X l: Khng k n thuc ny, v khng th ngn cn ngi bnh khng ung
ru. Nguy c an thn bun ng c bit nguy him ngi li xe hoc vn hnh
my. Khuyn ngi bnh khng ung ru, khng t dng thuc hoc cc ch phm
c ru.
Baclofen; thuc chng ng kinh khng barbituric (Ethosuximid)
Phn tch: Tng tc dng c ch thn kinh trung ng dn n tng tc dng an
thn gy ng. Tng tc dc lc.
ngi li xe hoc vn hnh my. Khuyn khng ung ru v khng t dng thuc
hoc cc ch phm c ru.
Benzamid
109
Phn tch: Tng tc dng c ch thn kinh trung ng, dn n tng tc dng an
Ch ti gim tnh to ngi li xe hoc vn hnh my. Khuyn khng ung ru v
khng t dng thuc hoc cc ch phm c ru.
Phn tch: Hip ng tc dng c ch h thn kinh trung ng. Thn trng khi
iu tr ngoi tr, vi ngi li xe v ngi vn hnh my. Cn nh rng rilmenidin, vi
liu thng thng, khng lm tng tc dng c ch h thn kinh trung ng ca
benzodiazepin.
Ch ti gim tnh to ngi li xe hoc vn hnh my. Khuyn khng ung ru v
Estrogen hoc thuc nga thai estroprogestogen
Phn tch: Cc estrogen c th c ch cc enzym tham gia vo qu trnh oxy ho
cc benzodiazepin gan (clorazepat, flurazepam, triazolam), cn i vi cc
benzodiazepin lin kt vi acid glycuronic th iu ny cn tranh ci. Nguy c tng tc
dng ca cc benzodiazepin dng thi gian di.
X l: V na i ca cc benzodiazepin c th ko di, gim liu cc ph n
dng thuc nga thai di hn. Thn trng vi ph n li xe v ph n cn lun lun
tnh to.
Flumazenil
Phn tch: i khng dc l hc tc ng trn cng cc th th v c s
dng trong iu tr.
X l: Ch yu c cc bc s chuyn khoa gy m v cc n v chm sc tch
cc s dng iu tr qu liu hoc lm ngng ng li b hoc ng ng m. Ch c
bc s thc hnh c kinh nghim mi c cho thuc.
Lansoprazol
Phn tch: Tng tc dc ng hc: Cn thn trng vi cc thuc c chuyn
ho bi cc cytochrom P450, c th l lansoprazol, v c nguy c gim hot tnh cc
thuc , do cm ng enzym, c th dn n tht bi trong iu tr.
X l: Lansoprazol l thuc tng i mi v cc nhn xt lm sng cn thiu.
y l cc tng tc c th c v khuyn nn gi cc nhn xt lm sng cho cc Trung
tm cnh gic dc. t li nguy c trong bi cnh iu tr. Thng bo cho ngi bnh,
iu chnh liu tu thuc vo cc xt nghim sinh ho khi bt u v kt thc iu tr
bng lansoprazol.
Levodopa
Phn tch: Tc dng iu tr ca levodopa c th b gim, thm ch mt, mt s
ngi bnh khi dng cc benzodiazepin nh clordiazepoxyd, diazepam v nitrazepam.
110
X l: Cn theo di tng tc ny, c xc nh vi cc thuc k trn,

iu tr tt bnh Parkinson. Vi cc benzodiazepin khc, cn cnh gic v thng bo
cho Trung tm cnh gic dc nhng tht bi iu tr trong trng hp phi hp.
Nilutamid
Phn tch: C l v cc tnh cht c ch enzym ca nilutamid, c nguy c ko di
v tng cc tc dng ca mt s benzodiazepin c th b chuyn ho.
X l: Vi mt s benzodiazepin nh diazepam, alprazolam, dikali clorazepat,
flurazepam, nitrazepam, triazolam hoc clordiazepoxyd th nguy c ng g tng. Hoc
chn mt benzodiazepin khng b chuyn ho, hoc iu chnh liu cc benzodiazepin,
lc bt u, trong v sau khi iu tr.
Omeprazol
Phn tch: c ch mt s cytochrom P450 c th dn n chm tr trong chuyn
ho mt s thuc, tng nng ca chng trong huyt thanh v trong trng hp ny,
tng nhng tc dng khng mong mun do qu liu.
X l: Tng tc ch c th xy ra vi cc benzodiazepin chuyn ho kiu
clordiazepoxyd, diazepam, flurazepam, triazolam..., bng cch chn chuyn ho ca
chng, cc tc dng an thn, gii lo tng ln. Hoc gim liu hoc i thuc c ch
bm proton khc cho nhng ngi bnh ny.
Phenytoin
Phn tch: C th c nguy c tng hoc gim nng phenytoin trong huyt
thanh khng d on c.
X l: Theo di ngi bnh v mt lm sng v theo di v sinh hc nng
phenytoin.
Tacrolimus
Phn tch: Tng nng tacrolimus trong huyt tng, c quan st in vitro ch
ring vi midazolam. Tng tc dc ng hc v chuyn ho thuc.
X l: Nn gim liu tacrolimus v theo di chc nng thn thng qua nh lng
creatinin trong mu. Theo di nng tacrolimus trong huyt tng trong khi iu tr v
khi ngng iu tr.
Thuc chng lot khng H2 kiu cimetidin
Phn tch: Cimetidin l mt cht c ch cc enzym oxydase gan (cytochrom P450)
cn cho chuyn ho mt s thuc. Hn na, cimetidin lm gim lu lng mu gan.
Nh vy, nng trong huyt tng ca mt s benzodiazepin s tng (nguy c qu
liu), nhng cng bng cch c ch mt s bin i sinh hc, cimetidin chn cc c ch
kh c. Cimetidin c ch cc oxydase gan chu trch nhim v chuyn ho cc
benzodiazepin, nn tc dng dc l ca chng tng. iu ny khng c m t vi cc
benzodiazepin lin kt vi acid glycuronic: lorazepam, oxazepam, temazepam.
flurazepam, nitrazepam, triazolam hoc clordiazepoxyd, tng nguy c ng g khi phi
hp vi cimetidin. Hoc thay i thuc chng lot, hoc iu chnh liu cc
benzodiazepin lc bt u, trong khi v sau khi iu tr. Bo cho ngi bnh v nhng
nguy c ng g, khuyn h c bit cnh gic khi li xe v/hoc vn hnh my.
111

Phn tch: C th gim thanh lc ca clordiazepoxid v cc benzodiazepin c
th chuyn ho nh midazolam v triazolam, c bit khi phi hp vi ketoconazol v
itraconazol.
X l: Cn theo di khi phi hp, c bit vi ketoconazol l thuc chng nm
c vi gan nht. Phi ch n nguy c gia tng an thn bun ng. Chuyn nhng
nhn xt, nu c, ti Trung tm cnh gic dc.
Thuc gy m khng barbituric; thuc gy m bay hi cha halogen
Phn tch: Tng c ch h thn kinh trung ng, dn n tng tc dng an thn
X l: Khuyn ngi bnh sp phu thut, bo cho thy thuc gy m bit nhng
thuc ang dng.
Zidovudin
Phn tch: c ch cnh tranh qu trnh lin kt zidovudin vi acid glycuronic v
gim thanh lc ca n, nht l vi cc benzodiazepin lin kt v i acid glycuronic
(lorazepam, oxazepam, temazepam). Nguy c tng c tnh ca zidovudin.
X l: S phi hp cn c theo di v mt lm sng; nu c th, trnh phi
hp, trong trng hp tng c tnh ca zidovudin; hoc chn dng mt benzodiazepin
chuyn ho.
Phn tch: i khng tc dng. C th tng tnh hung hn nhng ngi nghin
amphetamin.
ngi bnh nn gp li bc s iu tr, nu thy iu tr khng n nh.
Barbituric; clozapin; fluoxetin; fluvoxamin; metyldopa; mianserin; oxaflozan;
thuc chng trm cm ba vng hoc thuc tng t; thuc khng
histamin khng H1, an thn; viloxazin
Phn tch: Tng c ch thn kinh trung ng, dn n tng tc dng an thn.
Tng tc dc lc.
K n: Lu nguy c ny iu chnh liu ca hai thuc, khi cn phi hp.
Ngh ti gim tnh to ngi li xe hoc vn hnh my. Khuyn khng ung ru v
Thuc gy m nhm barbituric
Phn tch: Nguy c tng tc dng c ch thn kinh trung ng.
X l: Nu cn phi hp hai thuc, lu nguy c ny khi gy m v chn liu.
Cht ch vn morphin
an thn. Tng tc dc lc.
112
X l: Lu nguy c ny iu chnh liu hai thuc, khi cn phi phi hp.

Ngh ti gim tnh to ngi li xe v ngi vn hnh my. Khuyn khng ung ru
v khng t dng thuc hoc cc ch phm c ru.
Cisaprid
Phn tch: Tng vn tc hp thu, c m t duy nht vi diazepam, do c
nguy c tng tnh cht an thn.
X l: Khuyn khng nn dng diazepam trong thi gian iu tr bng cisaprid,
nht l i vi nhng ngi vn hnh my v li xe (gim tnh to). Cn thn vi cc
bit dc c mch hoc t dng thuc c th cha ru: tc dng cn tng thm.
Citalopram
Phn tch: Tng cc tc dng an thn ca cht c ch ti thu nhn serotonin.
X l: Thn trng khi ng thi ung ru, nht l vi ngi li xe v ngi vn
hnh my.
Cura cc loi
Phn tch: Mt s nghin cu cho thy diazepam v cc benzodiazepin khc c
th tng tc dng ca cc loi cura. Mt s nghin cu khc li thy c th phi hp
m khng tng tc dng .
X l: S phi hp phi thc hin ti c s chuyn khoa. Ngi bnh cn cho
bc s gy m bit nhng thuc mnh dng, c bit benzodiazepin. Bc s gy m
nn theo di phi hp thuc ny v cc nghin cu khng cho kt lun thng nht.
Methadon
Phn tch: Tng tc dng c ch h thn kinh trung ng, km theo an thn bun
ng mnh, c bit c hi vi nhng ngi li xe v vn hnh my.
K n: Phi lu s tng tc dng an thn ny v cho nhng li khuyn thch
hp (trnh li xe hoc vn hnh my; thng bo cho ngi xung quanh bi t mi nguy
him).
Saquinavir
Phn tch: Do cnh tranh khu cc cytochrom P450, saquinavir c th lm gim
s chuyn ho ca benzodiazepin vi hu qu l tng nng trong huyt tng v
tng c tnh ( c m t vi triazolam v midazolam).
X l: Theo di ngi bnh cht ch pht hin cc tc dng c.
BENZOFURAN (dn cht)

Thuc cha bnh gt, to thun li thi tr acid uric
113
CC THUC TRONG NHM

BENZBROMARON vin nn (25 mg benzbromaron; 100 mg alopurinol); vin nn 100
mg
Desatura vin nn (25 mg benzbromaron; 100 mg alopurinol)
Desuric vin nn 100 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Bnh gt: Bnh gt th pht sau cc bnh mu.
Si thn: V tnh cht gy acid uric niu ca cc thuc ny.
Thn trng: mc 2
Cng gip: Khi dng benziodaron, mt thuc cha iod, nhng trng hp gim
nng v cng gip hi phc khi ngng thuc c thng bo.
Suy thn: V cc benzofuran gy acid uric niu, nn chng ch nh dng trong
trng hp suy thn nng.
TNG TC THUC
Salicylat
Phn tch: Gim cc tc dng gy acid uric niu ca hai thuc dng ng thi.
Hnh nh c s cnh tranh v o thi acid uric thn. Khng nhng c nguy c tht
bi trong iu tr m cn nguy c bnh cnh nng thm.
X l: Nn dng mt thuc gim au chng vim khc thay dn cht salicylat.
Phn tch: Tng tc dc ng hc: vi liu mnh, tng hm lng cc khng
vitamin K, do gim d ho gan.
X l: iu chnh liu lc bt u, trong v sau khi iu tr bng thuc cha gt.
Theo di k t l chun ha quc t (INR) v/ hoc t l prothrombin.
BENZOYL PEROXYD
Thuc c tc dng khng khun mnh v tc dng tiu lp sng
Vi nng thp (t 2,5 n 10%), ch phm c dng cha bnh trng
c. Vi cc nng mnh hn (20%), ch phm c dng cha cc lot gin tnh
mch v gip to m ht.
114
CC THUC TRONG NHM

BENZOYL PEROXYD gel bi da 2,5%; 5%; 10%
Acnecide gel bi da 5 v 10%
Eclaran 5 gel bi da 5%
Oxy 10 gel bi da 10%
Oxy 5 gel bi da 5%
Panoxyl gel bi da 2,5%; 5%; 10%
CH KHI CH NH THUC
Khng dung np cc peroxyd.
BENZYL BENZOAT
Thuc dit ve, dng dit con gh, m , rn
CC THUC TRONG NHM

BENZYL BENZOAT nh dch dng ngoi 25%
Benzyl benzoat nh dch dng ngoi 25%
CH KHI CH NH THUC
Cn theo di: mc 1
Trng hp khc: Trnh dng thuc ny trn da c tn thng (tng nguy c tc
dng ton thn), c.
BEPRIDIL
Thuc chng au tht ngc, chn knh calci, c tnh cht chng lon nhp tim
(nhm I theo phn loi Vaughan-Williams: cht n nh mng).
Bepridil c th gy xon nh
CC THUC TRONG NHM
BEPRIDIL vin nn 100 mg
Cordium vin nn 100 mg
115
CH KHI CH NH THUC
Thi k cho con b: Khng nn dng thuc cho ph n ang thi k cho con b.
Thi k mang thai: Khng nn dng thuc cho ngi mang thai.
Suy tim: Bepridil gim hot ng ca tim v gim tiu th oxy ca c tim do chn
calci vo t bo tim, vi nguy c tru tim hoc suy tm tht tri, ngi suy tim khng
b tr.
Thn trng: mc 2
Blc nh tht.
Cn theo di: mc 1
Ngi cao tui: Gim liu i vi ngi bnh cao tui v tc dng c ch c tim
ca thuc chng au tht ngc ny v trnh phi hp vi cc thuc lm chm nhp tim
khc.
TNG TC THUC
Amiodaron; bretylium; disopyramid; quinidin hoc dn cht; vincamin
Phn tch: Tng nguy c xon nh do tc dng hip ng, nht l khi c cc yu
t thun li nh h kali mu, nhp tim chm v khong QT di c t trc (ch biu hin
trn in tm ). Xon nh l mt kiu nhp tht c bit, c th xut hin tng cn
rt ngn (vi giy, mt thu, cm gic ngt m khng mt tri gic).
X l: Chng ch nh v khng c k n phi hp v c tim nng gy t
vong.
Benzamid
Phn tch: Tng nguy c xon nh do tc dng hip ng, nht l khi c cc yu
t thun li nh h kali mu, nhp tim chm v mt khong QT di c t trc (ch thy
trn in tm ). Ch , sultoprid l thuc duy nht trong nhm benzamid, do tnh cht
in sinh l c bit, c th him gy ri lon nhp tim, trong c xon nh. Lo n
nhp tim (xon nh) xut hin tu thuc vo liu.
X l: Chng ch nh v khng c k n phi hp, v c tim nng gy t
vong.
Dantrolen
Phn tch: Rung tht gy t vong, lun lun quan st c ng vt. V thn
trng, chng ch nh phi hp, ngay c khi mt s ngi, phi hp khng thy gy
tr ngi.
X l: Khng phi hp nu khng c mi phng tin theo di v can thip tc th
(c s hi sc)
Khng histamin khng H1 khng an thn
Phn tch: Tng tc ch c m t vi astemizol, khng histamin H 1 c coi l
khng an thn: tng nguy c xut hin xon nh.
116
X l: V chng ch nh phi hp, chn mt thuc khng histamin khng an thn

khc khng gy xon nh (cetirizin, loratadin).
Macrolid
Phn tch: Trong nhm macrolid, (theo hiu bit hin nay ca chng ta) ch duy
nht c erythromycin tim tnh mch c th d gy xon nh (ko di khong QT,
ngoi tm thu tht, xon nh, blc nh tht), nht l khi c h kali mu, nhp tim chm
v khong QT di c t trc (ch thy trn in tm ). Xon nh l mt kiu nhp
tht c bit, c th xut hin tng cn rt ngn (vi giy, mt thu, cm gic ng t m
khng mt tri gic).
X l: Chng ch nh v khng c k n phi hp c bit gy t vong ny.
Ngay c khi dng mt mnh, erythromycin tim tnh mch cng c th dn n ri lon
nhp tim. Khuyn khng nn tim thuc nhanh c liu, m phi truyn nh git tnh
mch lin tc hoc gin on, thi gian cho thuc mi ln truyn ti thiu phi l 60
pht.
Ritonavir
Phn tch: V ritonavir c i lc mnh vi isoenzym 3A 4 ca cc cytochrom P450,
nn lm gim, do tnh cht cnh tranh, chuyn ho ca bepridil, mt thuc c
chuyn ho mnh bi cc cytochrom P450. Do , nng bepridil trong huyt tng
tng v c nguy c tng c tnh. Nguy c c vi tim: khong QT ko di v xut hin
xon nh. Tng tc dc ng hc v chuyn ho thuc.
X l: Khng k n phi hp ny. Tm cch thay th thuc.
Sparfloxacin
Phn tch: Tng nguy c xon nh. Xon nh l mt kiu nhp tht c bit, c
th xut hin tng cn rt ngn (vi giy, mt thu, cm gic ng t m khng m t
thc), i khi tin trin thnh rung tht, gy t vong.
X l: Khng nn phi hp thuc. Nn chn mt fluoroquinolon khc, hoc mt
thuc khc, tu theo mc tiu iu tr. Nu nht thit phi phi hp, bt buc phi theo
di lm sng v in tm .
Verapamil
Phn tch: V nguy c xon nh do bepridil, nn trnh phi hp vi mt thu c
chng lon nhp lm chm nhp tim.
X l: Trnh phi hp ny, tr khi c theo di thng xuyn (c s hi sc).
Phi hp cc thuc chng lon nhp tim vi nhau ni chung rt kh, i hi tng cng
theo di lm sng v in tm , nhng ring bepridil th cn trnh.
Amphotericin B
Phn tch: Nguy c xon nh khi phi hp vi amphotericin B tim, nht l khi c
h kali mu, nhp tim chm v khong QT di t trc (ch thy trn in tm ). Xon
nh l mt kiu nhp tht c bit, c th xut hin tng cn rt ng n (vi giy, mt
thu, cm gic ngt m khng mt tri gic).
117
X l: Khng nn phi hp. Dng nhng thuc khng gy xon nh. Nu nht
thit phi phi hp, phi sn c phng tin theo di thng xuyn (monitoring)
khong QT v tin hnh kim tra thng xuyn kali mu. Ch cc du hiu lm sng
c th bo hiu h kali mu, nh mt mi, yu c, chut rt...
Glucocorticoid; halofantrin; corticoid-khong; pentamidin; tetracosactid; thuc
nhun trng kch thch.
Phn tch: Nguy c xut hin xon nh khi phi hp. H kali mu, nhp tim chm
v mt khong QT di c t trc (ch thy trn in tm ) l nhng yu t c th
to thun li cho xon nh xut hin.
Phn tch: Nguy c xut hin xon nh khi phi hp hai thuc. H kali mu, nhp
tim chm v khong QT di c t trc (ch thy trn in tm ) l nhng yu t
thun li cho xon nh xut hin.
Thuc nhun trng lm trn
Phn tch: S dng ko di thuc nhun trng lm trn (cng nh tiu chy nng)
c th gy h kali mu.
X l: Nu cn phi phi hp thuc nhun trng lm trn vi thuc ny, phi d
phng h kali mu bng cch b sung kali v, tu theo lm sng, theo di in tm
(nguy c h kali mu t hn so vi cc thuc nhun trng kch thch). Khuyn ng i
bnh t b sung kali (n nhiu chui, mn...). Cn nh h kali mu biu hin qua triu
chng mt mi, yu c, thm ch chut rt. Nu cc triu chng xut hin, khuyn
ngi bnh gp li bc s iu tr.
Calci
Phn tch: C th dng phi hp iu tr qu liu thuc chn calci v ngc
li. Tc dng dc l c c ch yu bng calci tim tnh mch, nh vy calci tim
tnh mch lm gim tc dng thuc chn calci. Calci ung khng c tng tc ny.
X l: Phi hp ny c dng iu tr h huyt p v nhp tim chm do
bepridil gy ra. C th dng phi hp ny iu tr qu liu thuc chn calci, hoc
rung tht do calci gluconat gy nn.
Clozapin
118
X l: Theo di huyt p ng mch v iu chnh liu ca bipridil trong v sau

khi ngng iu tr bng clozapin. Thn trng c bit khi s dng ngi bnh cao
tui.
Dextropropoxyphen
Phn tch: Tc dng h huyt p nh ca dextropropoxyphen, cng nh cc
thuc h huyt p khc lm tng thm tc dng h huyt p v tng thm nguy c h
huyt p t th ng.
X l: Cn theo di huyt p trong khi phi hp hai thuc (trong khi iu tr v sau
khi ngng mt trong hai thuc). Tu theo thuc dng, h huyt p c th nng ho c
nh. Nu cn, iu chnh liu mt hoc hai thuc. Lp mt k hoch ung thuc u
dn. Khuyn ngi bnh, nu thy chng mt khi bt u iu tr, nn gp li bc s
iu tr iu chnh liu mt hoc c hai thuc, nu cn. Tng cng theo di
ngi bnh cao tui (nguy c ng) v khuyn h chuyn dn dn t t th nm hoc
ngi sang t th ng.
Glycosid tr tim
Phn tch: Ri lon tnh t ng ca tm tht, khi phi hp hai thuc lm chm
nhp tim (nguy c nhp tim chm qu mc) Ri lon dn truyn xoang- tht, c th dn
n suy tim.
X l: Phi hp phi c qun l ti c s chuyn khoa, theo di ngi bnh
lin tc, ch yu khi bt u iu tr.
Thuc chn alpha
Phn tch: Phi hp hai tc dng dc l chng tng huyt p khi thuc , c th
dn n nguy c h huyt p quan trng ngi bnh.
X l: C th phi hp hai thuc chng tng huyt p khi thuc kia cha tc
dng. Thng bo cho ngi bnh v nguy c h huyt p v ngh mt k hoch
ung thuc c tri u trong ngy, c tnh n tnh cht dc l ca cc thuc.
Khuyn ngi bnh t theo di huyt p u n khi dng thm thuc th hai v khi
ngng mt trong hai thuc.
Thuc chn beta
Phn tch: V cc thuc ny c tc dng gim co si c tim r rt (k c dng
thuc nh mt vi thuc chn beta), c nguy c nhp tim chm qu mc, ngng xoang
tim, ri lon dn truyn xoang v nh - tht v suy tim.
X l: Ch c th k n phi hp c, nu theo di in tm thng xuyn,
c bit ngi bnh cao tui v khi bt u iu tr. Thn trng khi ngng hai li u
php i vi ngi b au tht ngc.
Nitrat chng co tht mch vnh; nicorandil
Phn tch: Phi hp vi bt c thuc no c tc dng chng tng huyt p c th
lm tng nguy c h huyt p i khi c th dn ti chong.
X l: Theo di huyt p trong khi iu tr v sau khi ngng mt trong hai thuc.
c bit thn trng khi dng ngi bnh cao tui.
Thuc ch vn morphin
119
ng.
Phn tch: Tng tc dng h huyt p v tng thm nguy c h huyt p t th
X l: Theo di huyt p trong khi phi hp hai thuc. Tu theo thuc dng, h
huyt p c th nng hoc nh. Nu cn, iu chnh liu mt hoc hai thuc. Lp mt
k hoch ung thuc u n. Khuyn ngi bnh nu thy chng mt khi bt u
iu tr, nn gp li bc s iu tr iu chnh liu mt hoc c hai thuc. Tng
cng theo di vi ngi cao tui (nguy c ng) v khuyn h chuyn dn d n t t
th nm hoc ngi sang t th ng.
Phn tch: C th c ri lon dn truyn nh - tht, nht l vi halothan v ethran.
X l: Khuyn ngi bnh sp c phu thut bo cho thy thuc gy m bit
v nhng thuc mnh dng.
Phn tch: Dng ng thi thuc chng tng huyt p hoc thuc c th gy h
huyt p vi cc thuc gy m nhm barbituric c th gy h huyt p nng.
X l: Khuyn ngi bnh, phi qua phu thut, bo cho thy thuc gy m bit
cc thuc ang dng.
Thuc gin mch chng tng huyt p
Phn tch: Tng tc dng chng tng huyt p.
X l: Cn phi iu chnh liu. Lp mt k hoch ung thuc v khuyn ngi
bnh tun th. Khi bt u iu tr, khuyn ngi bnh theo di huyt p u n cho
ti khi t mt s cn bng iu tr.
Thuc nhun trng nhy v thm thu
Phn tch: H kali mu, nhp tim chm v mt khong QT di c t trc (ch thy
trn in tm ) l nhng yu t c th to thun li cho xon nh xut hin.
X l: Nu nht thit phi phi hp, phi sn c phng tin theo di thng
xuyn (monitoring) khong QT v tin hnh kim tra thng xuyn kali mu. Ch n
du hiu lm sng c th bo hiu h kali mu, nh mt mi, yu c, chut rt...
120
BETAHISTIN HOC THUC TNG T

Thuc hot ng khu tun hon m o, c tnh cht chng chng mt.
Thuc tng t histamin (betahistin)
CC THUC TRONG NHM

BETAHISTIN
Merislon vin nn 6mg
ACETYL - LEUCIN vin nn 500 mg; ng tim 500 mg/5mL
Tanganil vin nn 500 mg; ng tim 500 mg/5mL
CH KHI CH NH THUC
Cn theo di: mc 1
Thi k mang thai: Khuyn khng nn dng betahistin vi ngi mang thai, v
thn trng khi cha c d liu.
Lot d dy-t trng; vim d dy: Betahistin c kh nng gy cn au d dy.
Trng hp khc: U t bo a crom (do betahistin)
BIGUANID
Thuc chng tiu ng. C ch tc dng ch yu do glucose c s dng
tt hn t bo. Thuc khng tc dng trn s tit insulin
CC THUC TRONG NHM

BUFORMIN vin nn 50 mg
Silubin vin nn 50 mg
METFORMIN vin nn 250mg; 270mg; 500mg; 850mg; vin nn bao phim 500mg;
850mg
Diafase vin nn 500mg
Glucofine vin nn bao 500 mg; 850mg
Metformin vin nn 250 mg
Metformin vin nn bao phim 500 mg
Meglucon vin nn bao phim 850 mg
Metforal vin nn 270 mg; 850 mg
121
Siofor vin nn 500mg v 850mg

Glucophage vin nn 500 mg
CH KHI CH NH THUC
Thi k mang thai: Sinh qui thai sc vt; khng c dng biguanid cho
ngi mang thai.
Suy tim: Suy tim to thun li cho tng acid lactic mu, dn n gim oxy m.
Suy thn: Nguy c tch lu, c th dn n nhim acid lactic, l bin chng ch
yu v nng nht ca biguanid. Cc biu hin tin triu (co cng c, au n cc chi,
au ngc, lit c nh) n trc nhim acid (hn m, tru tim, st cao) nhi u ngy,
thng l t vong.
Suy h hp, hen: Suy h hp to thun li tng acid lactic mu, dn n gim
oxy m.
Thn trng: mc 2
Suy gan: Nguy c tch lu c th dn n nhim acid lactic, l mt bin chng
ch yu v nng nht ca biguanid. Cc biu hin tin triu (co cng c au n cc
chi, au ngc, lit c nh) n trc nhim acid (hn m, tru tim, st cao) nhiu ngy,
thng l t vong.
Cn theo di: mc 1
n ung-ru: Ngoi tc dng gy tng glucose mu, ru to thun li cho
nguy c nhim acid lactic do biguanid.
TNG TC THUC
Danazol
Phn tch: Tng glucose mu v tng khng insulin.
X l: Khi phi hp thuc, phi theo di cht ch glucose mu, khuyn ngi
bnh tng cng t gim st v, tu theo trng hp, iu chnh liu lng cho thch
hp lc bt u, khi ang v khi ngng iu tr danazol.
Diazoxyd
Phn tch: Diazoxyd l thuc chng tng huyt p khn cp, dng tim tnh mch
(gin ng mch nh v gim sc cn ngoi vi). Thuc gy tng glucose mu v c
dng iu tr mt s trng hp h glucose mu. i khng dc l vi iu ho
glucose mu. C th phi hp hiu chnh qu liu diazoxyd.
X l: Dng thuc tu theo mc tiu iu tr. C th phi hp hiu chnh qu
liu diazoxyd. Diazoxyd c dng ch yu trong bnh vin lm thuc chng tng
huyt p khn cp (Hyperstat) hoc hiu chnh mt s trng hp h glucose mu
(Proglicem).
Glucocorticoid; tetracosactid
122
Phn tch: Gim tc dng ca cc biguanid do corticoid c tnh cht gy tng

glucose mu gin tip. Gim dung np glucid bi cc corticoid v c nguy c xut hin
nhim ceton.
X l: Lu cc tc dng ca corticoid khi iu tr vi thuc chng tiu ng.
Cn lp cn bng glucose mu lc bt u, trong v sau khi iu tr vi corticoid. Thng
bo cho ngi bnh v nguy c bin ng glucose mu v xc nh k hoch dng
thuc.
Ru
Phn tch: Ru to thun l cho cc thuc chng tiu ng gy h glucose
mu bng mt c ch cha tht sng t. Hnh nh s tn to glucose gan c th b
ru c ch. Ngoi ra vi clorpropamid (Diabinese) v mc thp hn vi
tolbutamid (Dolipol), thy bng mt. Ngi ta coi phn ng ny nh mt tc d ng
chng nghin ru (antabuse) do tng acetaldehyd trong mu. Hn na, vi metformin,
c s gia tng nguy c nhim acid lactic khi nhim c ru, c bit, trong trng hp
nhn n, suy dinh dng hoc suy t bo gan.
X l: Thng kh hn ch mt s ngi bnh ung ru. Nn lu h v tng
nguy c h glucose mu v nn hn ch ung ru ti mc ti a. Nht l phi trnh
ung ru khi i. Nu bit ngi bnh ung ru, trnh k n clorpropamid
(Diabinese). Hng vo mt sulfonylur khc. Nu bit ngi bnh c ung ru, cn
nh nguy c bng da vi clorpropamid (Diabinese) v tolbutamid (Dolipol),
glibenclamid (Daonil, Euglucan, Hemidaonil, Miniglucan), glipizid (Glibenese, Minidiab).
Cimetidin
Phn tch: Nng trong huyt thanh ca metformin c th tng, lm tng tc
dng dc l. Tng tc xy ra nhanh. C ch: Cimetidin lm gim thanh lc ca
metformin thn do c ch bi tit qua ng thn.
X l: Gim st cn thn ngi bnh. Liu metformin c th phi gim hoc tng
khi bt u hoc ngng cho cimetidin.
Glucagon
Phn tch: Tng tc dc lc. Glucagon to thun li cho tn to glucose v
thu phn glycogen, bng cch kch thch adenylcyclase to AMP vng. Hu qu l
tng nng glucose trong huyt tng.
X l: Phi hp glucagon vi cc thuc gy gim glucose mu l khng hp l, tr
khi mun c i khng dc l.
Hormon tuyn gip
Phn tch: Dng hormon tuyn gip c th lm cho iu tr chng tiu ng b
mt cn bng do tng nhu cu v insulin hoc v thuc h glucose mu.
X l: Khi phi hp thuc, cn phi iu chnh liu. Thng bo cho ngi bnh
h tng cng t theo di ngay khi thay i liu lng hormon tuyn gip.
Octreotid
123
Phn tch: U tit glucagon c iu tr cng vi octreotid. Dng cc thuc chng

tiu ng trong khi iu tr cng vi octreotid c th to thun li cho h hoc tng
glucose mu.
X l: Do cch s dng octreotid v cc ch nh, vic iu tr thng tin hnh
c s chuyn khoa, v bt buc phi theo di sinh hc u n v c mc tiu.
Progestogen hoc dn cht
Phn tch: Tc dng sinh tiu ng ca cc progestogen liu cao.
X l: Nu k n hai thuc ny, cn theo di chnh xc glucose mu lc bt u,
khi ang iu tr v khi ngng iu tr cng vi progestogen. Thng bo cho ngi bnh
bit.
Thuc cng thn kinh giao cm beta
Phn tch: Ni chung gim tc dng ca cc thuc chng tiu ng do tnh cht
gy tng glucose mu ca cc thuc cng thn kinh giao cm beta (r rt nh t v i
ephedrin).
X l: Theo di cht ch glucose mu v thng bo cho ngi bnh. t k
hoch dng thuc u n.
Thuc i quang cha Iod
Phn tch: Nguy c nhim acid lactic do suy chc nng thn to nn bi cc cht
i quang, c bit l loi cha 3 ion iod ho v 6 ion iod.
X l: Ch n ngi bnh suy thn. Khuyn nn ngng iu tr metformin
trc khi xt nghim X quang 48 gi v ch iu tr li vi metformin 48 gi sau xt
nghim ny.
t
Thuc li tiu gi kali; thuc li tiu thi kali; furosemid hoc thuc tng
Phn tch: Tng nguy c nhim acid lactic do metformin (Stagid, Glucophage,
Glucinan), trong trng hp suy thn chc nng, sinh l v/ hoc lin quan n cc
thuc li tiu.
X l: Lu tng tc ny v trnh k n metformin nu ngi bnh suy thn,
vi creatinin mu trn 15 mg/lt (135 micromol/lt) nam, v 12 mg/lt (110 micromol/lt)
n. c bit ch khi k n ng thi metformin v thuc li tiu ngi cao tui.
Bo m c s theo di v thn cho ngi bnh khi iu tr. Cn nh nhng biu hin
nhim acid lactic: bun nn, nn, co cng c, th su nhanh, cm gic mt nhc, au
bng.
Steroid ng ho alkyl ho C17
Phn tch: Cc steroid ng ho c th lm gim glucose mu. Tng tc
c xc nh vi mt s steroid ng ho.
X l: Tng cng theo di glucose mu, thng bo cho ngi bnh bit nguy c
(du hiu h glucose mu) v iu chnh liu lng. Cn nh rng cc du hi u h
glucose mu gm nhng du hiu do tit adrenalin qu mc: ra m hi, run, nhp tim
nhanh, lo u, i; hoc nhng triu chng do lon chc nng h thn kinh trung ng:
124
cm gic mt nhc, nhc u, ri lon th gic, gim tr nng, l ln, hnh vi bt

thng, co git, mt thc.
Thuc khng cholinergic (atropin, biperiden...)
Phn tch: Nng huyt tng metformin c th tng, lm tng tc dng dc l
v tc dng ph. Tng tc xy ra nhanh. C ch thuc khng cholinergic c th lm
chm nhu ng rut d dy, lm tng hp thu metformin rut non.
X l: Theo di p ng lm sng khi bt u hoc ngng khng cholinergic
ngi ang dng metformin. iu chnh liu metformin nu cn.
125
BIPHOSPHONAT
Cht chelat ho cc ion calci, c dng trong bnh Paget v long xng.
Chng c tc dng chng hu ct bo v lm gim s thay i cu trc
CC THUC TRONG NHM

ACID ALENDRONIC
Alovell vin nn 10mg Na alendronat
Fosamax vin nn 70mg Na alendronat
PAMIDRONAT bt pha tim 15 mg; 30 mg; 60 mg; 90 mg
Aredia bt pha tim 15 mg; 30 mg; 60 mg; 90 mg
CH KHI CH NH THUC
Thi k cho con b: V thiu d liu.
Thi k mang thai: V thiu d liu.
Suy thn: Nguy c tch lu biphosphonat (thiu d liu lm sng chnh xc).
Trng hp khc: Trong trng hp gy xng, ngng iu tr cho ti khi lin
xng.
Thn trng: mc 2
n ung: Gim hp thu qua ng tiu ho bi cc thc n giu calci (ch phm
sa, phomat...)
TNG TC THUC
Calci; st
Phn tch: Gim hp thu cc biphosphonat qua ng tiu ho.
2 gi.
X l: Lu tng tc v khuyn ngi bnh ung hai thuc cch xa nhau t nht
Phn tch: Nguy c lot d dy c th tng. C ch thuc chng vim khng

steroid v bisphosphonat c th hip ng gy lot d dy.
X l: Phi thn trng khi dng nhng thuc ny cng vi nhau. Theo di cn
thn bnh nhn v tc dng khng mong mun ng tiu ho c th gp, c bit l
lot d dy.
Phn tch: Thuc khng acid lm gim hp thu qua ng tiu ho, lm gim tc
dng ca biphosphonat.
126
X l: Cn ung hai thuc cch nhau t nht 1 n 2 gi. Nn nh rng cc khng

acid thng c ung 1gi 30 pht sau ba n, v thc n lm tng tit dch d dy.
127
BRETYLIUM
Thuc chng lon nhp, ch dng ti c s chuyn khoa
(nhm III ca Vaughan - Williams)
CC THUC TRONG NHM

BRETYLIUM vin nn 50 mg; ng tim 100 mg/2mL
Bretylate vin nn 50 mg; ng tim 100 mg/2mL
CH KHI CH NH THUC
Chng ch nh: mc 4
Suy tim: Bin chng chnh ca bretylium, thuc chng lon nhp ch yu, l h
huyt p, biu hin r nht khi chuyn sang t th ngi. H huyt p ny g p ng i
cao tui nhiu hn v tng ln do gim th tch mu.
Thi k mang thai: Thn trng vi loi thuc c tnh cht dc l v tim ny.
Ngi cao tui: Bin chng chnh ca bretylium, cht chng lon nhp
ch yu, l h huyt p, biu hin r nht khi chuyn sang t th ngi. H huy t p
ny hay gp ngi cao tui nhiu hn v tng ln khi gim th tch mu.
Trng hp khc: Bloc nh-tht. H huyt p ng mch nng. Ri lon nhp do
cc thuc digitalis.
TNG TC THUC
Amiodaron; bepridil; disopyramid; quinidin hoc dn cht; sotalol; vincamin
Phn tch: Tng nguy c xon nh do tc dng hip ng. Gim kali mu, nhp
tim chm v khong QT di c t trc (ch nhn bit trn in tm ) l nhng
yu t thun li cho xut hin xon nh. Xon nh l mt kiu nhp tht c bit, c
th xut hin tng cn rt ngn (vi giy, mt thu: cm gic ng t m khng m t
thc).
X l: Chng ch nh v khng c k n phi hp c tim nng gy cht
ngi ny.
Benzamid
Phn tch: Ring mt mnh sultoprid (Barnetil) trong h benzamid c th c nguy
c. Mi thuc gim lc co c (gy nhp tim chm) c th dn n tng nguy c ri lon
nhp tht, nht l xon nh, do thm cc tnh cht in sinh l ca sultoprid.
X l: Chng ch nh v phi cm dng phi hp ny.
Cisaprid
128
Phn tch: C th tng nguy c lon nhp tim e do tnh mng, bao gm xon
nh. C ch c l do ko di thm khong QT.
X l: Chng ch nh cisaprid cho nhng ngi bnh ang dng thuc chng
lon nhp nhm Ia v III.
Macrolid
Phn tch: Tng nguy c xon nh do tc dng hip ng c m t ch ring
vi erythromycin tim tnh mch. Gim kali mu, nhp tim chm v khong QT di c
t trc (ch nhn thy trn in tm ) l nhng yu t thun li cho xut hin xon
nh. Xon nh l mt kiu nhp tht c bit, c th xut hin tng cn rt ng n (vi
giy, mt thu, cm gic ngt m khng mt thc). Trong h macrolid, ch mi c
erythromycin, c bit l dng tim tnh mch, c th dn n ri lon nhp tim (ko di
khong QT, ngoi tm thu tht, xon nh, bloc nh-tht).
ny. Ngay c khi dng n c, erythromycin tim tnh mch cng c th dn n ri
lon nhp tim. Khuyn khng nn tim c liu erythromycin ngay mt lc, m nn truyn
tnh mch lin tc hoc chia tng phn, thi gian truyn mi ln t nht l 60 pht.
Pentamidin
Phn tch: Tng nguy c xon nh do hip ng cc tc dng in sinh l. Gim
kali mu, nhp tim chm v khong QT di c t trc (ch nhn thy trn in tm )
l nhng yu t thun li cho xut hin xon nh. Xon nh l mt kiu nhp tht c
bit, c th xut hin tng cn rt ngn (vi giy, mt thu, cm gic ngt m khng
mt thc).
X l: Chng ch nh v khng c k n phi hp c tim nng gy t vong.
Quinolon (sparfloxacin, gatifloxacin, moxifloxacin)
Phn tch: Tng nguy c lon nhp tim e do tnh mng, bao gm xon nh.
Xon nh l mt kiu nhp tht c bit, c th xut hin tng cn rt ngn (vi giy,
mt thu, cm gic ngt m khng mt thc) i khi tin trin thnh rung th t, cht
ngi.
X l: Chng ch nh sparfloxacin cho ngi bnh ang dng cc thuc chng
lon nhp nhm Ia v III. Trnh dng gatifloxacin v moxifloxacin ng i bnh ang
dng thuc chng lon nhp nhm Ia hoc III. Nn chn mt fluozoquinolon khc hoc
mt thuc khc phi hp, tu theo mc tiu iu tr.
Thioridazin
nh. C ch c l do tc dng hip ng ko di khong QT.
X l: Chng ch nh thioridazin cho ngi bnh ang dng mt s thuc chng
lon nhp.
Phn tch: Tng tc ch c m t vi mt thuc khng histamin H 1, l
astemizol (Hismanal), c coi l khng an thn. Tng nguy c xut hin xon nh.
Xon nh l mt nhp tht c bit, c th xut hin tng cn rt ngn (vi giy, mt
thu: cm gic ngt m khng mt thc), i khi tin trin thnh rung tht, cht ngi.
129
X l: Chng ch nh phi hp. Chn mt khng histamin khng an thn khc

khng gy xon nh (nh cetirizin, loratadin).
Ziprasidon
nh. C ch c l do tc dng hip ng ko di khong QT.
X l: Chng ch nh ziprasidon cho ngi bnh ang dng mt s thuc chng
lon nhp.
Glycosid tr tim
Phn tch: Bretylium lm gii phng ban u noradrenalin gy nguy c lm tng
thm c tnh ca digitalis (ri lon nhp tim).
X l: Thay i chin lc iu tr nu khng c phng tin theo di thng
xuyn ti c s chuyn khoa.
Halofantrin
Phn tch: Nguy c xut hin xon nh, khi phi hp thuc, do gim kali mu.
Gim kali mu, nhp tim chm v khong QT di c t trc (ch nhn thy trn in
tm ) l nhng yu t thun li cho xut hin xon nh. Xon nh l mt kiu nhp
tht c bit, c th xut hin tng cn rt ngn (vi giy, mt thu, cm gic ng t m
khng mt thc).
X l: Cn trnh phi hp ny. Dng nhng thuc khng dn n xon nh. Nu
cn phi hp thuc ny, phi b tr theo di thng xuyn (monitoring) khong QT v
tin hnh kim tra u n kali mu. Ch m t nhng du hiu lm sng bo tr c
gim kali mu, nh mt nhc, yu c, chut rt.
Thuc cng thn kinh giao cm alpha - beta
Phn tch: Bretylium, thuc chng lon nhp nhm III, gii phng catecholamin
trong thi gian u v th hin tc dng c ch thn kinh giao cm trong thi gian th
hai. Nh vy c nguy c bin ng huyt p mnh (tng huyt p) v ri lon nhp tim.
X l: Ch c dng bretylat ti bnh vin v di s theo di cht ch ca thy
thuc chuyn khoa. Tuy khuyn trnh, nhng s phi hp cn tu thuc bi cnh lm
sng.
Phn tch: Tng tc dng ca cc amin co mch, c bit l ca cc
catecholamin: Nguy c thay i huyt p do cc tnh cht cng thn kinh giao c m
gin tip ca bretylium.
X l: Cn trnh phi hp thuc, tr c s chuyn khoa c theo di in tm
thng xuyn.
Clozapin
130
X l: Theo di huyt p v iu chnh liu bretylium k n k u trong v

sau khi ngng iu tr vi clozapin. Thn trng c bit ngi cao tui.
Corticoid - khong (Mineralocorticoid)
Phn tch: Nguy c xut hin xon nh, khi phi hp nhng thuc ny. Gim kali
mu, nhp tim chm v khong QT di c t trc (ch nhn thy trn in tm ) l
nhng yu t thun li cho xut hin xon nh. Xon nh l mt kiu nhp tht c
bit, c th xut hin tng cn rt ngn (vi giy, mt thu, cm gic ngt m khng
mt thc).
X l: Nu phi phi hp cc corticoid - khong vi thuc ny, phi phng ng a
gim kali mu bng cch tng cng gim st v theo di in tm . Nu xut hi n
xon nh, th khng c dng thuc chng lon nhp. Khuyn ngi bnh g p l i
thy thuc nu thy mi mt, yu c, chut rt.
BROMOCRIPTIN HOC THUC TNG T

Alcaloid nm ca g, xp trong nhm ergolin,
cht ch vn dopaminergic c ch prolactin
CC THUC TRONG NHM

BROMOCRIPTIN vin nn 2,5 mg
Serocryptin vin nn 2,5 mg
ENTACAPON vin nn bao 200 mg
Comtan vin nn bao 200 mg
LISURID vin nn 0,2 mg
Cervalit vin nn 0,2 mg
Lysenyl forte vin nn 0,2 mg
PERGOLID vin nn 0,05 mg
Permax vin nn 0,05 mg
CH KHI CH NH THUC
Thn trng: mc 2
Thi k cho con b: Nhng thuc ny c ch tit sa; trnh s dng ph n
trong thi k cho con b.
Trm cm: Nhng thuc ny c th gy ri lon tm thn (l ln, o gic, hoang
tng), lm nng thm tnh trng trm cm.
131
Thi k mang thai: Khuyn nn ngng iu tr nhng thuc ny khi mang thai,
mc du khng c tc dng khng mong mun c trong qu trnh mang thai l n trn
thai.
Cn theo di: mc 1
n ung-ru: Ung ru lm gim dung np bromocriptin do tnh nghim trng
ca tc dng c hi. C ch: Ru lm tng tnh nhy cm ca th th dopamin vi
bromocriptin.
Lot d dy - t trng; vim d dy : V l do ri lon tiu ho (bun nn, nn)
c th xut hin lc bt u iu tr, nhng thoi trin t pht.
TNG TC THUC
Ergotamin hoc dn cht
Phn tch: Phi hp cc thuc co mch c nguy c gy cc t kch pht tng
huyt p vi cc alcaloid nm ca g c tnh cht co mch.
X l: Cn trnh phi hp ny. Thay i chin lc iu tr.
cht
Estrogen hoc thuc nga thai estroprogestogen; progestogen hoc dn
Phn tch: Bromocriptin l cht ch vn dopaminergic, c ch prolactin. Phi hp

c th dn n v kinh v/ hoc tit nhiu sa, nh hng n tc d ng ca
bromocriptin.
X l: Khng nn phi hp thuc, nht l vi ngi bnh iu tr v kinh hoc
iu tr tit nhiu sa.
Heptaminol
Phn tch: Tc dng chng tng huyt p mnh thm.
X l: Tm cch khc iu tr h huyt p t th ng.
Thuc cng giao cm alpha - beta
Phn tch: Bromocriptin l cht ch vn dopaminergic, do c nguy c gy co
mch v cc t tng huyt p kch pht.
X l: Cn trnh tng tc ny, do c th c nguy c.
Thuc tr dn cht nm ca g
Phn tch: Phi hp cc thuc co mch c nguy c gy cc t kch pht tng
huyt p vi cc alcaloid nm ca g c tnh cht co mch.
X l: Cn trnh phi hp. Thay i chin lc iu tr.
Benzamid; butyrophenon; phenothiazin
Phn tch: Do tnh i khng dopaminergic ca nhng thuc ny, c kh nng
tng nng prolactin v i khng tc dng ca bromocriptin.
132
X l: Tc dng i khng ny c nguy c gy nhiu mc tiu iu tr chnh. Cn

theo di khi phi hp thuc, hoc thay i thuc phi hp. Lu l tc dng i khng
dopaminergic kh yu v ph thuc liu.
Dextropropoxyphen
Phn tch: Dextropropoxyphen lm h huyt p nh. Khi phi hp vi thuc h
huyt p khc, tc dng h huyt p tng v tng nguy c h huyt p t th ng.
X l: Phi theo di huyt p khi phi hp hai thuc (trong khi iu tr v sau khi
ngng mt trong hai thuc). Tu theo thuc dng, h huyt p c th nng nhiu hay t.
Tu trng hp, iu chnh liu ca mt hoc hai thuc. Xc nh k hoch dng thuc
u n. Khuyn gp li thy thuc iu tr iu chnh liu lng, nu thy chng
mt lc bt u iu tr. Tng cng theo di ngi bnh cao tui (nguy c ng), v
khuyn ngi bnh chuyn dn dn t t th nm hoc ngi sang t th ng.
Erythromycin
Phn tch: Nng bromocriptin trong huyt thanh c th tng, dn n tng tc
dng dc l v c tnh ca bromocriptin. C ch: V erythromycin c bit l c ch
chuyn ho gan ca nhiu thuc khc, y c th c s tng kh dng sinh hc
ca bromocriptin, do gim chuyn ho qua gan ln u.
X l: Theo di ngi bnh. Nu nghi c tng tc, iu chnh liu ca
bromocriptin cho ph hp.
Levodopa
Phn tch: Do kch thch cc th th dopamin, thuc ny lm gim bt tm thi s
thiu ht dopamin, l c im ca bnh Parkinson. Mt khc, levodopa l tin cht
sinh l ca dopamin, s phi hp c th dn n tch lu dopamin.
X l: Hip ng cc tc dng dc l; gim liu ca levodopa.
Procarbazin
Phn tch: Do tnh i khng dopaminergic ca procarbazin (c cc tnh cht c
ch MAO), c kh nng tng nng prolactin v i khng tc dng ca bromocriptin.
X l: Tc dng i khng ny c nguy c gy nhiu mc tiu iu tr chnh, cn
theo di khi phi hp thuc hoc thay i thuc phi hp. Lu l tc dng i khng
dopaminergic kh yu v tu thuc liu.
Thuc ch vn morphin
Phn tch: Tng tc dng h huyt p v tng nguy c h huyt p t th ng.
X l: Theo di huyt p trong khi phi hp thuc. Tu theo thuc dng, h
huyt p c th nng hoc nh. Tu theo trng hp , iu chnh liu ca mt hoc hai
thuc. Xy dng k hoch dng thuc u n. Khuyn ngi bnh gp li thy thuc
iu chnh liu lng, nu thy chng mt lc bt u iu tr. Tng cng theo di
ngi bnh cao tui (nguy c ng), v khuyn ngi bnh chuyn dn dn t t th nm
hoc ngi sang t th ng.
133

Phn tch: Tc dng chng tng huyt p mnh thm.
X l: Cn iu chnh liu lng, xy dng k hoch dng thuc v nhn mnh
ngi bnh phi tun th y lnh. Lc bt u iu tr, khuyn ngi bnh o u n
huyt p cho ti khi t cn bng iu tr.
Phn tch: Nguy c xut hin l ln tm thn khi dng phi hp lisurid vi cc
thuc chng Parkinson khng cholinergic.
X l: Dng phi hp thuc ny phi theo di lm sng vi cc thuc khng
cholinergic.
Phn tch: Do tnh cht i khng dopaminergic ca cc thuc c ch MAO, c
kh nng tng nng ca prolactin v i khng tc dng ca bromocriptin.
theo di phi hp thuc ny hoc thay i thuc phi hp. Lu l tc dng i khng
Thuc c ch MAO typ B
Phn tch: Do tc dng c ch monoamin oxydase typ B, thuc ny (c ch MAO
typ B) ko di tc dng ca dopamin. Levodopa v bromocryptin l mt cht ch v n
dopaminergic nn phi hp c th gy tch lu dopamin.
X l: Hip ng cc tc dng dc l, gim liu ca bromocriptin (ch vn
dopaminergic).
Griseofulvin
Phn tch: Do cm ng cytochrom P450, nn griseofulvin c th lm tng chuyn
ho bromocriptin v gim tc dng iu tr ca bromocriptin. Tc dng ny ch th hin
sau khi dng griseofulvin t nht 7 n 10 ngy.
X l: iu chnh liu bromocriptin trong v sau khi iu tr griseofulvin.
BUSPIRON
Thuc gii lo u, t c tc dng an thn,
th gin c v chng co git
CC THUC TRONG NHM
BUSPIRON vin nn 5 mg; 10 mg
Buspar vin nn 5 mg; 10 mg
134
CH KHI CH NH THUC
Thn trng: mc 2
Suy gan: Nguy c gim chuyn ho ca thuc.
Suy thn: Nguy c gim o thi thuc qua nc tiu.
Cn theo di: mc 1
Thi k cho con b: Do qua c sa m.
Thi k mang thai: Thiu c liu chnh xc.
TNG TC THUC
Benzodiazepin
an thn. Tng tc dc l.
X l: Tnh n nguy c ny iu chnh liu dng ca hai thuc. Ch n
gim tnh to ngi li xe v ngi s dng my mc. Khuyn khng ung ru v
Baclofen; carbamat hoc thuc tng t; carbamazepin; butyrophenon;
fluoxetin; fluvoxamin; paroxetin; thuc khng histamin khng H1
an thn
X l: Phi tnh n nguy c ny hiu chnh liu ca hai thuc. Ngh n gim
tnh to ngi li xe v ngi s dng my mc. Khuyn khng ung ru, khng t
dng thuc hoc ch phm c ru.
Barbituric; benzamid; medifoxamin; phenothiazin; primidon hoc dn cht;
ru; thuc an thn kinh cc loi; thuc c ch thn kinh trung ng cc loi;
viloxazin
thn. C th ghi nhn mt s tc dng tm thn vn ng vi mt s thuc, nht l
trong tun u iu tr. Tng tc dc l.
X l: Tt nht, khng phi hp hai thuc, v ngi k n khng kim ch c
vic ngi bnh ung ru. Nguy c an thn c bit nguy him i vi ng i li xe,
v ngi s dng my mc. Khuyn khng ung ru, khng t dng thuc hoc ch
phm c ru.
Diltiazem
Phn tch: Tc dng dc l v tc dng khng mong mun ca buspiron c th
tng. C ch: Kh dng sinh hc ca buspiron c th tng do kt qu ca s gi m
chuyn ho bc u (CYP3A4) rut non v gan.
135
X l: Theo di cht ch p ng lm sng ca ngi bnh i vi buspiron khi bt

u hoc ngng diltiazem. iu chnh liu ca buspiron nu cn. Mt thuc gii lo m
khng b chuyn ho bi CYP3A4 (th d lorazepam) c l khng tng tc vi diltiazem.
Mt thuc chn knh calci loi dihydropyridin m khng c ch CYP 3A4 c l khng
tng tc vi buspiron.
Khng sinh macrolid
Phn tch: Nng buspiron trong huyt tng c th tng, lm tng tc d ng
dc l v tc dng khng mong mun. C ch do cc macrolid c ch CYP 3A4 chu
trch nhim chuyn ho buspiron.
X l: ngi bnh ang dng buspiron, phi theo di cht ch p ng lm
sng khi bt u, khi ngng hoc thay i liu ca macrolid. ngi bnh ang dng
khng sinh macrolid, m bt u dng buspiron, th nn dng thuc ny v i li u v a
phi, ri iu chnh liu nu cn. Azithromycin v dirithromycin khng b chuyn ho bi
CYP3A4 nn c th khng tng tc vi buspiron.
Phn tch: Nguy c tng huyt p khi phi hp hai thuc.
X l: Theo di huyt p khi bt u, khi ang v sau khi iu tr vi mt trong hai
thuc. Nu khng, thay i thuc hoc ngng buspiron trong khi iu tr vi cc thuc
c ch MAO v c 15 ngy sau. Khuyn ngi bnh gp li thy thuc, nu c vn
v huyt p.
Rifamycin
Phn tch: Nng buspiron trong huyt tng v tc dng dc l ca n c th
gim. C ch do cc rifamycin gy cm ng enzym chuyn ho buspiron l CYP3A4.
X l: ngi bnh ang dng buspiron, phi theo di cht ch p ng lm
sng khi bt u, khi ngng hoc thay i liu ca rifamycin. iu chnh liu ca
buspiron nu cn.
Phn tch: Nng buspiron trong huyt tng c th tng, lm tng tc d ng
dc l v tc dng khng mong mun. C ch do cc thuc chng nm azol c ch
isozym CYP3A4 chu trch nhim chuyn ho buspiron.
X l: ngi bnh ang dng buspiron, phi theo di cht ch p ng ca
ngi bnh khi bt u, khi ngng hoc thay i liu ca thuc chng nm azol.
ngi bnh ang dng thuc chng nm azol, nu bt u dng buspiron th nn dng
thuc ny vi liu va phi, ri iu chnh nu cn.
Phn tch: Tc dng i khng. C th tng tnh hung hn ngi nghin
amphetamin.
X l: Lu tng tc ny xc nh mc tiu iu tr chnh. Khuyn ngi
bnh gp li thy thuc, nu thy iu tr t ra khng n nh.
136
BUTYROPHENON (dn cht)

L thuc an thn kinh, u bng l haloperidol
CC THUC TRONG NHM

DROPERIDOL
Droleptane ng tim 25 mg/10mL; 50mg/10mL
HALOPERIDOL vin nn 1mg; 1,5mg; 2mg; 5mg; ng tim 5mg/ 1mL; l thuc
git 40mg/20 mL
Apo-Haloperidol vin nn 1mg; 5mg
CH KHI CH NH THUC
n ung-ru: Ru lm tng tc dng an thn ca butyrophenon, l thuc an
thn kinh a nng.
Thi k cho con b: Butyrophenon qua c sa m c th gy an thn cho tr
ang thi k b m.
Thi k mang thai: Haloperidol b gn cho l nguyn nhn d tt cc chi phi
thai ngi.
Hi chng parkinson: Cc tc dng trn thn kinh ca butyrophenon ch yu l
tc dng ngoi thp, gi bnh Parkinson c km tng vn ng.
Cn theo di: mc 1
ng kinh: Butyrophenon c th lm gim ngng gy ng kinh, buc phi
iu chnh liu ca thuc chng ng kinh.
Suy tim/ suy vnh: Butyrophenon c th dn n nhng ri lon thn kinh thc
vt v tim mch. Hay gp h huyt p t th ng nn buc phi theo di ch t ch
ngi suy tim.
Suy gan: Suy gan dn n tch lu butyrophenon, km vi tng c tnh ca
chng.
Suy thn: Suy thn dn n tch lu butyrophenon, km vi tng c tnh ca
chng.
Ngi cao tui: Ngi cao tui nhy cm hn vi cc tc dng khng mong
mun, c bit l hi chng ngoi thp v l ln. H huyt p t th ng c th nguy
kch ngi hoc c nguy c tai bin mch mu no. Cn trnh dng li u cao
ngi cao tui.
TNG TC THUC
137
Levodopa
Phn tch: Phi hp levodopa vi thuc c tc dng i khng dopamin, c th
dn n tc dng i khng.
X l: Chng ch nh phi hp ny, tr khi mun tm kim mt i khng dc
l, s tm kim ny phi c tin hnh ti c s chuyn khoa.
Thuc c ch MAO typ B
Phn tch: c ch c hiu monoamin oxydase typ B dn n ko di tc dng
ca levodopa, iu gii thch vic cng k n vi levodopa. Nh vy, cc tng tc
ging
cc
tng
tc
ca
levodopa.
Phi
hp
levodopa
vi mt s thuc c tc dng i khng dopamin c th dn n cc tc d ng i
khng.
X l: Chng ch nh phi hp ny, tr khi mun tm kim mt i khng dc
l, s tm kim ny phi c thc hin ti c s chuyn khoa.
Cc benzodiazepin
Phn tch: Tng cc tc dng c ch h thn kinh trung ng, dn n tng tc
dng an thn. Tng tc dc lc.
X l: Phi tnh n nguy c ny hiu chnh liu lng ca hai thuc. Ngh
n gim tnh to ngi li xe v ngi s dng my mc. Khuyn khng ung ru,
v khng t dng cc thuc hoc ch phm c ru.
Phn tch: Gim tc dng chng tng huyt p do c ch ti thu nhn guanethidin
nron bi cc butyrophenon, m cht u bng l haloperidol.
X l: Thay i chin lc iu tr bng cch chn mt thuc chng tng huyt
p khc. Cn trnh phi hp ny.
Lithi
Phn tch: c thng bo cc tai bin c thn kinh kiu hi chng l ln mt
s ngi bnh dng phi hp ny.
X l: Cn trnh phi hp ny. Thay i chin lc iu tr tr khi ngi bnh c
iu tr ti mt c s chuyn khoa, cho php theo di thng xuyn.
Methyldopa
Phn tch: Methyldopa c th lm tng cng tc dng an thn kinh ca
haloperidol hoc s phi hp c th gy lon thn. C ch: C hai thuc c th c tc
dng hip ng, lm gim dopamin no.
X l: Nu cc triu chng tm thn xut hin, nn ngng thuc ny hay thuc
kia (tu theo tnh hnh iu tr) v thay th cch iu tr thch hp.
Ritonavir
Phn tch: Ritonavir c i lc cao vi isoenzym 3A4 ca cc cytochrom P450; c
nguy c quan trng v cnh tranh gia ritonavir v cc thuc khc nhau b, hoc nghi b
138
chuyn ho bi isoenzym ny. S cnh tranh s gy gim chuyn ho nhng thuc

v nguy c tng ng k nng ca chng trong huyt tng. Nguy c h huyt p,
an thn v tng cc tc dng ngoi thp (c m t vi haloperidol, trong h thu c
ny). Tng tc dc ng hc v chuyn ho thuc.
X l: Theo di cht ch ngi bnh v s xut hin cc tc dng c v gim
liu thuc an thn kinh.
Ru
Phn tch: Tng cc tc dng c ch thn kinh trung ng, dn n tng tc
dng an thn. C th thy vi mt vi sn phm, mt s tc dng tm thn vn ng,
nht l trong tun u iu tr. Tng tc dc lc.
X l: Tt nht l khng nn phi hp hai sn phm, v ngi k n khng c
th kim ch c ngi bnh ung ru. Nguy c an thn nguy him nht l ngi
li xe v ngi s dng my mc. Khuyn khng ung ru, v khng t dng thuc
hoc ch phm c ru.
Benzamid; reserpin; thuc an thn kinh cc loi
Phn tch: Hip ng cc tc dng khng mong mun, th hin bng nguy c gy
trm trng thm cc tc dng ngoi thp.
Phn tch: Do tnh i khng dopaminergic ca nhng sn phm ny, c kh
nng tng nng prolactin v i khng tc dng ca bromocriptin.
theo di phi hp hoc thay i thuc phi hp. Lu l tc dng i khng
Buspiron; medifoxamin; primidon hoc dn cht; procarbazin
n gim tnh to ngi li xe v ngi vn hnh my mc. Khuyn khng ung ru
v khng t dng cc thuc hoc cc ch phm c ru.
Carbamazepin
Phn tch: Tc dng iu tr ca haloperidol c th gim, cn tc dng ca
carbamazepin c th tng. C ch do carbamazepin c th lm tng chuyn ho ca
haloperidol gan, cn haloperidol c th c ch chuyn ho ca carbamazepin.
X l: Nu nghi ng c tng tc, xem xt iu chnh liu ca hai thuc.
Carbamat hoc thuc tng t; baclofen; dantrolen; dextropropoxyphen;
thuc c ch h thn kinh trung ng cc loi
139
X l: Lu nguy c ny iu chnh liu ca hai thuc, khi cn phi hp
thuc. Ngh n gim tnh to ngi li xe v ngi s dng my mc. Khuyn khng
ung ru v khng t dng cc thuc hoc cc ch phm c ru.
Phn tch: Hai nguy c: nguy c tng tc dng chng tng huyt p, l tc dng
khng mong mun ca butyrophenon; nguy c tng tc dng c ch h thn kinh trung
ng, dn n tng tc dng an thn. Tng tc dc l. Lu l rilmenidin, vi li u
thng thng, khng lm tng cc tc dng c ch h thn kinh trung ng ca nhng
thuc ny.
X l: Lu cc nguy c ny iu chnh liu ca hai thuc, nu cn phi hp
thuc. Ngh n gim tnh to nhng ngi li xe v ngi s dng my mc. Khuyn
khng ung ru v khng t dng cc thuc hoc cc ch phm c ru.
Clozapin; thuc chn beta; thuc gin mch chng tng huyt p; thuc li
tiu gi kali; thuc li tiu thi kali; furosemid hoc thuc tng t; sotalol
Phn tch: Tng tc dng lm h huyt p ca nhng thuc ny.
X l: Nu cn phi hp thuc, tng cng theo di huyt p trong v khi ngng
iu tr bng mt trong hai sn phm. Tin hnh iu chnh liu lng, nu cn. Nhn
mnh n k hoch dng thuc v tun th dng thuc. Phi c bit cnh gic
ngi cao tui.
Fluoxetin
Phn tch: Dng haloperidol v fluoxetin cng vi nhau gy phn ng ngoi thp
nng. C ch cha r.
X l: Nu cc triu chng ngoi thp xy ra trong khi ang dng cc thuc ny,
nn xem xt ngng mt hoc c hai thuc.
Phn tch: Ngoi vic b sung thm tc dng c ch h thn kinh trung ng,
natri valproat v dn cht cn lm tng nng ca nhng sn phm ca cc thuc
ny trong huyt tng, c l do c ch enzym nn lm gim d ho chng.
X l: Nu cn phi hp, phi gim liu ca butyrophenon. Ngh n gim tnh
to ngi li xe v ngi s dng my mc. Khuyn khng ung ru v nu ngi
bnh t dng thuc, cn kim tra xem cc t dc ca nhng thuc ny c cha ru
khng?
Phenothiazin
Phn tch: Nng haloperidol trong huyt tng c th tng, lm tng nguy c
xut hin cc tc dng khng mong mun. C ch c l do chuyn ho ca haloperidol
(CYP2D6) b c ch bi mt s phenothiazin (nh clorpromazin, perphenazin,
fluphenazin, thioridazin).
X l: Theo di p ng lm sng ca ngi bnh vi haloperidol khi bt u, khi
ngng hoc thay i liu ca mt s phenothiazin.
140

Phn tch: Thuc khng acid gy gim hp thu ng tiu ho v lm gim tc
dng ca thuc c phi hp.
X l: Cn mt khong cch t nht t 1 n 2 gi gia lc ung thuc khng
acid v thuc. Cn nh rng cc thuc khng acid thng c ung
1 gi 30 pht sau ba n, v n ung gy tng tit dch d dy.
Phn tch: Tng tc dng h huyt p ca cc thuc c tnh cht an thn kinh v
th pht gy h huyt p.
X l: Nu cn phi hp thuc, tng cng theo di huyt p, trong v khi ngng
iu tr bng mt trong hai thuc. iu chnh liu, tu trng hp. Nhn mnh v k
hoch dng thuc v yu cu tun th. c bit cnh gic ngi cao tui.
Phn tch: i khng tc dng. C th tng tnh hung hn ngi nghin
amphetamin.
X l: Lu tng tc dc l ny xc nh mc tiu iu tr chnh. Khuyn
ngi bnh gp li thy thuc, nu thy iu tr t ra khng n nh.
Barbituric; fluvoxamin; oxaflozan; thuc khng histamin khng H1 an thn;
viloxazin
tnh to ngi li xe v ngi s dng my mc. Khuyn khng ung ru v khng
t dng cc thuc hoc cc ch phm c ru.
Cht ch vn morphin
X l: Lu nguy c ny iu chnh liu ca hai thuc, nu cn phi hp.
Ngh n gim tnh to ngi li xe v ngi s dng my mc. Khuyn khng ung
ru v khng t dng cc thuc hoc cc ch phm c ru.
Methadon
Phn tch: Tng tc dng c ch h thn kinh trung ng, km theo an thn
mnh, c bit c hi cho ngi li xe v vn hnh my mc.
X l: S tng tc dng an thn ny phi c ngi k n lu cho ngi
bnh nhng li khuyn ph hp: trnh li xe hoc vn hnh my mc; thng bo cho
ngi xung quanh bit nguy c ny.
141

h huyt p. Hn na, nu c s ph thuc, s phi hp hai thuc c th lm tng
nguy c ph thuc.
ru v nu ngi bnh t dng thuc, phi kim tra xem cc t dc ca nhng
thuc ny c ru khng?
Phn tch: Nguy c tng cc tc dng c ch h thn kinh trung ng.
X l: Nu cn phi hp hai thuc, phi lu n nguy c ny khi gy m v khi
chn liu.
CC THUC LOI CURA

Tc nhn chn ng tip ni thn kinh-c.
Thuc gin c khng kh cc
CC THUC TRONG NHM
GALLAMIN TRIETHIODID ng tim 40 mg/1mL; 40 mg/2mL; 40 mg/3mL
Flaxedil ng tim 40 mg/1mL; 40 mg/2mL; 40 mg/3mL
ATRACURIUM DIBESYLAT ng tim 25 mg/2,5 mL; 50 mg/5mL
Tracrium ng tim 25 mg/2,5 mL; 50 mg/5mL
PANCURONIUM BROMID ng tim 4 mg/2mL
Pavulon ng tim 4 mg/2mL
PIPECURIUM l 4 mg
Arduan l 4 mg
ROCURONIUM ng tim 50 mg/5mL; 100 mg/10 mL
Esmeron ng tim 50 mg/5mL; 100 mg/10 mL
MIVACURIUM ng tim 10 mg/5mL; 20 mg/10 mL
Mivacron ng tim 10 mg/5mL; 20 mg/10 mL
VECURONIUM
Norcuron NC 45
CH KHI CH NH THUC
Thi k mang thai: Do cn thiu d liu.
142
Nhc c: Phi dng tht thn trng v vi liu rt thp cho ngi nhc c
hoc ngi c hi chng nhc c.
Trng hp khc: Bnh c: Trong trng hp ny (th d: lon trng lc c),
xc nh liu dng mt cch thn trng.
Cn theo di: mc 1
Suy tim: Nguy c gim huyt p, khuyn nn tim chm.
Suy thn: Gim liu, nht l trong nhng can thip ngoi khoa di thi gian.
Ngi cao tui: Gim liu, nht l trong nhng can thip ngoi khoa di thi
gian.
TNG TC THUC
Cn nhc nguy c/ li ch : mc 3
c t ca Clostridium botulinum
Phn tch: Tng tc dng dc l ca c t ca Clostridium botulinum (lit do c
ch gii phng acetylcholin ng tip ni thn kinh - c).
X l: Trnh k n hai thuc ny ng thi; nu cn phi hp, phi tnh n
tng tc ny xc nh liu.
Mui magnesi
Phn tch: Magnesi sulfat c th lm tng cng tc dng ca thuc gin c
khng kh cc, c th dn n c ch h hp nghim trng. C ch c l do tng
cng tc dng dc l.
X l: Phi thn trng khi phi hp cc thuc ny; iu chnh liu ca thuc gin
c khng kh cc nu cn thit v theo di tnh trng suy h hp.
Aminosid tim hoc dng ti ch
Phn tch: Tng nguy c chn thn kinh c, c th dn n yu c, c ch h hp,
thm ch lit. Ch l s chn ny c th xy ra mc thp hn vi cc thuc gy m
bay hi halogen ho v mt s thuc gim au loi thuc phin.
X l: Ngi gy m phi b tr thuc khng cholinesterase v cc mui calci tim
x l chn thn kinh - c. Nu ngi bnh c thng kh c hc, nguy c ny s
mt i. Tng tc ny phi trnh v qun l c s ngoi khoa v / hoc sau ph u
thut, vi mi thn trng cn thit.
Amphotericin
Phn tch: Nguy c tng chn thn kinh - c, do gim kali mu, nht l vi nhng
tc nhn loi cura khng kh cc. Ch ring amphotericin tim cng c th l ngun gc
ca h kali mu.
cc.
t
143
X l: C th phi nh lng kali mu trc khi dng thuc loi cura khng kh
Cht ch vn morphin; khng sinh polypeptid; lidocain hoc thuc tng
Phn tch: Tc dng c ch trung tm h hp ca cc thuc gim au trung ng

c th gp thm vo nguy c lit h hp do cht loi cura.
X l: Khi gy m, tng tc ny c th b trung ho bng thng kh t ng. Tuy
nhin, theo di cn thn sau phu thut, tu theo dng n c mt thuc hay phi hp
hai thuc. Vic phi hp thuc ny lin quan ch yu n thy thuc gy m.
Furosemid hoc thuc tng t; glucocorticoid; mineralocorticoid;
tetracosactid; thuc li niu thi kali; thuc nhun trng kch thch; thuc nhun
trng lm trn; thuc nhun trng nhy v thm thu.
Phn tch: Nguy c tng chn thn kinh - c do gim kali mu, nht l vi cc tc
nhn loi cura khng kh cc.
X l: C th phi nh lng kali mu trc khi dng cht cura khng kh cc.
Lincosamid
Phn tch: Tng cc tc dng ca cura, c th dn n nguy c chn thn kinh c c th tin trin n lit h hp. C ch do hip ng tc dng dc l.
X l: Trnh phi hp, nu c th. Nu phi hp cn c thy thuc gy m
theo di ti c s chuyn khoa. Tu theo ngi bnh c c thng kh hay khng,
nguy c khng ging nhau.
Quinidin hoc dn cht
Phn tch: Tng nguy c lit h hp, do thuc loi cura. C ch do hip ng tc
dng dc l.
X l: khu gy m, c th qun l tng tc ny bng thng kh t ng. Tuy
nhin, cn theo di cn thn sau phu thut, tu theo dng ring hay phi hp hai
thuc ny.
Thuc cholinergic
Phn tch: i khng dc l gia neostigmin v edrophonium dng trong trng
hp iu tr bng cura qu mc.
X l: C th dng trong iu tr tnh cht i khng gia cc thuc.
Phn tch: Tng nguy c chn thn kinh - c, c th dn n yu c, suy gim h
hp, thm ch lit, c bit vi enfluran v isofluran.
X l: Ngi gy m phi b tr thuc khng cholinesterase v cc mui calci tim
x l chn thn kinh - c. Nguy c gim thiu khi c h tr h hp, ch ng i
bnh lc tnh li. Tng tc ny phi trnh hoc qun l c s ngoi khoa v / hoc
sau phu thut, vi mi s thn trng cn thit.
Thuc nhun trng lm mm
Phn tch: Nguy c tng chn thn kinh - c do gim kali mu, nht l vi cc tc
nhn loi cura khng kh cc v ngi bnh dng thuc nhun trng di ngy.
X l: Nguy c tng i thp. Hi ngi bnh bit h c dng thuc nhun
trng u n khng? Cn nh lng kali mu trc khi dng cht cura khng kh
cc.
144

Benzodiazepin
Phn tch: Mt vi nghin cu cho thy diazepam v cc benzodiazepin khc c
th lm tng tc dng ca cc thuc loi cura. Mt s khc, s phi hp l c th c
m khng lm tng tc dng .
X l: Tt nht thy thuc gy m nn theo di phi hp thuc v cc kt qu
nghin cu khc nhau. Yu cu ngi bnh thng tin cho ngi gy m cc thuc m
h dng, c bit l benzodiazepin.
CAFEIN
Cht kch thch tim v thn kinh, c tnh cht li niu
CC THUC TRONG NHM

CAFEIN vin nn 0,1 g; ng tim 0,07g/1mL; 0,25 g/1mL; 0,4 g/1mL
TNG TC THUC
Idrocilamid
Phn tch: Idrocilamid c ch chuyn ho cafein. Trong khi iu tr nhiu ngy,
phi gim, thm ch ngng dng n hoc thuc c cafein.
X l: Idrocilamid ch bn Php di dng thuc m. Cn phi bi mt lng
ln trn c th mi c nhng tc dng ton thn.
Procarbazin
Phn tch: ngi nghin c ph v tr rt nng, c th tng nguy c lon nhp
tim nng v / hoc h huyt p nng, do tc dng cng giao cm ca cafein (nh l
procarbazin c tnh cht c ch MAO).
X l: Khuyn ngi bnh gim hoc ngng ung c ph hoc nc tr c
trong khi iu tr. C nhng thuc khng phi bn theo n, c cha trimethylxanthin
(cafein), cn cnh gic.
Phn tch: ngi nghin c ph v tr rt nng, c th tng nguy c lon nhp
tim nng v/ hoc h huyt p nng, do tc dng cng giao cm ca cafein c trong
c ph v tr.
X l: Khuyn ngi bnh gim hoc ngng ung c ph hoc nc tr c
trong khi iu tr. C nhng thuc khng phi bn theo n, c cha trimethylxanthin
(cafein), cn cnh gic.
145

Amantadin hoc cc cht tng t
Phn tch: Thn trng khi phi hp amantadin vi cc cht kch thch tm thn,
trnh cc tc dng hng thn kiu d kch thch, mt ng, thm ch lon nhp tim.
X l: Phi thn trng v cnh gic trc phi hp ny v nu cn phi chuyn
cc tc dng n Trung tm cnh gic thuc.
Cimetidin
Phn tch: Tc dng ca cafein c th tng ln khi dng cng cimetidin. C ch
do cimetidin c ch chuyn ho ca cafein microsom gan.
X l: Nu xut hin nhiu tc dng kiu kch thch, d kch ng, thm ch mt
ng, th khuyn ngi bnh gim hoc trnh dng cafein.
Lithi
Phn tch: ngi nghin c ph v tr, c nguy c tng o thi lithi qua nc
tiu, c th dn n gim tc dng iu tr.
X l: Hi ngi bnh v s dng c ph v tr, v nu cn, khuyn h gi m
thm ch ngng ung c ph v tr trnh nhng dao ng v nng lithi trong mu
v t cn bng iu tr.
Nicotin
Phn tch: Nicotin c tnh cm ng enzym: V mt ny, nicotin c th kch thch
chuyn ho mt s thuc v dn n gim tc dng iu tr.
X l: Phi cnh gic vi nhng thuc c phm vi iu tr hp, trong khi iu tr
thay th nicotin v c khi phi xem li cc liu lng trong v sau khi iu tr. Cn nhc
li cm ng enzym l mt hin tng ch xut hin sau mt s ngy. N ngc li vi
c ch enzym l mt hin tng tc th.
Phenytoin
Phn tch: Phi hp vi mt cht cm ng enzym. Sau 10 -12 ngy, c s kch
thch chuyn ho cafein gan bi cht cm ng v gim tc dng, nng ca cafein
trong huyt tng.
X l: Nu cafein c dng trong iu tr (kch thch h hp) vi s kim tra cc
hm lng trong huyt thanh, nn theo di ngi bnh v lm sng v sinh hc. i u
chnh liu lng trong v sau khi ngng iu tr vi thuc gy cm ng.
Phn tch: ngi nghin c ph hoc nc tr c, c nguy c tng tc dng
hng thn, c th dn n d b kch thch, mt ng, v trong mt s him trng hp
co git v lon nhp tim.
X l: Hi ngi bnh v s dng c ph v tr. nh gi nguy c tu theo cc
dng bo ch dng.
Quinolon
146
Phn tch: Tc dng dc l ca cafein c th tng. C ch do chuyn ho ca

cafein gan b gim bi mt s quinolon.
X l: Tng tc ny c m t vi mc nghim trng khc nhau, gia
enoxacin v acid pipemidic (phi hp cn trnh), vi ciprofloxacin v norfloxacin (ph i
hp cn theo di). Hi ngi bnh v mc tiu th c ph v tr v khuyn h gi m,
thm ch ngng dng, trong khi iu tr bng fluoroquinolon.
CALCI (mui)
Trong nhm ny c cc mui calci c th dng c bng ng tim tnh mch
v ng ung (mt s tng tc ch gp trong trng hp ny liu cao)
CC THUC TRONG NHM
CALCIUM
Calcium folinat Ebewe nang mm 1000 DPP
Cenovis Calcium 600 mg & Vitamin D
Dianeal Low calcium dung dch thm thu (2,5mEq/L)
Europerol with 1,5% dextrose dung dch thm thu (2,5mEq/L)
CH KHI CH NH THUC
Si thn: Chng ch nh dng nhng thuc ny trong cc trng hp tng calci
mu, si calci v vi ho m.
Trng hp khc: Chng ch nh dng nhng thuc ny trong tng calci mu,
vi ho m v bt ng ko di.
TNG TC THUC
Glycosid tr tim
Phn tch: Tim tnh mch calci v magnesi cng lc vi cc thuc digitalis c th
c hu qu gy t vong. Ung magnesi hoc calci, phi hp vi vitamin D, c th lm
xut hin cc ri lon nhp tht (ngoi tm thu, nhp tim nhanh rung tht).
X l: Chng ch nh phi hp calci tim tnh mch vi digitalis. Thay i chin
lc iu tr. Cn theo di (v lm sng v nu cn, v in tm ) khi phi hp calci
hoc magnesi ung vi vitamin D.
Bepridil
147
Phn tch: C th dng phi hp thuc ny iu tr qu liu cht c ch calci

v ngc li. Tc dng dc l thu c ch yu vi calci tim tnh mch v do lm
gim tc dng ca cc thuc c ch calci.
X l: Phi hp ny c dng kim sot h huyt p v nhp tim chm do
bepridil gy ra. C th dng phi hp ny iu tr qu liu cht c ch calci, hoc
rung tim do calci gluconat gy ra. Phi hp khng c hoc c t tc dng, nu dng calci
ung.
Diltiazem; dihydropyridin; verapamil
Phn tch: C th dng phi hp thuc ny iu tr qu liu thuc c ch calci
v ngc li. Tc dng dc l thu c ch yu vi calci tim tnh mch v nh vy
lm gim tc dng ca cc thuc c ch calci.
verapamil gy ra. C th s dng phi hp ny iu tr qu liu thuc c ch calci,
hoc rung tim do calci gluconat gy ra. Phi hp khng c hoc c rt t tc d ng, nu
dng calci ung
Diphosphonat
Phn tch: Gim hp thu ng tiu ho cc diphosphonat khi ung.
X l: Tng tc cn lu v khuyn ngi bnh ung hai thuc ny cch xa
nhau t nht 2 gi.
Tetracyclin
Phn tch: Tng tc l ho. l s chelat ho cc cation (Fe, Al, Ca) vi
tetracyclin dn n gim hp thu tetracyclin v nguy c tht bi iu tr. Ung sa hoc
n cc ch phm ca sa cng lm gim hp thu tetracyclin.
X l: Trnh s dng cng lc cc tetracyclin vi cc mui calci. Nn dng cch
xa nhau t 3 n 4 gi.
Vitamin A
Phn tch: Gim tc dng ca cc mui calci. Khi dng nhiu vitamin A (Trn
5000 n v quc t / ngy), nguy c mt cht khong xng c th dn n tng
calci mu v gim tc dng ca vic b sung calci.
X l: Phi tnh n nguy c tng calci mu ny iu chnh liu vitamin A.
Vitamin nhm D
Phn tch: Phi hp kinh in trong iu tr. Tht vy, dng ng thi
hai thuc ny dn n tng kh nhiu s hp thu calci rut khi dng calci liu cao.
X l: Nn ch n vic dng u n cc ch phm giu mui calci (cc
khng acid). Nguy c tng calci mu tn ti. Nu cn, kim sot calci mu. Cng ch
c n t dng calci ba bi ng thi vi vitamin nhm D.
Thuc li tiu thi kali
Phn tch: Vi cc thuc li tiu thiazid, phi hp u n c th dn n tng
calci mu do lm gim o thi calci qua nc tiu. C ch: Cc thuc li tiu thiazid
148
lm tng ti hp thu calci ng thn, v gii phng calci t xng. Hai tc dng ny c
th c khuch i bi calci nhp t ngoi vo.
X l: Theo di calci trong huyt thanh v ch n cc du hiu tng calci mu
khi ang dng cc mui calci cng vi cc thuc li tiu thiazid, nht l ngi bnh
cng ph gip trng hoc ang dng vitamin D.
149
CALCITONIN
Hormon gy gim calci mu, chng hu ct bo, dng trong bnh Paget
v cc ri lon khc ca chuyn ho xng
CC THUC TRONG NHM

CALCITONIN dung dch ht 200 IU/mL; 500 IU/mL
Calco dung dch tim 50 IU/mL v 100 IU/mL
Miacalcic dung dch ht 200 IU/mL
Miacalcic dung dch ht 500 IU/mL
CH KHI CH NH THUC
Thi k cho con b: Do thn trng, v thiu d liu.
Tr em: Gii hn thi gian iu tr, c tnh n cc nguy c ri lon pht trin
xng.
Trng hp khc: Qu mn vi calcitonin.
Thn trng: mc 2
Thi k mang thai: Calcitonin hnh nh khng qua hng ro nhau-thai, nhng
cha d liu.
Suy thn: Do gim thanh lc bng chuyn ho.
TNG TC THUC
Lithi
Phn tch: Nng lithi trong huyt thanh c th gim, lm gim tc dng iu tr.
C ch cha r. Nghi do lithi gim hp thu rut hoc tng o thi thn.
X l: Theo di p ng lm sng ca ngi bnh v nng lithi trong huyt
thanh. iu chnh liu ca lithi nu cn.
CARBAMAT HOC THUC TNG T

Thuc gii lo, an thn v doi c
CC THUC TRONG NHM

MEPROBAMAT vin nn 200 mg
150
Precyclan vin nn 200 mg

CH KHI CH NH THUC
Chng ch nh: mc 4
Suy h hp: Tng suy h hp.
Lon chuyn ho porphyrin: Chng ch nh dng meprobamat ngi lon
chuyn ho porphyrin, v tc dng cm ng enzym ca n c th dn n cn ri lon
porphyrin.
n ung-ru: Tng tc dng an thn do ru.
Thi k cho con b: Nguy c an thn v ri lon tiu ho tr s sinh.
Thn trng: mc 2
Thi k mang thai: Cn trnh dng trong nhng thng u ca thai k, an ton
s dng carbamat cha c xc nh chc chn. Hn na, nu dng meprobamat di
ngy c nguy c gy hi chng cai (kch ng, mt ng, trm cm v i khi c cn co
git ton th).
Nhc c: Do tnh cht doi c ca cc carbamat.
Cn theo di: mc 1
Suy thn: ngi suy thn, c s tch lu km tng c tnh.
TNG TC THUC
Benzodiazepin
n gim tnh to ngi li xe v ngi vn hnh my mc. Khuyn khng ung
ru, v khng t dng thuc hoc ch phm c ru.
Ru
an thn. Vi mt s thuc, c th thy, nht l trong tun u iu tr, mt s tc dng
tm thn vn ng. Tng tc dc lc.
X l: Tt hn, khng nn phi hp hai thuc, v ngi k n khng ch ng
c ngi bnh ung ru. Nguy c an thn c bit nguy him ngi li xe v s
dng my mc. Khuyn ngi bnh khng ung ru, khng t dng thuc hoc cc
ch phm c ru.
Baclofen; benzamid; butyrophenon; carbamazepin; dextropropoxyphen; thuc
chng ng kinh khng barbituric; thuc c ch h thn kinh trung ng cc loi
151
X l: Lu nguy c ny iu chnh liu lng ca hai thuc, nu cn phi
hp ny. Ngh n gim tnh to ngi li xe v ngi vn hnh my mc. Khuyn
khng ung ru, khng t dng cc thuc hoc cc ch phm c ru.
Buspiron; clozapin; gluthetimid hoc thuc tng t; interferon alpha ti t
hp; medifoxamin; methyldopa; paroxetin; phenothiazin; primidon hoc dn cht;
procarbazin; thuc an thn kinh cc loi
X l: Lu nguy c ny iu chnh liu lng ca hai thuc. Ngh n gim
tnh to ngi li xe v ngi s dng my mc. Khuyn khng ung ru, v khng
an thn. Tng tc dc l. Nn nh rng rilmenidin vi liu thng dng khng lm
tng tc dng c ch h thn kinh trung ng ca nhng thuc .
hp ny. Ngh n gim tnh to ngi li xe v ngi vn hnh my. Khuyn khng
ung ru, v khng t dng thuc v cc ch phm c ru.
amphetamin.
X l: Lu tng tc dc l ny xc nh mc tiu iu tr chnh. Khuyn ngi
bnh gp li thy thuc nu thy kt qu iu tr khng n nh.
Cht ch vn morphin
hp ny. Ngh n gim tnh to ngi li xe v ngi vn hnh my. Khuyn khng
ung ru v khng t dng thuc hoc ch phm c ru.
Fluvoxamin; fluoxetin; khng histamin khng H1 an thn; oxaflozan thuc
chng trm cm ba vng hoc thuc tng t barbituric; viloxazin
X l: Phi tnh n nguy c ny iu chnh liu lng ca hai thuc. Ngh
n gim tnh to ngi li xe hoc vn hnh my. Khuyn khng ung ru v
khng t dng thuc hoc ch phm c ru.
Methadon
152
Phn tch: Tng tc dng c ch h thn kinh trung ng, km theo an thn
mnh, c bit c hi cho ngi li xe v vn hnh my mc.
X l: Phi lu n tng tc dng an thn ny cho nhng li khuyn thch
hp: trnh li xe, khng vn hnh my mc, thng bo cho ngi xung quanh bi t mi
nguy him.
X l: Nu cn phi hp hai thuc, lu n nguy c ny khi gy m v khi chn
liu. Khuyn ngi bnh sp c phu thut, bo cho thy thuc gy m bi t cc
thuc ang dng.
CARBAMAZEPIN
Thuc chng ng kinh, chng au dy thn kinh
CC THUC TRONG NHM

CARBAMAZEPIN vin nn 200 mg; vin bao phim 200 mg; siro 2%
Tegretol vin nn 200 mg
Tegretol siro 2%
Tegretol CR vin bao phim 200 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Lon chuyn ho porphyrin: Tng nguy c ln cn.
Trng hp khc: Bloc nh - tht, gim sn ty.
Thi k cho con b: Carbamazepin qua c sa m; khng nn cho con b.
Thi k mang thai: Nh vi mi thuc chng ng kinh, c nguy c d tt bm
sinh, nht l trong ba thng u.
Cn theo di: mc 1
n ung-ru: Trnh ung ru; carbamazepin lm tng tc dng ca ru.
Tr em, tr ang b: Nguy c thiu ht vitamin K1 tr ra c m iu tr
bng carbamazepin.
Glocom: Nu gp qu liu carbamazepin, c th gy ri lon v mt (gin ng
t, rung git nhn cu).
153
Ph i tuyn tin lit/ u tuyn tin lit: Do nguy c b tiu tin, trong trng
hp qu liu.
Suy tim/ ngi cao tui: Ngi suy tim v ngi cao tui nhy cm hn vi c
tnh tim mch ca carbamazepin (nhp tim nhanh, h huyt p, trng thi sc).
Suy gan: Suy gan dn n tch lu carbamazepin trong c th v do tng tc
dng c ch h thn kinh trung ng.
Suy thn: Suy thn dn n tch lu carbamazepin trong c th v do tng tc
dng c ch h thn kinh trung ng.
TNG TC THUC
Thuc c ch MAO
Phn tch: Cn tng huyt p, co git nng do st cao v t vong xy ra khi
dng thuc chng trm cm ba vng cng vi thuc c ch MAO. V cu trc,
carbamazepin c s tng ng vi thuc chng trm cm ba vng. V vy v l thuyt,
chng ch nh dng carbamazepin cng vi thuc c ch MAO.
X l: Tng tc ny phi cm. Sau khi ngng thuc c ch MAO, phi ch t
nht 2 tun mi c dng carbamazepin v ngc li cng vy.
Clozapin
an thn. Tng tc dc lc. Vi clozapin, tng nguy c gim bch cu.
X l: Lu nguy c ny iu chnh liu lng ca hai thuc, nu cn phi hp
ny. Ngh n gim tnh to ngi li xe v ngi vn hnh my mc. Khuyn khng
Benzodiazepin
X l: Phi lu nguy c ny iu chnh liu lng ca hai thuc. Ngh n
gim tnh to ngi li xe v ngi vn hnh my mc. Khuyn khng ung ru v
khng t dng cc thuc hoc cc ch phm c ru.
Isoniazid hoc thuc tng t
Phn tch: Tng tc dng khng mong mun ca hai thuc ngi chuyn ho
acetyl chm. S c ch chuyn ho ca carbamazepin do isoniazid c th dn n cc
du hiu qu liu.
X l: Cn trnh dng phi hp ny, do nguy c tc dng khng mong mun c
th xut hin.
Lithi
154
Phn tch: Nguy c triu chng c thn kinh nh ng lm, yu c, mt iu vn,

run, tng phn x ngay c vi liu bnh thng, do tc dng hip ng. Ngi thi u
nng tuyn gip c th c bit nhy cm.
X l: Phi hp ny cn trnh, nhng cng c mt s thy thuc chuyn
khoa s dng trong mt s chng trm cm kh cha.
Phn tch: Tng chuyn ho ca estroprogestogen gan, do cm ng enzym bi
carbamazepin, do c nguy c mang thai.
X l: Trnh dng cc thuc nga thai liu thp v nn dng cc thuc nga thai
liu cao hoc khuyn dng mt phng php nga thai khc nu iu tr cng vi
carbamazepin ko di (th d ph n tr tui b ng kinh), v cm ng enzym khng
bao gi l hin tng tc th.
Macrolid
Phn tch: Nng carbamazepin trong huyt thanh v c tnh c th tng. C
ch do c ch chuyn ho ca carbamazepin gan, dn n gim thanh l c thuc
ny.
X l: Hoc chn dng cc khng sinh khc hoc cc macrolid khc khng gy
nh hng (roxithromycin, azithromycin...) hoc iu chnh liu ca carbamazepin tu
theo kt qu nh lng trong huyt tng. Theo di cht cc du hiu ng c nu c.
Mefepriston
Phn tch: Nguy c gim hiu lc ca liu php do tng chuyn ho mefepriston
v cm ng enzym.
X l: Trc tin phi nh rng cm ng enzym l hin tng chm xut hin
(chng ba tun) v chm mt i. C th xem xt tng liu.
Phn tch: Tng chuyn ho ca cc thuc nga thai progestogen gan do cm
ng enzym, do c nguy c mang thai.
liu cao hoc khuyn dng mt phng php nga thai khc nu iu tr bng cht
cm ng ny ko di (cm ng enzym khng bao gi l mt hin tng tc th).
Natrivalproat hoc dn cht
Phn tch: C th tng c tnh m khng tng tc dng chng ng kinh. Nng
ca valproat trong huyt tng thng gim v nng ca cht chuyn ho c
hot tnh ca carbamazepin trong huyt tng thng tng.
X l: Theo di nng cc thuc trong huyt thanh v nhn xt tc dng chng
ng kinh, v c tnh khi bt u, khi ang v khi ngng iu tr bng mt trong hai
thuc. iu chnh liu nu cn.
Ritonavir
Phn tch: Nng carbamazepin trong huyt thanh c th tng, gy tng nguy
c c tnh, cn nng ritonavir c th gim, dn n tht bi iu tr chng
155
retrovirus. C ch nghi c s c ch chuyn ho ca carbamazepin gan (CYP 3A4),

cn carbamazepin c th gy cm ng chuyn ho ca ritonavir. Tng tc ca
carbamazepin vi cc cht c ch protease khc (lopinavir, indinavir, nelfinavir,
saquinavir, amprenavir) cng xy ra tng t nh ritonavir.
X l: Theo di cht ch nng carbamazepin trong huyt thanh khi bt u,
khi ngng hoc thay i liu ca cht c ch protease v theo di p ng lm sng
vi vic iu tr bng cht c ch protease. iu chnh liu nu cn.
Ru
an thn. C th thy vi mt s sn phm, nht l trong tun u iu tr, mt s tc
dng tm thn vn ng. Tng tc dc l.
X l: Tt nht, khng nn phi hp hai thuc, v ngi k n khng ch ng
c ngi bnh ung ru. Nguy c an thn c bit nguy him vi ngi li xe v
ngi vn hnh my mc. Khuyn khng ung ru v khng t dng cc thuc hoc
cc ch phm c ru.
Baclofen; buspiron; dantrolen; medifoxamin;
procarbazin; thuc an thn kinh cc loi
paroxetin;
phenothiazin;
n gim tnh to ngi li xe v ngi vn hnh my mc. Khuyn khng ung ru
Benzamid; carbamat hoc thuc tng t; dextropropoxyphen; thuc c
ch h thn kinh trung ng cc loi
X l: Lu nguy c ny iu chnh liu ca hai thuc, nu cn phi hp ny.
Ngh n gim tnh to ngi li xe v ngi vn hnh my mc. Khuyn khng ung
Butyrophenon
an thn. Cng nh rng c nguy c gim hm lng ca haloperidol trong huyt tng
( do cm ng enzym) km nguy c tht bi iu tr.
X l: Lu nhng nguy c ny iu chnh liu ca hai thuc lc bt u, khi
ang v sau khi iu tr cng vi carbamazepin, nu cn phi hp ny. Ngh n gim
tnh to ngi li xe v ngi vn hnh my mc. Khuyn khng ung ru v khng
Ciclosporin
156
Phn tch: Hm lng cyclosporin trong huyt tng c th gim, dn n gim

tc dng dc l. C ch do carbamazepin c th cm ng enzym xc tc cho chuyn
ho cyclosporin microsom gan.
X l: Theo di hm lng cyclosporin v quan st ngi bnh v nhng du
hiu thi mnh ghp hoc c tnh nu a thm hoc ngng carbamazepin trong
phc iu tr. iu chnh liu ca cyclosporin, nu cn.
Cimetidin
Phn tch: Nng carbamazepin trong huyt tng c th tng, dn n c
tnh. C ch do cimetidin c ch chuyn ho carbamazepin gan.
X l: Theo di nng carbamazepin trong huyt thanh v quan st ngi bnh
v cc du hiu c gan khi bt u iu tr bng cimetidin. iu chnh liu cho ph
hp. Cn nhc li nhng du hiu lm sng ca qu liu carbamazepin (xut hin t 1
n 3 gi sau khi ung): cc triu chng thn kinh c, ri lon tim mch, co git (nht
l tr nh), kch thch vn ng, rung git c, run, ri lon iu vn, chng mt, gin
ng t, rung git nhn cu, biu hin tm thn vn ng, tng ri gim phn x.

Phn tch: Tc dng hip ng trn hot tnh c ch h thn kinh trung ng.
Ch n ngi bnh ngoi tr, ngi li xe hoc vn hnh my mc. Nn nh rng
vi liu thng thng, rilmenidin khng lm tng cc tc dng c ch h thn kinh trung
ng ca nhng thuc ny.
Corticoid khong (Mineralocorticoid)
Phn tch: Carbamazepin gy cm ng enzym, lm tng d ho cc
mineralocorticoid. Cm ng enzym ch th hin 10 - 12 ngy sau lc bt u iu tr.
X l: Cm ng enzym khng phi l mt hin tng tc thi. Vic iu tr cng
vi mt thuc cm ng enzym trung v di hn phi tnh n nguy c gim tc d ng
iu tr. iu chnh liu trong khi iu tr v sau khi ngng cht cm ng.
Danazol
Phn tch: Nng carbamazepin trong huyt thanh c th tng, dn n tng
tc dng dc l v c tnh. C ch do danazol c ch chuyn ho ca
carbamazepin.
X l: Nu c th, nn trnh phi hp ny. Khi cho dng c hai thuc ny, cn
theo di hm lng carbamazepin trong huyt thanh v quan st ng i bnh v cc
du hiu c tnh sau khi bt u iu tr bng danazol. ngi bnh n nh vi
carbamazepin, c th cn phi thay i liu khi bt u hoc ngng danazol.
Desmopressin
157
Phn tch: Desmopressin l cht tng t hormon khng niu t nhin:

vasopressin. Gim tc dng khng niu bi tnh trng gim natri mu do carbamazepin
gy ra.
X l: Theo di lm sng v iu chnh liu ca desmopressin tu theo kt qu
sinh hc v lm sng.
Diltiazem; verapamil
Phn tch: Tng tc dc ng hc lm tng nhiu hm lng ca
carbamazepin trong huyt thanh do c ch enzym xc tc cho chuyn ho ca thuc
ny.
X l: Hoc chn mt thuc i khng calci khc khng c nhc im ny, hoc
iu chnh liu lc bt u, khi ang v khi ngng iu tr cng vi mt trong cc thuc.
Gim liu ca carbamazepin.
Disopyramid
Phn tch: Do cm ng enzym lm gim nng ca disopyramid trong huyt
thanh ti nng khng hiu lc.
X l: Theo di in tm , lm sng, nng ca thuc chng lon nhp trong
huyt thanh v tu theo trng hp iu chnh liu.
Fluoxetin; fluvoxamin
Phn tch: Nguy c tng hm lng carbamazepin trong huyt thanh km nguy c
qu liu.
X l: Theo di lm sng v sinh hc. c bit, kim tra nng carbamazepin
trong huyt tng lc bt u, khi ang v khi ngng iu tr vi thuc chng trm cm
serotoninergic thun tu (fluoxetin, fluvoxamin).
Glucocorticoid
Phn tch: Tng d ho ca cc thuc ny bi cc cht cm ng enzym
(carbamazepin). Cm ng enzym ch th hin sau nhiu ngy iu tr.
Hormon tuyn gip
Phn tch: Tng d ho ca thuc phi hp bi thuc cm ng enzym
(carbamazepin). S cm ng ch th hin 10-12 ngy sau lc bt u iu tr.
Quinidin hoc dn cht
Phn tch: Tng chuyn ho gan bi cm ng enzym, dn n gim tc dng
ca quinidin (v dn cht). iu chnh liu. Khi cn, th phi theo di cn thn cc hm
lng trong huyt tng v cnh gic khi ngng iu tr.
158

ru.
Rifampicin
Phn tch: Tng chuyn ho gan do cm ng enzym, dn n gim tc dng
ca carbamazepin. iu chnh liu. Khi cn, th phi theo di cn thn cc hm l ng
trong huyt tng v cnh gic khi ngng iu tr.
Tetracosactid
Phn tch: Tng d ho cc adrenocorticoid bi thuc cm ng enzym. S cm
ng ch th hin 10 - 12 ngy sau lc bt u iu tr.
Tetracyclin
Phn tch: Tng d ho doxycyclin gan, do cm ng enzym. Mc du tng tc
ny cha c xc nh i vi cc tetracyclin khc khng b o thi qua ng ti t
niu, cng vn buc phi thn trng.
X l: Tng tc ny cn nhiu ngy iu tr c th ghi nhn c s cm
ng enzym. C nguy c tht bi iu tr nu nng c ch ti thiu ca khng sinh
khng i vi mm bnh. Lu nguy c v tu trng hp chn hoc khuyn dng
mt chin lc khng sinh khc.
Phn tch: Hm lng theophylin c th tng hoc gim. Hm lng
carbamazepin c th gim. C ch: C th c s cm ng chuyn ho ln nhau gan.
X l: Theo di hm lng ca theophylin v carbamazepin. iu chnh liu ca
hai thuc ny cho ph hp.
Thuc chng ng kinh khng barbituric
an thn. Hn na, thy c s gim nng ethosuximid trong huyt tng, c l do
cm ng enzym.
ru v khng t dng thuc hoc ch phm c ru. Theo di lm sng hiu qu
ca iu tr chng ng kinh. iu chnh liu nu cn, tu theo nng trong huyt
tng.
Phn tch: Nng carbamazepin trong huyt tng c th tng, lm tng tc
dng lm sng v tc dng khng mong mun. C ch: c th do thuc chng nm
159
azol c ch chuyn ho ca carbamazepin (CYP 3A4). Fluconazol, c bit l vi liu

qu 200mg/ngy, c th c ch CYP3A4.
X l: Theo di cht ch nng carbamazepin v p ng lm sng ca ngi
bnh khi bt u dng hoc khi ngng thuc chng nm azol.
Phn tch: To thun li xut hin cn co git do hai c ch: Gim ngng gy
ng kinh bi thuc chng trm cm nhm imipramin v tng chuyn ho ca thuc
chng trm cm ny, do cm ng enzym, dn n km hiu qu hn.
X l: Ngoi vic theo di hiu qu lm sng, nn iu chnh liu ca nhng
thuc ny lc bt u, lc ang v sau iu tr.
Phn tch: Vic s dng lu di cc carbamazepin c nguy c dn n to thnh
cc cht chuyn ho c vi gan ca cc thuc gy m bay hi cha halogen
(enfluran, halothan, methoxyfluran).
X l: Khuyn ngi bnh phi can thip ngoi khoa, thng bo cho ngi gy
m nhng thuc ang dng.
Phn tch: Tc dng chng ng ca warfarin c th gim khi dng cng vi
carbamazepin. C ch cha r, nhng c th do carbamazepin gy cm ng chuyn
ho ca thuc chng ng gan.
X l: Theo di thi gian prothrombin khi bt u hoc ngng iu tr
carbamazepin ngi bnh ang dng warfarin. iu chnh liu ca warfarin khi cn.
Viloxazin
Phn tch: Ba tc dng c ghi nhn l gim ngng gy ng kinh bi
viloxazin, c ch cnh tranh s hydroxyl ho, lm cho d ho carbamazepin b gi m,
tng tc dng c ch h thn kinh trung ng, dn n tng tc dng an thn. Tng
tc dc lc.
Zidovudin
Phn tch: Ngoi suy t rifampicin v rifabutin, gim nng ca zidovudin do
tng chuyn ho (cm ng enzym).
X l: Nu nhn thy gim p ng vi zidovudin, iu chnh liu zidovudin.
Phn tch: Tc dng i khng, c th tng tnh hung hn ngi nghin
amphetamin.
160

ngi bnh gp li thy thuc nu thy iu tr t ra khng n nh.
Phn tch: Gim nng carbamazepin trong huyt thanh, c th dn n gim
tc dng ca thuc ny. C ch: do cm ng chuyn ho ca carbamazepin gan
(epoxy ho).
X l: Theo di nng carbamazepin trong huyt thanh v quan st ngi bnh
v gim hiu lc ca thuc ny. Xem xt vic ngng barbituric hoc iu chnh liu
ca carbamazepin nu cn.
Cht ch vn morphin; khng histamin khng H1 an thn; methyldopa;
oxaflozan
Citalopram
liu.
Phn tch: Tng hm lng carbamazepin trong huyt tng km nguy c qu
X l: Theo di hm lng carbamazepin trong huyt tng v s xut hin cc

du hiu qu liu (ng g/ l ln, ). Gim liu, nu cn.
Glycosid tr tim
Phn tch: Tng chuyn ho gan do cm ng enzym, dn n gim tc d ng
ca dn cht digitalis c chuyn ho (tc l digitalin, tri vi digoxin).
X l: Lu nguy c ny iu chnh liu ca digitalin (digoxin c o thi
qua ng thn), nu cn phi hp ny. iu chnh liu trong v sau khi iu tr v i
carbamazepin.
Methadon
Phn tch: Tc dng dc l ca methadon c th gim. Ngi bnh ang dng
methadon duy tr chng trnh cai nghin ma tu c th b cc triu chng cai. C
ch: nghi do tng chuyn ho methadon gan.
X l: ngi bnh ang dng carbamazepin, c th cn dng methadon vi liu
cao hn.
Phenytoin
Phn tch: Tng chuyn ho gan, do cm ng enzym, dn n gim tc dng
ca hai thuc.
X l: iu chnh liu lc bt u, khi ang v sau khi iu tr vi mt trong hai
thuc. Nu cn, th theo di cn thn cc hm lng trong huyt tng, v cnh gic
khi ngng dng mt trong hai thuc. Cn theo di.
Progabid
161
Phn tch: Tng tc dc ng hc. Tng chuyn ho gan, do cm ng

enzym dn n gim tc dng ca progabid.
X l: Progabid l thuc chng ng kinh la chn hng th hai, c vi gan. Nn
tnh n nguy c tht bi iu tr. iu chnh liu.
CARMUSTIN
Thuc km t bo alcoyl ho
CC THUC TRONG NHM
CARMUSTIN bt pha dung dch tim 100 mg/l
Bicnu bt pha dung dch tim 100 mg/l
CH KHI CH NH THUC
Phi l thy thuc chuyn khoa mi c k n dng nhng thuc ny cho
ngi bnh. V vy, cc chng ch nh phi c cn nhc, tu theo tnh trng ngi
bnh, v phi c thy thuc chuyn khoa nh gi.
TNG TC THUC
thn. Hip ng cc tc dng khng mong mun.
X l: Cc phi hp thuc ny hay gp, nht l bnh vin: mc du tim mt
liu duy nht mi ngy hn ch c c vi thnh gic v vi thn, nhng khi cn phi
hp, nn tin hnh iu chnh liu tu theo thanh lc creatinin (cng thc Cockroft
v Gault). c bit, phi gim st ngi bnh cao tui.
Cht c ch HMG - CoA reductase
Phn tch: S dng ng thi vi cc thuc c ch min dch lm tng nguy c
xut hin tiu c vn v suy thn.
X l: Tuy cc bo co ch lin quan n lovastatin, nguy c tim tng vn c vi
simvastatin v pravastatin. Cn trnh phi hp.
Tacrin
X l: Nu cn, tng cng theo di gan. Trnh cc phi hp c nguy c ngi
cao tui.
Vaccin sng gim c lc
162
Phn tch: Nguy c xut hin nhim khun ng vi vaccin, do tc dng c ch

min dch ca thuc phi hp.
X l: Khong thi gian cn tn trng gia hai thuc t ba thng n mt nm v
tu thuc vo cng ca s c ch min dch.
Actinomycin D
Phn tch: Nguy c tng c tnh v mu do c ch tu xng, do tc dng hip
ng, c th dn n mt bch cu ht.
X l: Nu cn phi hp, nn dng liu thp vi tng thuc. Theo di cn thn
huyt .
Amineptin; dantrolen; estrogen hoc thuc nga thai estroprogestogen;
fluvoxamin; griseofulvin; isoniazid hoc thuc tng t; macrolid; natri valproat
hoc dn cht; progabid; rifampicin; thuc chng nm, dn xut imidazol
khng mong mun).
gan (ASAT, ALAT, phosphatase kim, bilirubin), hoc, nu c th, hon mt trong hai
thuc. Xc minh l ngi bnh khng ung ru thng xuyn, v khng c ti n s
vim gan virus. Cc triu chng lm sng chnh khng c hiu l bun nn, st, vng
da,... Phi hp ban da, nga v hch to, minh chng cho bnh cn do thuc. Phn bit
r, tu theo kt qu xt nghim sinh hc, nguy c xut hin vim gan tiu t bo khng
hi phc vi vim gan mt hi phc c khi ngng iu tr.
Amphotericin B
Phn tch: Phi hp amphotericin B tim vi cc thuc c vi tu xng i hi
phi tht thn trng. Nguy c thiu mu hoc cc ri lon huyt hc khc.
X l: Nu cn phi hp, nn theo di cn thn huyt , v nu cn, thc hin
gim liu.
Azathioprin; cisplatin hoc dn cht; cyclophosphamid hoc thuc tng
t; doxorubicin hoc dn cht; fluoro-5-uracil; ganciclovir; interferon alpha ti t
hp; levamisol; melphalan; mercaptopurin; methotrexat; procarbazin; thiotepa;
Thuc chng ung th cc loi; vincristin hoc thuc tng t
Phn tch: Nguy c tng c tnh v mu, do c ch tu xng, do tc dng hip
X l: Nu c th c, trnh phi hp. Nu phi hp xt thy c li, dng liu
thp vi tng cht v theo di cn thn huyt . Phi hp thuc ny phi do cc nh
chuyn khoa thc hin v cc phc iu tr thng c xc nh r.
Cc phenicol
ng, c th dn n mt bch cu ht. Vi cc phenicol, ch dng n c cng c
th gy mt bch cu ht nghim trng, thm ch gy t vong (c tnh min dch).
163
X l: Nu cn phi hp, nn dng cc liu thp cho tng thuc. Khng c g bo

trc mt bch cu ht vi cc phenicol. Vic theo di cn thn huyt , thc hin
bnh thng khi s dng mt thuc km t bo, vn c gi tr. Tuy nhin, ng i bnh
phi c thng bo l nu st nh, vim hng v lot ming th phi ngng iu tr vi
phenicol.
Ciclosporin
Phn tch: Phi hp hai thuc c tnh cht c ch min dch. Do s c ch min
dch ny qu mnh, c nguy c pht trin u lympho gi.
X l: Phi hp hai thuc c ch min dch phi c suy xt v phi cn nhc
nguy c/ li ch, tu theo mc tiu iu tr. Phi hp ny ch c th tin hnh c s
chuyn khoa vi s theo di cht ch ngi bnh.
Cimetidin
Phn tch: Cimetidin c th lm tng tc dng c ch tu xng ca carmustin v
c th dn n c tnh. C ch cha xc nh r, nhng c th do hip ng tc dng
c ch tu xng hoc do c ch chuyn ho carmustin bi cimetidin.
X l: Trnh dng hai thuc ny cng nhau, tr khi khng c cch la chn no
khc.
Clozapin
ng, c th dn n mt bch cu ht. Vi clozapin hoc noramidopyrin dng n
c, cng c th gy mt bch cu ht nghim trng, thm ch gy t vong ( c tnh
min dch).
X l: Trnh phi hp. Nu cn phi hp, dng liu thp cho tng thuc. Khng
c g bo trc mt bch cu ht vi clozapin. Vic theo di cn thn huyt , ti n
hnh bnh thng khi s dng mt thuc km t bo, vn c gi tr. Tuy nhin ngi
bnh phi c thng bo l nu st nh, vim hng v lot ming th phi ngng iu
tr.
Phn tch: S dng ng thi mt thuc km t bo v mt thuc chng bnh gt
lm tng hm lng acid uric. Ngoi ra cn tng nguy c gim bch cu v gim tiu
cu do hip ng cc tc dng khng mong mun ca cc thuc.
X l: Nn trnh dng hai thuc ng thi, nu khng iu tr chng gt s tht
bi. Nn dng alopurinol (thuc c ch tng hp acid uric) hn l dng cc thuc gy
acid uric niu trnh cc bnh thn.
Glycosid tr tim
Phn tch: Phi hp vi thuc km t bo dn n km hp thu cc thuc nhm
digitalis khong 50%, do tn thng nim mc rut c hi phc.
tr.
X l: Theo di cn thn hm lng digitalis trong huyt thanh trong thi gian iu
Foscarnet
164
Phn tch: Phi hp hai thuc c vi thn dn n nguy c xut hin suy thn
khng hi phc.
X l: Thng iu tr phi hp thuc bnh vin. Theo di u n ion v
thanh lc creatinin v iu chnh liu theo .
Phn tch: Mc tiu chnh l iu tr ung th tuyn thn. Interleukin cng c vi
gan. Nh vy l s phi hp hai thuc c tim nng c vi gan, c vi thn v c
ch tu xng.
X l: Vic iu tr ch c th tin hnh ti c s chuyn khoa. Interleukin i hi
c s theo di thng xuyn. Trng hp ny nn cn nhc tu theo tnh trng chung
ca ngi bnh. Khi phi hp hai thuc c vi gan, c vi thn v c ch tu xng,
cn theo di cht ch huyt , chc nng thn v gan (ASAT, ALAT, phosphatase
kim, bilirubin, creatinin mu) hoc hon dng mt trong hai thuc, nu c th c.
Niridazol
Phn tch: Phi hp hai thuc c vi gan. Niridazol cn c c tnh thn kinh.
Nguy c xut hin co git, ri lon tm thn v c vi gan trong trng hp phi hp
thuc.
X l: Khi phi hp hai thuc c vi gan, phi theo di cht ch chc nng gan
(ASAT, ALAT, phosphatase kim, bilirubin) hoc, nu c th c, hon dng mt trong
hai thuc. Xc minh l ngi bnh khng ung ru thng xuyn v khng c tin s
vim gan do virus. Nhng triu chng lm sng chnh khng c hiu l bun nn, st,
vng da,... Phi hp ban da, nga v hch to minh chng cho bnh cn do thuc. Cn
phn bit r, cn c theo kt qu xt nghim sinh hc, nguy c xut hin vim gan tiu
t bo khng hi phc vi vim gan mt hi phc c khi ngng iu tr.
Paracetamol
Phn tch: Paracetamol dng ko di vi liu trn 6 gam/ ngy (tu theo th trng)
s c vi gan (vim gan kiu tiu t bo). Khi phi hp vi mt thuc khc c v i
gan, nguy c c vi gan tng.
(ASAT, ALAT phosphatase kim, bilirubin), hoc phi hon mt trong hai thuc, nu c
th c. Xc minh l ngi bnh khng ung ru thng xuyn, v khng c tin s
vim gan do virus. Cc triu chng lm sng chnh khng c hiu l bun nn, s t,
vng da Phi hp ban da, nga v hch to minh chng cho bnh cn do thuc. Phn
bit r, tu theo kt qu xt nghim sinh hc, vim gan tiu t bo khng hi phc vi
vim gan mt hi phc c khi ngng iu tr.
ng, c th dn n bt sn ty.
X l: Nu cn phi hp, nn dng liu thp cho mi thuc v theo di cn thn
huyt .
Pentostatin
165
Phn tch: Dng phi hp hai thuc c ch tu xng c th dn n ri lon

mu nng tu theo di thi gian iu tr
X l: Phi hp cn theo di v mt huyt hc.
Vng
Phn tch: Phi hp hai thuc c tim nng c vi gan v c vi mu.
X l: Khi phi hp hai thuc c vi gan v c vi mu, phi theo di ch t
ch chc nng gan (ASAT, ALAT, phosphatase kim, bilirubin) v huyt hoc hon
mt trong 2 thuc, nu c th c. Xc minh l ngi bnh khng ung ru thng
xuyn v khng c tin s vim gan do virus. Cc tri u chng lm sng chnh khng
c hiu l bun nn, st, vng da Phi hp ban da, ng a v hch to minh ch ng
cho bnh cn do thuc. Phn bit r, tu theo kt qu xt nghim sinh h c, nguy c
xut hin vim gan tiu t bo khng hi phc vi vim gan mt hi phc c sau
khi ngng iu tr.
Zidovudin
Phn tch: Phi hp zidovudin vi cc cht c hi vi tu xng i hi phi tht
thn trng. Nguy c thiu mu hoc ri lon huyt hc khc.
X l: Khi cn phi hp thuc, phi theo di cn thn huyt v thc hin gim
liu, nu cn.
CAROTENOID
Cc tin cht vitamin A, dng gim cc phn ng nhy cm nh sng
CC THUC TRONG NHM

BETA - CAROTEN vin bao 100 mg
Difrarel 100, vin bao 100 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Glocom: Tng trng lc trong mt c th to thun li xut hin cc cht ngng
ng vng mc. Do , chng ch nh dng, khi b glocom hoc b tn thng vng
mc.
Thi k mang thai: Cc thuc ny i qua hng ro nhau - thai v c nguy c mc
bnh tch lipid m li (thesaurismose).
Thi k cho con b: Cc thuc trn qua c sa m.
166
CEPHALOSPORIN HOC THUC TNG T

Cc khng sinh dit khun h beta- lactam. Nhm ny khng bao gm cc
cephalosporin c nhn thiomethyltetrazol trong cu trc ( ring)
CC THUC TRONG NHM
CEFACLOR nang 250mg; 500mg; bt pha hn dch 125 mg/5 mL; 250 mg/5 mL;
vin nn 500mg; 375 mg
Ceclor nang 250mg; bt pha hn dch 125 mg/5 mL; 250 mg/5 mL
Ceclor CD vin nn 500mg
Cefaclor nang 250mg
Cefaclor C 500, Stada vin 500mg
Cleancef nang 250mg
Clex nang 250mg
Cloracef nang 250mg
Cloracef forte nang 500mg
Mekocefaclor nang/cm 250mg
Declor nang 250mg
Ilclor nang 250mg
Keflor nang 250mg
Keflor MR vin nn 375mg
Medoclor nang 250 v 500mg
Keflor bt pha hn dch 125mg/5mL
Nockwoo-cefaclor nang 250mg
Panacef nang 250mg
CEFADROXIL nang 500mg; bt pha hn dch 250mg/5mL; bt pha siro
125mg/5mL; 250mg/5mL
Sonben nang 500mg; bt pha hn dch 250mg/5mL
Biodroxil nang 500mg; bt pha hn dch 250mg/5mL
Dexacef nang 500mg ; bt pha siro 125mg/5mL
Opedroxil bt pha hn dch ung 250mg/5mL
Oracefal bt pha siro 250mg/5mL
Oracefal nang 500mg
Mekocefal nang 500mg
167
Medicefa nang 500mg

CEFALEXIN nang 250mg; 500 mg; hn dch ung 125mg/5mL; 250 mg/5 mL;
thuc bt 250mg
Cephalexin nang 250mg; 500 mg
Cefrax nang 500mg
Servispor nang 250mg
Servispor hn dch ung 125mg/5mL; 250 mg/5 mL
Meko-Cepha thuc bt 250mg
Ospexin nang 250mg ; 500 mg
Cephalexin nang 250mg v 500mg
Ceporex thuc tim l 1g ; siro 125 mg/5mL ; 250 mg/5mL
Ceporex vin nn, nang 250 v 500mg
Sepexin nang 250 mg; 500 mg
Keflex nang 250 mg; hn dch 125 mg/ 5 mL
CEFALORIDIN l 0,5g; 1g
Ceporin bt pha tim l 0,5g; 1g
CEFEPIM l 0,5g; 1g; 2 g
Axepim bt pha tim l 0,5g; 1g; 2g
Maxipime bt pha tim l 1g/l
CEFALOTIN l 1g
Cefalotine Panpharma bt pha tim l 1g
Intralotine bt pha tim l 1g
Pan-Cefalotin bt pha tim l 1g
CEFAPIRIN l 1g
Cefaloject bt pha tim l 1g
CEFATRIZIN nang 500mg; bt pha hn dch ung 125mg/5mL; 250mg/5mL;
500mg/5mL
Cefaperos nang 500mg; bt pha hn dch ung 125mg/5mL; 250mg/5mL;
500mg/5mL
CEFETAMET PIVOXIL vin nn bao 500mg
Tarcevis vin nn bao 500mg
CEFOTAXIM l 0,5g; 1g; 2g
Clacef bt pha tim l 1g
Claforan bt pha tim l 0,5 g; 1g; 2 g
168
Fortax bt pha tim l 1g

Fotaran 1g/l
Petcef bt pha tim l 1g
Kalfoxime l 0,5 g; 1g; 2g
Itrazoline l 1 g
Lyforan l 1 g
CEFIXIM vin nn 200 mg; cm pha hn dch 100 mg/5mL
Cifex vin nn 200 mg ; cm pha hn dch 100mg/5mL
CEFOXITIN l 1g; 2g
Cefoxitin Human bt pha tim l 1g
Cefoxitin Human bt pha tim l 2 g
CEFAZOLIN l 1g
Cefazolin l 1g
Cefzone l 1g
CEFRADIN nang 250mg; 500mg; l 1g
Cefadin bt pha tim l 1g
Cefradine bt pha tim l 1g
Doncef nang 250mg; 500mg
Racef nang 250mg; 500mg
Dynacef bt pha tim l 1g
Racef bt pha tim l 1g
CEFTAZIDIM l 250 mg; 500 mg; 1g; 2g
Cefazime bt pha tim l 1g
Fortum bt pha tim l 250 mg; 500 mg; 1g; 2g
Kefadin bt pha tim l 1g
CEFPIROM l 0,5g; 1g; 2g
Cefrom bt pha tim l 0,5g; 1g; 2g
CEFPODOXIM vin nn 100mg; bt pha hn dch ung 100mg/5mL; 40 mg/5mL
Cepodem vin nn 100mg; bt pha hn dch ung100mg/5mL
Orelox vin nn 100mg; hn dch ung 40mg/5mL
CEFTRIAXON l 250 mg; 500 mg; 1g; 2g
Axon bt pha tim l 1g
Cefaxone bt pha tim l 1g
169
Cefin bt pha tim l 1g

Nakaxone bt pha tim l 1g
Rocephine bt pha tim l 250 mg; 500 mg; 1g; 2g
Lyfaxone bt pha tim l 1g
Medocephine bt pha tim l 1g
Tartriakson bt pha tim l 1g
CEFUROXIM vin nn 125 mg; 500 mg; vin nn bao 125 mg; 250 mg; hn dch
ung 125 mg/5mL; vin nn bao 500 mg; l 750 mg
Axetine bt pha tim l 750 mg
Cavumox bt pha tim 750mg
Zinnat vin nn 125 mg; vin nn bao 125 mg; 250 mg; hn dch ung 125
mg/5mL; vin nn 500 mg; vin nn bao 500 mg
Tarsime bt pha tim 750mg; 1,5g
Zinacef bt pha tim 750mg; 1,5g
CH KHI CH NH THUC
hp)
Trng hp khc: Tnh n nguy c d ng cho vi penicilin (5-10% trng

Cn theo di: mc 1
n ung - ru: Nguy c thp v tc dng antabuse.
Thi k cho con b: i vi phn ln cc cephalosporin, thuc qua c sa

m rt t.
Thi k mang thai: Cc cephalosporin qua hng ro nhau - thai, nhng khng
thy c tc dng khng mong mun no xy ra cho thai.
Suy thn: c tnh vi thn ca cefaloridin, l cephalosporin th h mt c
xc nh r (bnh thn ng thn k c to thun li bi furosemid). i vi cc
cephalosporin khc, phi iu chnh liu trnh nguy c tch lu.
TNG TC THUC
Aminoglycosid tim hoc dng ti ch
Phn tch: Phi hp vi cefalotin lm tng nguy c c vi thn. Tuy nhin, nguy
c ny cn bn ci v hnh nh ch gii hn thuc ny.
X l: Theo di chc nng thn nu iu tr phi ko di vi mt aminosid tim.
Phn tch: Phi hp cc thuc c vi thn (cefalotin v cefaloridin).
170
X l: Cisplatin c bit c vi thn. Theo di cn thn chc nng thn, nu cn

phi hp, nht l ngi suy thn v ngi cao tui. iu chnh liu tu theo
thanh lc creatinin.
Khng sinh polypeptid; foscarnet
Phn tch: Vi cefalotin v cefaloridin, l phi hp cc thuc c vi thn.
X l: Theo di cn thn chc nng thn, khi cn phi phi hp, nht l ngi
suy thn v ngi cao tui. iu chnh liu tu theo thanh lc creatinin.
Synergistin
Phn tch: Tc dng km khun ca synergistin c th i khng tc dng dit
khun ca cephalosporin. Tc dng dit khun th hin trn cc vi khun ang pht
trin giai on hm s m. S i khng ny c th gy tn hi trong iu tr vim
mng no m ta cn can thip nhanh v mnh.
X l: Phi tnh n nguy c ny tu theo bi cnh sinh bnh l. C th thc hin
phi hp, tu theo thuc dng v cc mm gy bnh (nng ti thiu c ch).
Tetracyclin
Phn tch: Tc dng km khun ca cc tetracyclin c th i khng tc dng dit
khun ca cc cephalosporin. Tc dng dit khun th hin trn cc vi khun ang
pht
trin
giai
on
hm
s
m.
S
i
khng
ny
c th gy tn hi trong iu tr vim mng no, m ta cn can thip nhanh v mnh.
X l: Phi tnh n nguy c ny tu theo bi cnh sinh bnh l. C th thc hin
phi hp, tu theo thuc dng v cc mm gy bnh (nng ti thiu c ch).
Furosemid hoc thuc tng t
Phn tch: Tng tc ch c m t duy nht vi furosemid v cefaloridin
(cephalosporin hin nay t dng). Ring cefaloridin c vi thn, nhng cha r t i sao
c tnh vi thn ny b nng thm bi furosemid. Nhiu cephalosporin khc hnh nh
khng tng tc vi furosemid.
X l: Nghi ng c vi thn tn ti khi phi hp mt vi cephalosporin
vi furosemid. Cn cnh gic v theo di chc nng thn, nu cn phi hp hai thuc
ny. Ch ngi cao tui, nu nghi c nhng bt thng v chc nng thn
Phn tch: Interleukin ch c dng ti c s chuyn khoa. Vi cefalotin v
cefaloridin, y l phi hp cc thuc c vi thn.
X l: iu tr bng interleukin 2 ch c th thc hin ti c s chuyn khoa, do
mc nghim trng ca ch nh. Cc tng tc phi c cn nhc tu theo tnh trng
chung ca ngi bnh. Nu khng th hon mt trong hai iu tr, phi theo di c n
thn ion v thanh lc creatinin.
Probenecid
171
Phn tch: Tng tc dc ng hc. S gim bi tit cc cephalosporin o thi

qua ng thn, dn n tng hm lng cephalosporin trong mu v tng na i o
thi ca khng sinh. C th dng phi hp ny ko di tc dng ca cephalosporin.
172
CEPHALOSPORIN C NHN THIOMETHYLTETRAZOL

Cc khng sinh dit khun h beta lactam c nhn
thiomethyltetrazol trong cu trc
CC THUC TRONG NHM
CEFAMANDOL l 500 mg; 1g; 2g
Mandol bt pha tim l 500 mg; 1g; 2g
Tarcefandol bt pha tim 0,5 v 1g/l
CEFOPERAZON l 1g
Cefapezone bt pha tim l 1g
Cefobis bt pha tim l 1g
Dardum bt pha tim l 1g
Karezon bt pha tim l 1g
CEFOTETAN l 1g
Apacef bt pha tim l 1g
Cefizox bt pha tim l 1g
CH KHI CH NH THUC
Trng hp khc: C tnh n nguy c d ng cho vi cc penicilin (5-10%
trng hp).
Cn theo di: mc 1
n ung - ru: Tc dng antabuse va phi.
Thi k cho con b: Phn ln cc cephalosporin qua sa m rt t.
Thi k mang thai: Cc cephalosporin i qua hng ro nhau - thai, nhng khng
thy bt k tc dng khng mong mun no nng i vi thai.
lu.
Suy thn: iu chnh liu tu theo thanh lc creatinin trnh nguy c tch
TNG TC THUC
Aminoglycosid
Phn tch: c tnh c th tng. Tc dng dit khun i vi mt s tc nhn gy
bnh c th tng. C ch cha r.
X l: Theo di cht ch hm lng aminoglycosid v chc nng thn. Nu xut
hin ri lon chc nng thn, nn gim liu hoc ngng mt hoc c hai thuc v dng
thuc thay th.
173
Heparin; indometacin hoc dn cht; pyrazol; salicylat; ticlopidin; thuc

tiu huyt khi; thuc ung chng ng khng vitamin K
Phn tch: Tng nguy c chy mu, ch yu vi cc cephalosporin c nhn
thiomethyltetrazol (latamoxef, cefoperazon, cefamandol, cefmenoxim, cefotetan). Nhn
ny c tc dng nh mt dn cht coumarin, c tc dng chng ng (khng vitamin
K), do cng thm cc tnh cht chng ng ca n vo nhng tnh cht khng
vitamin K, hoc chng kt tp tiu cu ca cc hp cht khc nhau kho st.
X l: Phi hp ny, ch yu c m t vi latamoxef, khng nn dng, v l do
lm tng nguy c chy mu. c bit, phng khi dng cc liu cao ca nhng khng
sinh ny.
Oxaflozan; ru
Phn tch: Tc dng antabuse (kiu disulfiram) cng thm vi nguy c c vi
gan: hm lng bt thng acetaldehyd tch lu trong cc m (c ch enzym), dn n
mt s du hiu lm sng, nh cn bng vn mch, gin mch nhiu, nhp tim nhanh,
st cao, bun nn, nn, ban da, i khi h huyt p v tru tim mch. Nhng triu
chng ny quan trng t hay nhiu tu theo lng ru ung. Nguy c tc dng
antabuse ch tn ti vi cefamandol, latamoxef, cefoperazon v cefmenoxim. iu ny
l do c mt nhn tetrazol trong nhng phn t ny. Tc dng ny xy ra khi ung ru
sau khi dng cephalosporin (xut hin ngay hoc sau vi ngy). C ch: C s c ch
aldehyd dehydrogenase bi nhm methyltetrazol thiol dn n tch t acetaldehyd.
ru.
X l: Trong khi dng cc cephalosporin ny, khuyn ngi bnh khng ung
Synergistin
Phn tch: Tc dng km khun ca cc synergistin c th i khng tc dng dit

khun ca cc cephalosporin. Tc dng dit khun th hin trn cc vi khun giai
on pht trin theo hm s m. S i khng ny c th gy t n hi trong i u tr
vim mng no,v cn can thip nhanh v mnh.
X l: Phi tnh n nguy c ny tu theo bi cnh sinh bnh l; c th thc hin
phi hp thuc tu theo thuc dng v cc mm gy bnh (nng ti thiu c ch).
Tetracyclin
Phn tch: Tc dng km khun ca cc tetracyclin c th i khng tc dng dit
khun ca cephalosporin. Tc dng dit khun ny th hin trn cc vi khun giai
on sinh trng theo hm s m. S i khng ny c th gy tn hi trong iu tr
vim mng no m ta cn phi can thip nhanh v mnh.
X l: Phi tnh n nguy c ny tu theo bi cnh sinh bnh l; c th thc hin
phi hp thuc tu theo thuc dng v cc mm gy bnh (nng ti thiu c ch).
Probenecid
Phn tch: Tng tc dc ng hc. Gim bi tit cc cephalosporin qua ng
thn, dn n tng hm lng cephalosporin trong huyt thanh v tng na i o
thi ca khng sinh. Cng c th s dng cch phi hp ny ko di tc dng ca
cephalosporin.
174
X l: Xc nh mc tiu iu tr v lu n tng tc ny. liu bnh thng,

vi mt vi cephalosporin, c nguy c c vi thn, mc du cn
bn ci.
CHOLESTYRAMIN
Nha trao i ion, h cholesterol mu. Do nguy c hp thu mi thuc,
cn thn trng khi ngng iu tr
CC THUC TRONG NHM
COLESTYRAMIN gi thuc bt ung 4 g
Questran gi thuc bt ung 4 g
CH KHI CH NH THUC
Thi k mang thai: Tnh v hi ca nha ion ny cha c chng minh ngi
mang thai.
Suy gan: Cholestyramin gi cc acid mt di dng phc hp khng tan, c ch
chu trnh rut- gan ca nhng cht ny v lm tng o thi ra phn. Chng ch nh
cholestyramin cho ngi suy gan v c bit khng c dng cho ngi tc hon ton
ng mt.
Thi k cho con b: Nguy c km hp thu cc vitamin tan trong lipid.
Cn theo di: mc 1
Bnh i trng: Hay gp ri lon tiu ho, nht l vi liu cao, liu tht s c
hiu lc. To bn nhiu, c th dn n hi chng tc gi, l tc d ng khng mong
mun ch yu.
Tr em: tr em cha xc nh c tnh v hi di hn. Hnh nh khng c
bin i v hp thu cc vitamin A v K, mc du c thng bo v mt vi trng hp
chy mu khi iu tr ko di. i khi cng cn b sung vitamin.
TNG TC THUC
Phn tch: Acid ursochenodesoxycholic gp phn lm tng t s acid mt/
cholesterol. Bng cch thit lp li cn bng cc thnh phn ca mt, thuc ny c th
gp phn lm thoi trin cc si mt cha cholesterol. Bng cch to phc hp vi acid
ursodesoxycholic (dng cholestyramin v cc khng acid), hoc bng cch lm tng
bo ho ca mt (dng estrogen, progestogen, fibrat, neomycin ung), s thy c gim
tc dng ca acid ursodesoxycholic.
175
X l: iu tr vi acid ursodesoxycholic phi ko di (t 6 thng n mt nm).

Nn trnh tht bi iu tr v khng phi hp cc thuc lm gi m tc d ng c a thu c
k n, tr khi iu tr ng thi din ra trong mt thi gian r t ng n. Cn nh nguy
c tht bi iu tr, khi cholestyramin, estrogen, progestogen, neomycin ung hoc
cc fibrat c k n trong mt thi gian di.
Acid valproic
Phn tch: Nng trong huyt thanh v sinh kh dng ca acid valproic c th
gim, dn n gim tc dng iu tr. C ch: do cholestyramin lm cn tr s hp thu
ca acid valproic ng tiu ho.
X l: Nn ung acid valproic t nht 3 gi trc cholestyramin, v khng c
ung trong vng 3 gi sau cholestyramin. Theo di p ng lm sng ca ngi bnh
v iu chnh liu ca acid valproic nu cn.
Cc glycosid tr tim
Phn tch: Gim hp thu glycosid tr tim qua ng tiu ho. Tc dng dc l ca
thuc ny cng c th gim ngi bnh dng cholestyramin thng xuyn. Do
cholestyramin l nha trao i ion, c th gn kt glycosid tr tim.
X l: Nu k n hai thuc, phi ung glucosid tr tim trc 2 gi hoc sau khi
dng cholestyramin 4 gi.
Cht c ch HMG CoA reductase (statin)
Phn tch: Tc dng dc l ca cc cht c ch HMG CoA reductase (cc
statin) c th gim. C ch: do cc cht c ch HMG CoA reductase c th b hp
ph bi cholestyramin, do b gim hp thu ng tiu ho.
X l: Dng cc cht c ch HMG CoA reductase cch xa cholestyramin t nht
4 gi. Nu ung cholestyramin trc cc ba n, th nn ung cc cht c ch HMG
CoA reductase vo bui ti.
Corticosteroid
Phn tch: Tc dng iu tr ca hydrocortison c th gim. C ch: do
Cholestyramin nh hng n s hp thu ca hydrocortison ng tiu ho.
X l: Ung hai thuc cch xa nhau, c th ci thin s hp thu ca
hydrocortison. Nu ung cng nhau, ngi bnh c th cn phi dng liu
hydrocortison cao hn t tc dng mong mun. Xem xt dng thuc h cholesterol
khc thay th.
Dn cht salicylat
Phn tch: Gim hp thu dn cht salicylat ng tiu ho.
X l: Nu k n hai thuc, khuyn dng dn cht salicylat trc 2 gi hoc sau
khi dng cholestyramin 4 gi.
Phn tch: Gim hp thu cc estrogen v thuc nga thai estroprogestogen qua
ng tiu ho.
176
X l: Nu k n hai thuc, khuyn dng cc estrogen v thuc nga thai

estroprogestogen trc 2 gi hoc sau khi dng cholestyramin 4 gi.
Phn tch: Gim hp thu furosemid ng tiu ho. Tc dng dc l c th
gim. C ch: do cholestyramin l nha trao i ion, c th gn kt furosemid.
X l: Nu k n hai thuc, furosemid phi ung trc 2 gi hoc sau khi dng
cholestyramin 4 gi.
Hormon tuyn gip
Phn tch: Tc dng ca hormon tuyn gip c th mt v c tim nng mc phi
thiu nng tuyn gip. C ch: do cholestyramin l nha trao i ion c kh nng gn
kt hormon tuyn gip, cn tr hp thu thuc ny.
X l: Nu k n hai thuc, phi dng cc hormon tuyn gip trc 2 gi hoc
sau khi dng cholestyramin 4 gi.
Penicilin
Phn tch: Gim hp thu cc penicilin ng tiu ho.
X l: Nu k n hai thuc, khuyn dng cc penicilin trc 2 gi hoc sau khi
Pyrazol
Phn tch: Gim hp thu cc pyrazol ng tiu ho.
X l: Nu k n hai thuc, khuyn dng cc pyrazol (tc dng gy lot) trc 2
gi hoc sau khi dng cholestyramin 4 gi.
Phn tch: Hm lng ca sulfamid h glucose mu trong huyt thanh c th gim,
gy gim tc dng ca chng. C ch: khi ung cng cholestyramin c th lm gim s
hp thu ca cc sulfamid h glucose mu.
X l: Nu k n hai thuc, phi ung sulfamid h glucose mu trc 2 gi hoc
sau khi dng cholestyramin 4 gi.
St
Phn tch: Gim hp thu st ng tiu ho.
X l: Nu k n hai thuc, khuyn dng mui st trc 2 gi hoc sau khi dng
cholestyramin 4 gi.
Tetracyclin
Phn tch: Gim hp thu cc tetracyclin ng tiu ho.
X l: Nu k n hai thuc, khuyn dng cc tetracyclin trc 2 gi hoc sau khi
Thuc chng ng
177
Phn tch: Tc dng ca cc thuc chng ng ung (dicumarol, warfarin) c th

gim do cholestyramin. C ch: do gim hp thu thuc chng ng ung v tng o
thi.
X l: Dng cc thuc ny cch xa nhau t 3 gi tr ln. Theo di tc dng chng
ng v iu chnh liu ca thuc chng ng theo nhu cu.
Phn tch: S hp thu v tc dng dc l ca cc thuc li tiu b gim. Do
cholestyramin l nha trao i ion, c th gn kt cc thuc li tiu thi kali.
X l: Nu k n hai thuc, thuc li tiu thi kali phi ung trc 2 gi hoc
sau khi dng cholestyramin 4 gi. C th cn phi tng liu ca thuc li tiu.
Phn tch: Tc dng dc l ca thuc chng vim khng steroid c th gim. C
ch: thanh lc ca thuc chng vim khng steroid (piroxicam, diclofenac, Sulindac)
trong huyt tng tng v s hp thu ng tiu ho ca chng gim.
X l: Nu nghi ng c tng tc, xem xt tng liu ca thuc chng vim khng
steroid trong thi gian dng cholestyramin.
Vitamin A
Phn tch: Gim hp thu vitamin A ng tiu ho.
X l: Nu k n hai thuc, khuyn dng vitamin A trc 2 gi hoc sau khi
Vitamin nhm D
Phn tch: Gim hp thu cc vitamin nhm D ng tiu ho.
X l: Nu k n hai thuc, khuyn dng vitamin D trc 2 gi hoc sau khi
CHOLINERGIC
Cc thuc cng ph giao cm trc tip (acetylcholin v dn cht, pilocarpin)
hoc gin tip (eserin, neostigmin), cc cht c ch cholinesterase.
CC THUC TRONG NHM

PILOCARPIN dung dch nh mt 2%
P.V.Carpine dung dch nh mt 2%
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: Do thuc qua c sa m.
178

Thi k mang thai : Nguy c ri lon c h hp tr s sinh.
Trng hp khc: Trng hp tc c hc ng tiu ho v ng tit niu.
Thn trng: mc 2
Suy h hp; hen: Nguy c cn hen do acetylcholin kch thch cc th th
muscarinic v gy co tht ph qun.
Parkinson: Cc thuc cholinergic, khi qua hng ro mu - no, lm r thm cc
triu chng Parkinson(tng trng lc, run, chy nc bt nhiu).
Cn theo di: mc 1
Bnh i trng: Nguy c tiu chy do tng tit dch ng tiu ho v tng nhu
ng rut.
TNG TC THUC
Phn tch: Phi hp khng hp l, tr trng hp ng c. i khng dc lc.
X l: Xc nh mc tiu iu tr. Phn bit r cc tc dng khng mong mun
kiu khng cholinergic gp nhng thuc chng trm cm ba vng v mt s hp cht
phenothiazin ( kh ming, gin ng t) vi tc dng chnh ca cc thuc khng
cholinergic cn tm kim v s dng vo nhng mc ch iu tr.
Phn tch: Tng tc ch yu vi neostigmin (prostigmin). Phi hp vi cc thuc
c tnh cht chn thn kinh - c, c th c i khng.
X l: iu tr thng c tin hnh ti c s chuyn khoa. Lu tng tc ny
khi phi hp thuc v theo di iu tr. Tc dng cng r khi liu ca thuc chng
nhc c cng cao.
Disopyramid
Phn tch: Tnh cht khng cholinergic ca disopyramid c th nh hng n
cc tc dng cholinergic nh tm kim.
X l: Lu nguy c tht bi hoc gim tc dng iu tr nu mc tiu iu tr
chnh i hi k n thuc cholinergic. Hi ngi bnh khi pht li theo n. Tc d ng
khng cholinergic c th yu hoc va phi (dng ti ch: thuc nh mt)
Heptaminol
Phn tch: Cc tnh cht khng cholinergic ca heptaminol c th nh hng n
tc dng cholinergic nh tm kim.
179

chnh i hi k n thuc cholinergic. Hi ngi bnh khi pht li thuc theo n. Tc
dng khng cholinergic c th yu hoc va phi (dng ti ch: thuc nh mt).
Khng histamin khng H1 an thn
Phn tch: Tnh cht khng cholinergic ca thuc khng histamin c th nh
hng n cc tc dng cholinergic cn c. Nn nh rng ketotifen v oxadomid khng
c hoc t c tc dng khng cholinergic.
dng khng cholinergic c th yu hoc va phi (dng ti ch: thuc nh mt)
Quinidin hoc dn cht
Phn tch: Tnh cht khng cholinergic ca nhng thuc ny c th nh hng
n tc dng cholinergic cn tm kim.
dng khng cholinergic c th yu hoc va phi (dng ti ch: thuc nh mt).
Thuc loi cura
Phn tch: i khng dc l gia neostigmin v edrophonium, dng trong trng
hp iu tr cura qu mc.
X l: C th s dng tnh cht i khng gia cc thuc.
Tacrin
Phn tch: Tng tc dc l. Hip ng cc tc dng cholinergic.
X l: Tng cc tc dng khng mong mun. Nu c th, hon k n cc thuc
cholinergic phi hp vi tacrin.
CICLOSPORIN
Thuc c ch min dch, dng trong ghp thn,
hoc trong mt s ch nh nh bnh vy nn
CC THUC TRONG NHM

CICLOSPORIN nang mm 25 mg; 50 mg; 100 mg
Sandimmun nang mm 25 mg; 50 mg; 100 mg
CH KHI CH NH THUC
180

Thi k cho con b: Ciclosporin qua c sa m.
Thi k mang thai: Do thn trng.
Cn theo di: mc 1
Tng huyt p: Tng huyt p ng mch c m t nhng ngi bnh
iu tr bng ciclosporin.
Suy gan: Nhn xt thy tng bilirubin mu v aminotransferase (transaminase).
Theo di cc thng s ny v iu chnh liu.
Suy thn: Thng hay thy tng creatinin mu v ure mu. Theo di cc thng
s ny v iu chnh liu.
TNG TC THUC
Tacrolimus
Phn tch: Theo cc nghin cu, tng nng ciclosporin hoc nng
tacrolimus trong huyt tng, do c ch chuyn ho ca chng rut v gan. Mi cht
hnh nh lm chm chuyn ho ca cht kia. Ngoi ra cn hip ng cc tc dng c
vi thn ca hai thuc ny.
X l: Phi cm phi hp thuc, nu khng s thy xut hin cc du hiu quan
trng v c tnh vi thn. Khuyn co nn ch t nht 24 gi sau liu cui cng ca
ciclosporin mi dng liu tacrolimus u tin.
Dihydropyridin
Phn tch: Phi hp nifedipin - ciclosporin c s dng cha tng huyt p
do ciclosporin gy ra, thm ch bo v chng c tnh vi thn ca ciclosporin. Nhng
tc dng khng mong mun ca nifedipin c th tng ( bng, ban) v nguy c tng
sn li c ghi nhn. Cn ch l xc nh r nng ciclosporin trong huyt
thanh c th tng gp i, thm ch gp ba, khi nicardipin c dng cng. Cn c
nhng nhn xt thm xc nh iu g xy ra vi cc dihydropyridin khc.
X l: Cn trnh phi hp. Vi nicardipin, nn gim liu dng khong mt na v
theo di tht cn thn hm lng trong huyt thanh v chc nng thn ( thanh l c
creatinin). Nu dng cc dihydropyridin khc, nn theo di ciclosporin mu v chuy n
cc nhn xt cho Trung tm cnh gic thuc. Lu l ciclosporin c nhng bin ng
rt mnh gia cc c th v vic theo di phi u dn.
Foscarnet; vng
X l: Nhng phi hp ny c th hay gp, nht l c s bnh vin; tuy cch
dng liu duy nht mi ngy hn ch c c tnh vi thnh gic v thn , nhng khi
cn phi hp, nn tin hnh iu chnh liu tu theo thanh lc creatinin (cng thc
181
Cockroft v Gault). Nu c tnh thn xy ra, nn ngng foscarnet v theo di ngi

bnh. Theo di c bit ngi cao tui.
Melphalan
Phn tch: Phi hp hai thuc c ch min dch, c th dn n pht trin
u lympho gi. Hip ng cc tc dng khng mong mun nng v chc nng thn.
X l: Cn trnh phi hp. Nu c th, xem xt li chin lc iu tr. Nu cn
phi hp, ch c th lm ti c s chuyn khoa, phi c theo di u n tu thuc
vo nguy c suy gim chc nng thn.
Ritonavir hoc thuc tng t c ch protease
Phn tch: Tng nng ca ciclosporin v tng nguy c c tnh c th xy ra.
Nng cht c ch protease cng c th tng. Tng nng ca nhng thuc ny
c th xy ra trong vng 3 ngy khi iu tr phi hp. C ch do c ch chuyn ho
ca thuc ny hay thuc kia.
X l: Theo di nng ciclosporin v creatinin trong huyt thanh khi bt u
hoc khi ngng dng cht c ch protease. C th cn phi gim liu.
Thuc chng ung th cc loi
Phn tch: Hip ng cc tc dng khng mong mun, biu hin bng tng c
tnh vi thn.
X l: Thc hin phi hp thuc ti c s chuyn khoa. Tng cng theo di
chc nng thn.
Vaccin sng gim c lc
Phn tch: Nguy c pht trin nhim khun tng ng vi vaccin, do tc dng c
ch min dch ca ciclosporin.
X l: Khong thi gian cn tn trng gia hai thuc l t 3 thng n 1 nm, tu
thuc vo cng c ch min dch.
Azathioprin; carmustin hoc dn cht; cisplatin hoc dn cht; dactinomycin;
doxorubicin hoc dn cht; fluoro-5-uracil; mercaptopurin; methotrexat; procarbazin;
thiotepa
dch ny qu mnh, c th xut hin u lympho gi.
X l: Phi hp hai thuc c ch min dch ny phi c suy xt v phi cn
nhc gia nguy c/ li ch, tu theo mc tiu iu tr. Phi hp ch c thc hin c
s chuyn khoa vi s theo di ngi bnh tht cht ch.
Phn tch: Gim hm lng ciclosporin trong huyt thanh do kch thch d ho bi
enzym.
X l: Nu cn phi hp thuc, theo di k hm lng ca ciclosporin trong huyt
thanh v iu chnh liu lc u v lc ngng iu tr bng thuc kia. Lu l
182
ciclosporin c nhng bin ng ln v nng trong mu gia cc c th ngi bnh

v do phi theo di u n.
Cc steroid ng ho, alkyl ho C 17-21
Phn tch: Tng hm lng ciclosporin trong huyt tng, do tng hp thu hoc
c ch chuyn ho gan.
X l: Tnh n nhng bin ng v nng ciclosporin trong mu kh quan
trng gia cc c nhn, thi gian u nn gim liu xung mt na v iu chnh u
n liu ciclosporin lc bt u, lc ang v sau khi ngng iu tr thuc tng ng
ho. Theo di u n ngi bnh.
Carbamazepin
Phn tch: Gim hm lng ciclosporin trong huyt thanh do kch thch d ho bi
enzym.
X l: Nu cn phi hp, theo di k hm lng ciclosporin trong huyt thanh v
iu chnh liu lc u v lc ngng iu tr bng carbamazepin. Lu l ciclosporin c
nhng bin ng ln v nng trong mu gia cc c th ngi bnh, do phi
theo di u n.
Corticosteroid
Phn tch: Mc du phi hp ny c li v mt iu tr i vi ghp c quan,
nhng c tnh c th tng. C ch: do c s gim thoi bin gan ca thuc ny
hoc thuc kia hoc ca c hai.
X l: iu chnh liu ca thuc ny hoc thuc kia hoc ca c hai cho ph hp
nu c du hiu c tnh hoc thi ghp xy ra.
Danazol
Phn tch: Tng nng ciclosporin trong huyt tng, km nguy c xut hin tc
dng c vi thn, khi phi hp vi danazol. S tng nng trong huyt thanh ny
th hin sau nhiu ngy iu tr. C ch do c s c ch chuyn ho ca ciclosporin.
X l: Theo di cn thn hm lng ciclosporin trong huyt thanh trong khi iu tr
v khi ngng iu tr vi danazol.
Diltiazem
Phn tch: Tng hm lng ciclosporin trong huyt thanh v tng c tnh. C ch
do c s c ch chuyn ho ca ciclosporin gan.
X l: Nu cn phi hp, theo di k hm lng ciclosporin trong huyt thanh v
iu chnh liu lc u v khi kt thc iu tr bng diltiazem, hoc verapamil. Lu l
ciclosporin c nhng bin ng ln v nng trong mu gia cc c th ngi bnh,
do phi theo di u n.
Griseofulvin
Phn tch: Gim nng ciclosporin trong huyt thanh dn n gim tc dng
dc l. C ch cha r.
183
X l: Nu cn phi hp, theo di k hm lng ciclosporin v iu chnh liu lc

u v lc chm dt iu tr vi griseofulvin. Lu l hm lng ciclosporin trong mu
chu nhiu bin ng mnh gia cc c th v phi theo di u n.
Phn tch: Interleukin ch c th s dng c s chuyn khoa. Nguy c hip
ng cc tc dng c vi thn ca hai thuc.
X l: iu tr bng interleukin ch c th lm ti c s chuyn khoa, c tnh n
tm quan trng ca ch nh. T , cc tng tc phi c cn nhc tu theo tnh
trng chung ca ngi bnh. Nu khng th hon c mt trong hai thuc, theo di
cn thn ion v thanh lc creatinin.
Macrolid
Phn tch: Tng nng trong mu ca ciclosporin v tng nguy c c tnh
(thn v thn kinh). C ch do c ch chuyn ho ca ciclosporin gan. Tng tc
c m t vi erythromycin, troleandomycin v clarithromycin.
X l: Cn trnh phi hp vi erythromycin, troleandomycin; cn theo di tng
tc vi cc macrolid khc. Theo di hm lng ciclosporin v creatinin trong huyt thanh
v quan st c tnh. iu chnh liu ca ciclosporin nu cn thit.
Phn tch: Tng nng ciclosporin trong huyt thanh, do valproat c ch mt
nhm cytochrom P450.
X l: Nu cn phi hp, theo di k nng ciclosporin trong huyt thanh v
iu chnh liu lc u v lc cui iu tr bng natri valproat. Lu l ciclosporin mu
bin ng nhiu gia cc c th bnh nhn v phi theo di u n.
Octreotid
Phn tch: Nguy c tt nng ciclosporin trong huyt thanh, dn n p ng
c ch min dch khng tho ng v nguy c tht bi iu tr. C ch khng chc
chn, c th l sandostatin lm gim hp thu ciclosporin rut.
X l: Phi hp ny c nhiu t liu thng bo. Nu cn phi hp, nn theo di
cht ch ciclosporin mu v iu chnh liu khi bt u, khi ang v khi ng ng iu tr
bng octreotid.
Phenytoin
Phn tch: Nng ciclosporin trong huyt thanh b gim do phenytoin, dn n
gim tc dng c ch min dch ca ciclosporin v ngi bnh d thi b mnh ghp.
iu ny xy ra trong vng 48 gi sau khi bt u iu tr phenytoin v gim nh trong
vng 1 tun sau khi ngng phenytoin. C ch: C th c s gim hp thu hoc tng
chuyn ho ca ciclosporin.
X l: Theo di cht ch nng ciclosporin trong khi dng cng vi phenytoin,
iu chnh liu ca ciclosporin duy tr nng trong phm vi iu tr.
Phn tch: C th tng nng ciclosporin trong mu, do gim o thi gan, v
tng c creatinin mu v transaminase.
184
X l: Lu nhng nguy c ny v tin hnh nh lng ciclosporin u n, c

bit ph n dng thuc ung nga thai. Vic k n ciclosporin do cc nh chuyn
khoa thc hin. C nhng bin ng mnh gia cc c th ngi bnh. Nn ch n
mi bin ng v ciclosporin mu.
Rifabutin
Phn tch: Tc dng c ch min dch ca ciclosporin c th gim. iu ny xy
ra sm sau khi bt u iu tr rifabutin khong 2 ngy v c th tn ti 1-3 tun sau
khi ngng thuc ny. C ch: Chuyn ho ca ciclosporin tng r rt do cm ng
enzym gan bi rifabutin. Sinh kh dng ca ciclosporin gim do cm ng cc enzym
cytochrom P450 rut.
X l: C th cn phi tng liu ca ciclosporin trong thi gian iu tr cng vi
rifabutin. Phi theo di thng xuyn nng ca ciclosporin v creatinin trong huyt
thanh trong thi gian iu tr rifabutin v sau khi ngng thuc ny. Nu c th, trnh
phi hp ny.
Rifampicin
Phn tch: Gim nng ciclosporin trong huyt thanh do kch thch d ho bi
enzym (rifampicin gy cm ng enzym). Cc nng ciclosporin c th gim mt na,
thm ch cn mt phn ba.
iu chnh liu lc u v lc cui iu tr bng rifampicin. Lu l ciclosporin mu bin
ng nhiu gia cc c th ngi bnh v phi theo di u n.
Synergistin
Phn tch: Tng tc c m t vi pristinamycin. Tng nng ciclosporin
trong huyt thanh, c l do c ch d ho ciclosporin gan.
X l: Theo di chc nng thn qua thanh lc creatinin. iu chnh liu trong
v sau khi ngng iu tr cng vi pristinamycin.
Phn tch: Cimetidin l cht c ch enzym oxydase gan (cytochrom P 450), chu
trch nhim v cc bin i sinh hc ca mt s thuc. Ngoi ra thuc lm gim dng
mu qua gan. Do , hm lng trong huyt tng ca mt s thuc tng (nguy c qu
liu), nhng khi c ch mt s bin i sinh hc, cimetidin chn cc c ch kh c.
C s tng hm lng ciclosporin trong mu do c ch enzym.
X l: Ciclosporin c phm vi iu tr hp, s c ch bin i sinh hc ca n
dn n nguy c qu liu. Nu cn, tng cng theo di hm lng ciclosporin trong
huyt tng, nu xut hin cc du hiu qu liu, hoc thay i thuc chng lot.
Ciclosporin c dng ti c s chuyn khoa bi cc thy thuc c kinh nghim v
thuc c ch min dch, liu lng thng c iu chnh qua vic theo di hm
lng ciclosporin trong huyt tng v cc thng s cho bit tnh trng cc chc nng
gan v thn.
185
Phn tch: Tng hm lng ciclosporin trong huyt thanh c th quan trng v r
rt, nht l vi ketoconazol (tng t 5 n 10 ln). C ch do c ch chuyn ho ca
ciclosporin gan v rut.
X l: Phi hp ny cn trnh, k c thc hin c s chuyn khoa; nu khng,
phi gim liu xung rt nhiu trnh c tnh nghim trng. Vi itraconazol v
fluconazol, c nhng bin i khng hng nh nhng quan trng. Cn nh r ng c
mt phc chnh xc v tng tc gia ketoconazol v ciclosporin, bng cch gim
hn 70% liu ca ciclosporin (gia 68% v 89%) gim nhng chi ph do ciclosporin.
Tuy vy phi theo di nng ciclosporin trong mu thng xuyn v u n hn.
Phn tch: c tnh vi thn ca c hai thuc c th tng. C ch cha r.
X l: Cn thng xuyn theo di chc nng thn.
Thuc i quang c iod
X l: Theo di chc nng thn ( thanh lc creatinin) trc v sau xt nghim X
quang. Nhng ngi bnh dng ciclosporin phn ln l nhng ngi ghp thn. Nn
trnh phi hp cc thuc c vi thn. Yu cu ngi bnh thng bo cho cn b X
quang l ang iu tr ciclosporin.
Thuc li tiu gi kali
Phn tch: ghi nhn c s tng creatinin mu m khng c bin i v
ciclosporin mu.
X l: Theo di creatinin mu v chc nng thn khi cn phi phi hp thuc.
Phn tch: Nguy c tng creatinin mu, nht l vi cc thuc li tiu thiazid.
Tng tc ny cn c nghin cu thm. Cc cng b cn him.
X l: Theo di chc nng thn khi phi hp cc thuc ny. Nu thy c bt
thng no, trao i cc nhn xt vi Trung tm cnh gic thuc, v tng tc ny cn
c xc nhn.
Thuc c ch HMG - CoA reductase
Phn tch: Hm lng trong huyt tng v tc dng c hi ca cc cht c ch
HMG CoA reductase tng. Tng nguy c tiu c vn v suy thn. Nhng nguy c ny
ph thuc liu. C ch: do gim chuyn ho thuc h cholesterol mu gan.
X l: Nu khng trnh c phi hp ny, nn xem xt gim liu ca thuc h
cholesterol mu. Yu cu ngi bnh thng bo ngay cho bc s iu tr khi xut hi n
au c hoc yu c.
Verapamil
Phn tch: Tng nng ciclosporin trong huyt thanh v tng c tnh. C ch
do c ch chuyn ho ca ciclosporin bi enzym microsom gan v thnh rut.
186

iu chnh liu lc u v lc cui iu tr bng verapamil. Lu l ciclosporin mu
bin ng nhiu gia cc c th v phi theo di u n.
X l: Nhng phi hp ny hay gp, nht l bnh vin. Mc du cch dng liu
duy nht trong ngy hn ch c c tnh vi thnh gic v thn, nhng khi cn phi
hp, nn iu chnh liu tu theo thanh lc creatinin (cng thc Cockroft v Gault ).
Theo di c bit ngi bnh cao tui.
Amphotericin B
Phn tch: Tng c tnh ca ciclosporin i vi thn. Tng tc xy ra trong vi
ngy sau khi dng thm amphotericin B cng vi ciclosporin. C ch cha r.
X l: Nu phi hp hai thuc ny, cn thng xuyn xc nh creatinin huyt
thanh. Ngi bnh no pht trin suy thn, phi tm thi gim liu ca ciclosporin hoc
thay th bng mt thuc c ch min dch khc.
Phn tch: Phi hp hai thuc c tc dng c ch min dch. Do s c ch min
dch ny qu mc, c th thy pht trin u lympho gi.
X l: S phi hp hai cht c ch min dch ny phi c suy tnh v tng
quan nguy c/ li ch phi c cn nhc tu theo mc tiu i u
tr. Ch c th tin hnh ti c s chuyn khoa vi s theo di cht ch ngi bnh.
Phn tch: Tng nng ciclosporin mu v tng nguy c c tnh. C ch do c
th gim chuyn ho ca ciclosporin.
X l: Nu c th, nn trnh phi hp ny. Nu dng cng vi nhau, cn theo di
nng ciclosporin v cc chc nng thn v gan. iu chnh liu ca ciclosporin.
Immunoglobulin chng lympho bo
Phn tch: Phi hp hai cht c ch min dch c th dn n pht trin u lympho
gi. Vi liu cao, nguy c c vi thn.
X l: Lu nguy c, c tnh n tnh trng sinh bnh l ca ngi bnh.
Trimethoprim
Phn tch: Tng nguy c c vi thn, c bit khi trimethoprim c phi hp
vi cc sulfamid. Gim hm lng ciclosporin xy ra khi phi hp sulfamidtrimethoprim tim tnh mch v ciclosporin. C ch cha sng t.
X l: Theo di c chc nng thn v ciclosporin mu, tu theo ng dng
trimethoprim, c cn nhc hay khng cc nguy c. iu chnh liu v, nu c th, xem
li chin lc iu tr. Nhc ngi bnh tun th cc ln lm cc xt nghim k.
187
CIMETIDIN
Thuc khng histamin chn cc th th H2 chng lot d dy t trng.
Cn ghi ch ranitidin v thuc tng t c xp vo mt h ring
CC THUC TRONG NHM

CIMETIDIN vin nn 200 mg; 300 mg; 400 mg; 800 mg; ng tim 300 mg/2mL
Brumetidin vin nn 400mg
Cimet 200 vin nn bao 200mg
Defense F.C vin nn 400 mg
Himetin vin nn 300 mg
Histodil vin nn 200 mg
Histodil ng tim 200 mg/2 mL
Suwelin ng tim 300 mg/ 2mL
CH KHI CH NH THUC
Thi k cho con b: Cimetidin qua c sa m v gy tng tit sa.
Thi k mang thai: Do thn trng, khi cha c d liu.
Cn theo di: mc 1
Tr em: S dng cimetidin cha lu rt c kinh nghim tr em. Nu
nht thit phi dng thuc, liu phi t 20 n 40 mg/kg/ngy chia nhiu ln.
Suy gan: Tng tm thi aminotransferase (transaminase) c m t.
Suy thn: iu chnh liu, v cimetidin c o thi ch yu qua thn di
dng khng thay i.
hn.
Ngi cao tui: Nguy c l ln hoc ri lon nhp tim (nhp xoang chm) cao
TNG TC THUC
Pentagastrin
Phn tch: Kh nng i khng gia cc tc dng dc l ca pentagastrin v ca
thuc khng H2.
X l: Khuyn ngi bnh ung pentagastrin cch thuc khng H2 24 gi.
188
Phenytoin
Phn tch: Cimetidin l mt cht c ch enzym oxydase gan (cytochrom P 450) xc
tc cho chuyn ho ca mt s thuc. Hn na, cimetidin lm gim lu lng mu
gan. Nh vy nng ca mt s thuc trong huyt tng tng (nguy c qu liu),
nhng cng do c ch mt s bin i sinh hc, nn cimetidin chn cc c ch kh
c. C th cimetidin c ch chuyn ho phenytoin gan, do c nguy c qu liu.
X l: Phenytoin c phm vi iu tr hp, chuyn ho b c ch dn n nguy c
qu liu. Tng cng gim st nng phenytoin trong huyt tng khi iu tr tht bi
hoc thay thuc chng lot d dy khc.
Amiodaron
Phn tch: Cimetidin c ch chuyn ho ca amiodaron lm tng nng huyt
thanh ca amiodaron v ca c cht chuyn ho cn hot tnh. Tng tc xy ra chm.
X l: Cn gim st nng huyt thanh ca amiodaron mi khi bt u iu tr
cimetidin, v phi d kin c th tng nng huyt thanh amiodaron iu chnh
liu.
Benzodiazepin
Phn tch: Cimetidin l mt cht c ch enzym oxydase gan (cytochrom P450) xc
gan. Nh vy nng ca mt s thuc trong huyt tng tng ln (nguy c qu liu),
nhng cng v c ch mt s bin i sinh hc, nn cimetidin chn cc c ch kh c,
c ch chuyn ho cc benzodiazepin, t tng cc tc dng dc l. iu ny khng
c m t vi cc benzodiazepin lin kt vi acid glucuronic nh lorazepam, oxazepam,
temazepam.
flurazepam, nitrazepam, triazolam hoc clordiazepoxyd, thy nguy c tng bun ng.
Thay i thuc chng lot d dy, hoc iu chnh liu cc benzodiazepin lc bt u,
trong v sau khi iu tr. Bo cho ngi bnh v nhng nguy c bun ng c th c,
khuyn ngi bnh c bit cnh gic khi li xe hoc vn hnh my.
Carbamazepin
nhng cng v c ch mt s bin i sinh hc, nn cimetidin chn cc c ch kh
c. C th cimetidin c ch chuyn ho gan ca carbamazepin, v vy dn ti nguy
c qu liu.
X l: Carbamazepin l thuc c phm vi iu tr hp, khi chuyn ho ca
carbamazepin b c ch s dn n nguy c qu liu. Nu cn , tng cng gim st
nng carbamazepin trong huyt tng khi du hiu qu liu xut hin, hoc thay
thuc chng lot d dy. Du hiu lm sng qu liu carbamazepin (xut hin 1 n 3
gi sau khi dng thuc) l triu chng thn kinh c, ri lon tim mch, co git (nht l
tr em nh tui), kch ng, git c, run, mt iu ho, chng mt, gin ng t, rung
git nhn cu, biu hin tm thn vn ng, tng ri gim phn x gn xng.
189
Cafein
gan. Nh vy nng ca mt s thuc trong huyt tng, trong c cafein tng ln
(nguy c qu liu), nhng cng v c ch mt s bin i sinh hc, cimetidin chn cc
c ch kh c.
X l: nhng ngi dng thuc khng H2 kiu cimetidin v ung cafein (c ph,
nc gii kht c ga cha cafein, ch...), nhng tc dng kiu kch thch, d b kch
ng, thm ch mt ng c m t. Thng bo cho ngi bnh bit cc tc d ng
ny, v nu cn, khuyn ngi bnh gim ung nc gii kht c cha cafein, n u
nhng tc dng ny biu hin.
Ciclosporin
c. Tng nng ciclosporin trong mu do c ch enzym.
X l: Ciclosporin c phm vi iu tr hp. Do c ch chuyn ho ciclosporin s
dn n nguy c qu liu. Nu cn, tng cng gim st nng ciclosporin trong
huyt tng khi du hiu qu liu xut hin, hoc thay thuc chng lot d dy. V
ciclosporin c thy thuc chuyn khoa ch nh, nn thng thng liu c iu
chnh tu thuc nng ciclosporin trong huyt tng v da theo chc nng gan v
thn.
Clomethiazol (chlormethiazol)
Phn tch: Cimetidin lm tng tc dng an thn gy ng ca clomethiazol. C
ch: Cimetidin c ch enzym cytochrom P450 ti gan lin quan n chuyn ho
clomethiazol, lm gim lu lng mu qua gan; c hai c ch u lm gim tc o
thi clomethiazol ra khi c th.
X l: Gim liu clomethiazol vo khong mt na hoc thay cimetidin bng
ranitidin.
Cloramphenicol (tim tnh mch)
Phn tch: Gy thiu mu gim sn nng ngi ang dng cimetidin, m l i
c tim tnh mch cloramphenicol. C ch: Tc dng hip ng c ch ty xng
ca hai thuc.
X l: Phi thn trng khi phi hp.
Cloroquin
Phn tch: Cimetidin c ch chuyn ho cloroquin gan, do lm gim chuyn
ho v o thi ca cloroquin ra khi c th.
X l: Cn theo di lm sng pht hin sm bt c du hiu nhim c no
ca cloroquin trong khi phi hp.
Dobutamin
190
Phn tch: Tng huyt p mnh khi truyn tnh mch dobutamin cho ngi ang
dng cimetidin (trong giai on tin m). C ch: Cimetidin c th c ch chuyn
ho v thanh lc ca dobutamin gan, do lm tng tc dng.
X l: Tuy mi c mt trng hp xy ra, nhng cng cn thn trng gim liu
u tin dobutamin ngi bnh ang iu tr cimetidin.
Erythromycin
Phn tch: Cimetidin c th lm tng gn gp i nng huyt thanh ca
erythromycin, nn c th gy c (ic c hi phc). C ch: Cimetidin lm chm
chuyn ho v o thi erythromycin, nn lm tng nng huyt thanh do c ch oxy
ho N kh methyl. ic l mt tai bin ca erythromycin vi nng cao.
X l: Tuy mi c mt trng hp c bo co, vn cn thn trng theo di lm
sng khi phi hp. Nh sn xut cho bit mt thnh gic c hi phc c th xy ra khi
dng erythromycin n c vi liu cao hn 4g/ngy.
Fluouracil
Phn tch: Nng trong huyt thanh ca fluouracil tng khong 75% khi phi
hp vi cimetidin trong 1 thng. C ch cha r, c th khi phi hp hai thuc chuyn
ho ca fluouracil b gim do cimetidin l mt cht c ch enzym v lm gim lu lng
mu qua gan.
X l: Phi ht sc thn trng khi phi hp v nguy c qu liu fluouracil. C th
cn phi gim liu fluouracil.
Khng histamin H2
Terfenadin phi hp cimetidin: C th gy lon nhp xon nh.
Cetirizin hoc hydroxyzin phi hp cimetidin: Khng c tng tc xu.
Phn tch: Cimetidin c ch cytochrom P450 gan, nn c th c ch chuyn ho
ca nhiu thuc, lm tng nng thuc trong huyt thanh v i khi gy c do qu
liu.
X l: Khng c l do chnh ng trnh phi hp cetirizin hoc hydroxyzin vi
cimetidin. Ch mi c mt thng bo v c tnh qu liu ca terfenadin v cimetidin
nn cha chng c cm phi hp.
gan. Nh vy cc nng lidocain trong huyt tng tng (nguy c qu liu), gy c
thn kinh v tim.
X l: Lidocain c phm vi iu tr hp; chuyn ho b c ch dn n nguy c
qu liu. Tng cng gim st cc nng lidocain trong huyt tng khi du hiu qu
liu xut hin, hoc thay i thuc chng lot d dy. Tuy lidocain c ch nh trong
d phng v iu tr cc ri lon nhp tim do tng kch thch tm tht, hoc trong gy t,
thuc c dnh ring dng ti bnh vin. Nh vy c th theo di cht ch nng
lidocain trong mu vi bt k ch nh no. Du hiu qu liu lidocain l vt v,
hoang tng, hi chng l ln, thm ch cn co git, hn m, tru tim mch.
191
Mebendazol
Phn tch: Tng nng huyt thanh ca mebendazol, nn tng tc d ng. C
ch: Cimetidin c ch enzym cytochrom P450 ti gan, nn lm chm chuyn ho
mebendazol.
X l: Tng tc c ch v iu tr, nhng phi cnh gic i vi bt c biu hin
no ca nhim c do nng cao ca mebendazol trong mu (phn ng d ng, gim
bch cu, rng tc, hi).
Methadon
Phn tch: Tng tc kiu dc ng hc do c ch enzym. C nguy c qu liu
hoc c ch h hp. Tng tc ny cn c khng nh. Tng tc xy ra nhanh v
nng.
X l: Tng tc i hi phi cnh gic. Kh th biu hin qu liu methadon:
iu tr bng naloxon, nu cn (ti c s chuyn khoa). Tng tc ny cn c khng
nh: ch gim st ngi bnh.
Nitroimidazol
nhng cng v c ch mt s bin i sinh hc, cimetidin chn cc c ch kh c. C
th cimetidin c ch chuyn ho nitro-imidazol nn c nguy c qu liu.
X l: Tng tc ny tu thuc dng bo ch c s dng. Nu phi hp
cimetidin, phi iu chnh liu metronidazol (v cng c gi tr vi cc nitro- 5 -imidazol
khc), hoc chn mt khng H2 khc t c ch enzym hn.
Quinidin hoc dn cht
c. C th cimetidin c ch chuyn ho quinidin gan v cc dn cht, nn c nguy
c qu liu.
X l: Quinidin c phm vi iu tr hp; c ch chuyn ho dn n nguy c qu
liu. Hoc thay i thuc chng lot d dy, hoc iu chnh liu quinidin lc bt u,
trong v sau khi iu tr bng quinidin, tu thuc vo nng quinidin trong mu
v/hoc s xut hin cc du hiu qu liu nu c. Liu quinidin c ngh gi m
25% liu (ung) v 35% (tim tnh mch). Du hiu lm sng qu li u quinidin l r i
lon tiu ho, thn kinh gic quan, vt v, ngng th, h huyt p.
Ru
c. Nguy c tng nng nh ca ru trong huyt tng v d gy say ru.
Tng tc ny cn tranh ci.
192
X l: Nn thng bo tng tc ny ti Trung tm cnh gic thuc trong vng.

Theophylin hoc dn xut
nhng cng v c ch mt s bin i sinh hc, cimetidin chn cc c ch kh c.
X l: Theophylin c phm vi iu tr hp; chuyn ho b c ch dn n nguy c
qu liu. Tng cng gim st nng theophylin trong huyt tng khi c bi u hi n
cc du hiu qu liu hoc thay thuc chng lot d dy. Du hiu lm sng ca qu
liu theophylin ngi ln l co git, st cao, ngng tim; tr em l vt v, ni nhiu,
l ln, nn lin tip, st cao, nhp tim nhanh, rung tht, co git, h huyt p, ri lon h
hp, tng thng kh phi, ri c ch h hp.
Thuc chn beta
Nguy c tng nng trong huyt tng ca cc thuc chn beta chuyn ho gan
(acebutolol, alprenolol, betaxolol, labetalol, metoprolol, oxprenolol, propranolol, timolol)
c th gy tt huyt p v nhp tim chm.
X l: Vi mt s thuc chn beta nh acebutolol, alprenolol, betaxolol, labetalol,
metoprolol, oxprenolol, propranolol, timolol, mt vi trng hp nhp tim chm v h
huyt p c m t. Hoc thay thuc chng lot d dy, hoc iu chnh liu
thuc chn beta lc bt u, trong v sau khi iu tr bng thuc khng H 2. X l ny
cn c khng nh thm, v tng tc ny khng c ngha nhiu v mt lm sng.
Thuc chn calci
Phn tch: Cimetidin c ch chuyn ho ca mt s thuc chn calci (ditiazem,
nifedipin...) lm tng nng huyt thanh ca cc thuc chn calci; c th:
Diltiazem, nifedipin: Tng nng trong huyt thanh do cimetidin.
Felodipin, lacidipin, nimodipin, nisoldipin hoc nitrendipin : Tng nng trong
huyt thanh do cimetidin nhng c v khng quan trng v lm sng.
Amlodipin: Khng tng tc vi cimetidin.
nh.
Diltiazem phi hp cimetidin v nifedipin phi hp cimetidin tng tc c xc
Felodipin, lacidipin... cng tng nng huyt thanh nhng bin i huyt ng
khng quan trng.
X l: Khi phi hp diltiazem-cimetidin hoc nifedipin-cimetidin, cn phi ch
n tng tc dng ca thuc chn calci. Liu diltiazem c ngh gim khong 3050% v liu nifedipin khong 4%.
Thuc chng nm dn xut imidazol, terbinafin
Phn tch:
193
Hp thu itraconazol v ketoconazol b gim. C ch do cimetidin lm gim d dy

bi tit, lm tng pH dch v, nn lm itraconazol v ketoconazol km hp thu.
Tng nng huyt thanh ca terbinafin. C ch do cimetidin lm gim chuyn
ho v o thi terbinafin, nn lm tng nng ca terbinafin trong huyt thanh.
X l:
Khuyn ngi bnh ung thuc chng nm azol v cimetidin cch nhau t nht 23 gi. Gim st tc dng ca thuc chng nm.
Ch cn theo di kt qu lm sng ca terbinafin, v tng nng huyt thanh
khng ng k.
Phn tch: Cimetidin l mt cht c ch enzym oxydase gan (cytochrom P 450)
xc tc cho chuyn ho ca mt s thuc. Hn na, cimetidin lm gi m l u l ng
mu gan. Nh vy nng ca mt s thuc trong huyt tng tng ln (nguy c
qu liu), nhng cng v c ch mt s bin i sinh hc, nn cimetidin chn cc c
ch kh c. C th cimetidin c ch s bin i sinh hc gan ca cc thuc
chng trm cm ba vng, do c nguy c qu liu.
X l: Du hiu qu liu ca mt s thuc chng trm cm ba vng nh
amitriptylin, desipramin, doxepin, imipramin v nortriptylin c m t . Theo l
thuyt, nhng du hiu nh vy c th xy ra vi cc thuc chng tr m cm ba vng
khc. Tt nht l thay thuc chng lot d dy, hoc iu chnh liu thuc chng
trm cm (c th gim ti 33-50% liu) lc bt u, trong v sau khi i u tr thu c
khng H2. Cc du hiu qu liu ca thuc chng trm cm ba vng gm chng mt,
vt v, mt iu ho, co git, trng thi sng s, hn m, gin ng t , bl c tim, r i
lon ti cc, tru tim mch, nhp tim nhanh, lon nhp tim, h huyt p v c ch h
hp.
Phn tch: Thuc khng acid gy gim hp thu cimetidin qua ng tiu ho, nn
lm gim tc dng ca thuc phi hp.
X l: Nht thit phi ung hai thuc cch nhau t nht t 1 n 2 gi. Cc thuc
khng acid thng c ung 1 gi 30 sau ba n, v thc n lm tng tit acid dch v.
c. Nguy c h thrombin huyt c m t vi acenocoumarol do c ch d ho thuc
gan.
X l: Vi mt s khng vitamin K nh acenocoumarol, phenindion v warfarin,
nguy c gim thrombin huyt c m t. Hoc thay i thuc chng lot d dy,
hoc iu chnh liu lc bt u, trong v sau khi iu tr bng thuc khng H 2 tu theo
cc kt qu v t l chun quc t (INR) hoc t l prothrombin (mt liu trnh bng
khng H2 ko di 4 n 6 tun).
194
Thuc ung chng tiu ng

Metformin: Cimetidin lm tng nng trong huyt thanh ca metformin.
Sulfonylurea: Cimetidin lm tng tc dng h glucose mu ca sulfonylurea.
Phn tch: Cimetidin c ch chuyn ho sulfonylurea gan, do lm tng tc
dng. Cimetidin c ch bi tit metformin qua thn.
X l: Cn cnh bo cho ngi bnh bit v s tng tc dng h glucose mu ca
sulfonylurea, khi cimetidin c bt u dng (him v khng tin on c). Liu
lng ca metformin c th phi gim khi dng cimetidin v phi lun nh n kh nng
nhim acid lactic nu nng metformin qu cao.
Zalcitabin
Phn tch: Gim thanh lc qua thn ca zalcitabin v tng c tnh ca thuc
ny (bnh h thn kinh, vim tu, nhim acid lactic, gan to...)
X l: Hoc thay cimetidin bng sucralfat hoc ung hai thuc cch nhau 2 gi.
Carmustin hoc dn cht
Phi hp cimetidin vi carmustin lm tng tc dng c ch tu xng.
X l: Khi phi hp cimetidin vi carmustin, th s tng tc dng c ch tu
xng, vi gim bch cu trung tnh v gim tiu cu c m t. C th thay thuc
chng lot d dy, hoc iu chnh liu ca carmustin lc bt u, trong v sau khi
iu tr bng khng H2. Carmustin ch dng bnh vin, nn bao gi cng phi theo di
huyt bt k c phi hp hay khng.
Hormon gip
Phn tch: Gim hp thu levothyroxin (khi ung). C ch cha r.
X l: Hu qu ca tng tc ny khng ln, tuy vy vn cn thn trng theo di
kt qu iu tr khi phi hp hai thuc, nu cn phi tng liu levothyroxin.
Mefloquin
Phn tch: Gim o thi mefloquin do cimetidin. C ch do cimetidin lm gim
chuyn ho mefloquin gan, nn lm chm o thi mefloquin.
X l: Tnh cht quan trng v lm sng cha chc chn. Cn cnh gic vi bt
c biu hin no ca tng tc dng khng mong mun ca mefloquin (chng mt, bun
nn, nn, au but) v nhim c. Cn bo co ngay cho thy thuc trc khi dng liu
tip tc.
Metronidazol
Phn tch: Tng nng trong huyt thanh ca metronidazol. C ch do cimetidin
lm gim chuyn ho ca metronidazol.
195
X l: Tc dng ca tng tc ny yu. Cha c bo co no v nhim c

metronidazol khi phi hp vi cimetidin.
Praziquantel
Phn tch: Tng nng huyt thanh ca praziquantel. C ch do cimetidin c
ch chuyn ho praziquantel gan.
X l: c bo co phi hp hai thuc rt ngn c thi gian iu tr bnh
u trng sn ln thn kinh.
Quinin
Phn tch: Cimetidin lm gim o thi quinin ra khi c th. Na i tng, nhng
nng nh huyt thanh khng thay i. C ch do cimetidin c ch chuyn ho
quinin gan, nn lm chm o thi.
X l: Tc dng lm sng cha r, nhng cn phi cnh gic vi bt c biu hin
no v nhim c quinin trong khi phi hp.
Sertralin
Phn tch: Tng va phi nng trong huyt thanh ca sertralin. C ch
cimetidin c ch chuyn ho sertralin, lm chm o thi, gy tch lu.
X l: Nn thn trng gim st cc tc dng c hi c th tng ln (kh mi ng,
bun nn, tiu chy, kh tiu, run, chm xut tinh, v m hi) khi phi hp hai thuc.
Nu cn, gim liu sertralin, hoc thay cimetidin bng mt thuc chn H 2 khc khng
c tnh cht c ch enzym nh ranitidin, famotidin.
Tacrin
Phn tch: Tng nng tacrin trong huyt tng, c l do c ch chuyn ho.
X l: Nn chn mt khng H2 khc.
CISAPRID
Benzamid lm thay i chuyn ng rut, do tc dng ging cholin gin tip,
m v mt dc l v ho hc gn vi metoclopramid. S dng trong
chng tro ngc d dy - thc qun
CC THUC TRONG NHM

CISAPRID vin nn 5 mg; 10 mg
Peristil vin nn 10 mg
Prepulsid vin nn 5 mg
Pryde vin nn 10 mg
196
CH KHI CH NH THUC
Thi k cho con b: Thuc qua c sa m t.
Thi k mang thai: Thiu d liu.
Cn theo di: mc 1
Trng hp khc: Tc rut: do tc dng dc l (kch thch chuyn ng tiu
ho).
TNG TC THUC
Indinavir hoc cc cht c ch protease
Phn tch: Tng nng cisaprid trong huyt tng km theo tng c tnh trn
tim, nh ko di khong QT v c th xut hin xon nh. C ch do Indinavir v cc
cht c ch protease khc nh ritonavir, amprenavir, saquinavir, nelfinavir c th c
ch chuyn ho ca cisaprid gan (CYP3A4).
X l: Chng ch nh dng cc cht c ch protease cho ngi bnh ang dng
cisaprid.
Macrolid
Phn tch: Tng nng cisaprid trong huyt tng v c th tng c tnh trn
tim nh lon nhp e do tnh mng, bao gm xon nh, ko di khong QT, nhp
nhanh tht, rung tht. C ch: Mt s macrolid c th c ch chuyn ho ca cisaprid
gan (CYP3A4).
X l: Chng ch nh dng clarithromycin, erythromycin, troleandomycin cho
ngi bnh ang dng cisaprid. Azithromycin v spiramycin c th l thuc thay th an
ton hn.
Phn tch: Tng nng cisaprid trong huyt tng v tng c tnh trn tim c
th xy ra (lon nhp tim e do tnh mng, bao gm xon nh, ko di khong QT,
nhp nhanh tht, rung tht). C ch: Cc thuc chng nm azol c th c ch chuyn
ho ca cisaprid gan (CYP3A4).
X l: Chng ch nh dng cc thuc chng nm azol (ketoconazol, miconazol,
itraconazol hoc fluconazol) ngi bnh ang dng cisaprid. Phi thn trng trc khi
dng cisaprid nhng ngi bnh c ri lon in gii khng c hiu chnh (gim
kali
mu,
gim
magnesi
mu),
khong
QT ko di bm sinh hoc ang dng nhng thuc c kh nng ko di khong QT.
Tng tc cn thn trong: mc 2
Cc khng acid ung hoc than hot
Phn tch: Thuc khng acid lm gim hp thu ng tiu ho, do lm gim
tc dng ca thuc phi hp.
197
X l: Cn mt khong cch t nht l 1 - 2 gi gia khi dng khng acid v thuc.

Cn nh rng cc khng acid thng c ung 1 gi 30 pht sau ba n, do n ung
lm tng tit dch v.
Phn tch: Do lin kt mnh vi protein huyt tng, thuc phi hp c th y
cc khng vitamin K, c bit l acenocoumarol ra khi v tr lin kt vi protein huy t
tng. Nguy c chy mu.
X l: Theo di thi gian prothrombin v t l chun ha quc t (INR) v iu chnh
liu lc bt u, khi ang iu tr v trong 8 ngy sau khi ngng thuc.
Ru
Phn tch: Tng tc hp thu ru, t nguy c tng tc dng c ch h thn
kinh trung ng (an thn).
X l: Khuyn khng ung ru trong thi gian iu tr vi cisaprid, nht l vi
nhng ngi s dng my v ngi li xe, do gim tnh to. Ch n nhng bi t
dc khng phi n hoc t dng c th cha ru.
Benzodiazepin
Phn tch: Tng tc hp thu, ch oc m t vi ring diazepam, t , nguy
c tng tc dng an thn.
X l: Trnh dng diazepam trong thi gian iu tr vi cisaprid, nht l ngi
s dng my mc v ngi li xe, do gim tnh to. Khuyn khng ung ru v khng
CISPLATIN HOC DN CHT

Thuc chng ung th, km t bo
CC THUC TRONG NHM

CARBOPLATIN dung dch tim 10mg/mL
Carboplatin dung dch tim 450mg/45mL
Carboplatin EBEWE dung dch tim 50mg/5mL
Paraplatin dung dch tim 10mg/mL
CISPLATIN dung dch tim 25mg/50mL; 50 mg/50 mL
Cisplatin dung dch tim 50mg/50mL
Platinex dung dch tim 25mg/50mL
198
OXALIPLATIN l 50 mg; 100 mg

Eloxatin l 50 mg; 100 mg
CH KHI CH NH THUC
Nhng thuc ny phi do thy thuc chuyn khoa k n. Cc chng ch nh
phi c cn nhc tu theo tnh trng ngi bnh v phi c thy thuc chuyn
khoa nh gi.
TNG TC THUC
Cephalosporin hoc thuc tng t; foscarnet
Phn tch: Phi hp cc thuc c vi thn.
X l: Cisplatin c bit c vi thn. Theo di cn thn chc nng thn, nu cn
phi hp, nht l ngi suy thn v ngi bnh cao tui. iu chnh liu tu theo
thanh lc creatinin.
X l: Tuy cc trng hp c thng bo ch lin quan n lovastatin, nguy c
tim tng c c vi simvastatin v pravastatin. Nn trnh phi hp ny.
Vaccin sng gim c lc
Phn tch: Nguy c pht trin nhim khun tng ng vi vaccin, do hot tnh c
ch min dch ca cisplatin.
X l: Khong cch cn tn trng gia hai thuc l t 3 thng n 1 nm v tu
thuc vo cng ca c ch min dch.
Zalcitabin
Phn tch: C th xut hin bnh dy thn kinh ngoi vi.
X l: Theo di lm sng qua s xut hin d cm.
Amphotericin B
Phn tch: Phi rt thn trng khi phi hp amphotericin B tim cng cc cht c
vi tu xng khc. Nguy c thiu mu hoc cc ri lon huyt hc khc. Ngoi ra,
l s phi hp ca hai sn phm c vi thn.
X l: Khi cn phi hp thuc, phi theo di cn thn huyt , ion v
thanh lc creatinin v tin hnh gim liu, nu cn thit.
Azathioprin; carmustin hoc dn cht; doxorubicin hoc dn cht; fluoro-5uracil; ganciclovir; interferon alpha ti t hp; levamisol; melphalan;
mercaptopurin; methotrexat; penicilamin hoc thuc tng t; procarbazin;
thiotepa; thuc chng ung th cc loi; vincristin hoc thuc tng t
199
Phn tch: Nguy c tng c tnh v mu, do c ch tu xng, do hip ng cc

tc dng, c th dn n mt bch cu ht.
X l: Nu c th, nn trnh phi hp. Nu cn phi hp, phi dng liu thp cho
mi thuc v theo di cn thn huyt . Phi hp ny lin quan n cc nh chuyn
khoa v cc phc iu tr thng c xc nh r.
Ciclosporin
Phn tch: Phi hp hai thuc c tnh c ch min dch. Do s c ch min dch
ny qu quan trng, c th thy pht trin u lympho gi.
X l: Phi hp hai cht c ch min dch phi c suy xt v phi cn nhc
tng quan nguy c / li ch, tu theo mc tiu iu tr. Phi hp ch c th tin hnh ti
c s chuyn khoa, vi s theo di cht ch ngi bnh.
Phn tch: S dng ng thi mt thuc km t bo v mt thuc chng gt lm
tng nng acid uric. Ngoi ra, tng nguy c gim bch cu v gim tiu cu do hip
X l: Nn trnh dng ng thi hai thuc, nu khng, iu tr chng gt s tht
bi. Nn dng allopurinol (cht c ch tng hp acid uric) hn l cc thuc o th i
acid uric qua nc tiu trnh cc bnh thn.
Phn tch: Phi hp vi cc thuc c ch tu xng phi c lu .
X l: l mt iu tr khi u bnh vin. Theo di huyt v chc nng
tim.
Dactinomycin
tc dng, c th dn n mt bch cu ht.
X l: Nu cn phi hp thuc, dng liu thp cho tng thuc. Theo di cn thn
huyt .
Didanosin
Phn tch: Vin nn didanosin cha mt khng acid: nguy c gim hp thu
cisplatin ng tiu ho tu theo s tng pH d dy.
X l: Khuyn ngi bnh ung hai thuc cch nhau t nht 2 gi.
Glycosid tr tim
Phn tch: Phi hp vi thuc km t bo dn n km hp thu cc thuc digitalis
khong 50%, do tn hi nim mc rut c hi phc.
X l: Theo di cn thn hm lng digitalis trong huyt thanh trong sut qu
trnh iu tr.
200
Phn tch: Interleukin ch c th s dng c s chuyn khoa. Nguy c hip

ng cc tc dng c vi thn v c ch tu xng ca hai thuc.
X l: iu tr bng interleukin ch c th thc hin ti c s chuyn khoa, do
mc quan trng ca ch nh. Khi cc tng tc phi c cn nhc tu theo tnh
trng chung ca ngi bnh. Nu khng th hon mt trong hai thuc, cn theo di
cn thn ion , thanh lc creatinin v huyt .
Lozapin
tc dng, c th dn n mt bch cu ht. Vi clozapin v hoc vi noramidopyrin,
ch cn dng n c cng c th mt bch cu ht nng, thm ch gy t vong
(c tnh min dch).
X l: Trnh phi hp. Nu cn phi hp, dng liu thp cho mi thuc. Khng c
g cho php tin on s xut hin mt bch cu ht vi clozapin. Vic theo di c n
thn huyt , thc hin bnh thng vi mt thuc km t bo, vn c gi tr . Tuy
nhin ngi bnh phi c thng bo l khi c st nh, vim hng v lot ming, phi
ngng iu tr.
Pentostatin
Phn tch: Dng ng thi hai thuc c ch tu xng c th dn n ri lon
huyt hc nng, tu theo di thi gian iu tr.
X l: Khi phi hp thuc, cn theo di v mt huyt hc, sau khi xem xt bi
cnh iu tr.
Phenicol
tc dng, c th dn n mt bch cu ht. Vi cc phenicol, ch dng n c, cng
c th gy mt bch cu ht nng, thm ch gy t vong (c tnh min dch).
X l: Nu cn phi hp thuc, nn dng liu thp cho mi thuc. Khng c g
cho php tin on s xut hin mt bch cu ht vi cc phenicol. Vic theo di cn
thn huyt , thc hin bnh thng khi dng mt thuc km t bo, vn c gi tr. Tuy
nhin, ngi bnh phi c thng bo l khi c st nh, vim hng v lot ming th
phi ngng iu tr vi cc phenicol.
Phenytoin
Phn tch: Nng phenytoin trong huyt thanh c th gim, dn n mt tc
dng iu tr. C ch do c s gim hp thu hoc tng chuyn ho ca phenytoin.
X l: Theo di hm lng phenytoin huyt thanh v iu chnh liu ca
phenytoin cho ph hp.
Thuc li tiu quai
Phn tch: Hip ng tc dng c vi thnh gic. C ch cha r.
201
X l: Nu c th, nn trnh phi hp ny. Nu cn phi dng thuc li tiu quai

(furosemid, acid ethacrynic, bumetanid) cho ngi bnh ang iu tr cisplatin, cn thc
hin cc th nghim v thnh lc pht hin mt thnh lc sm.
Zidovudin
Phn tch: Phi hp zidovudin vi cc cht c vi tu cn phi rt thn trng.
Nguy c thiu mu hoc ri lon huyt hc khc.
X l: Nu cn phi hp thuc, nn theo di cn thn huyt v thc hin gim
liu, nu cn.
Phn tch: Tng tc dng c vi thn, do phi hp hai thuc c tim nng c
vi thn. Hip ng cc tc dng khng mong mun.
X l: Nhng phi hp ny hay gp, nht l bnh vin; mc du cch dng liu
duy nht mi ngy hn ch c c tnh vi thnh gic v thn, khi cn phi hp, nn
iu chnh liu tu theo thanh lc creatinin (cng thc Cockroft v Gault). c bi t
theo di ngi bnh cao tui.
CITALOPRAM
Thuc chng trm cm serotoninergic thun tu thuc
nhm cc cht c ch ti nhp serotonin
CC THUC TRONG NHM
CITALOPRAM vin nn 20 mg
Seropram vin nn 20 mg
Cipramid vin nn 20 mg
CH KHI CH NH THUC
Thi k cho con b/ mang thai: Cn thiu t liu. Khng nn dng.
Tr em: Thiu nghin cu chuyn bit.
Suy thn: V thiu d liu, trnh s dng ngi bnh c thanh lc creatinin
< 20 mL / pht. C th qu liu.
Trng hp khc: Trng hp qu mn vi ch phm.
Cn theo di: mc 1
n ung; ru: Do thn trng.
ng kinh: Nguy c xut hin cn ng kinh.
202
Suy gan: Lu n dc ng hc ca thuc.

TNG TC THUC
Sumatriptan
Phn tch: Tng tc dc l do hip ng cc tc dng serotoninergic, c th
dn n tng huyt p ng mch v co ng mch vnh.
X l: Trnh phi hp. Nu xt cn phi hp thuc, phi tn trng thi hn mt
tun gia khi ngng thuc chng trm cm v lc bt u dng sumatriptan.
Phn tch: Nguy c xut hin hi chng serotonin kinh in. Tp hp cc triu
chng kiu tm thn (kch ng, l ln, thm ch hn m...) vn ng (git rung c, run,
tng hot ng) thc vt (tng hoc gim huyt p, run rt, st cao, ra m hi) tiu
ho (tiu chy).
X l: Gi khong cch hai tun sau khi ngng thuc c ch MAO mi bt u
iu tr bng thuc chng trm cm. Ngc li, sau khi ngng thuc chng trm cm
mt tun, ri mi bt u iu tr bng thuc c ch MAO.
Thuc c ch MAO typ B
Phn tch: Hi chng serotonin xy ra khi phi hp mt hot cht serotoninergic
vi mt thuc c ch MAO do s phi hp mt thuc chng trm cm serotoninergic
thun tu vi mt thuc c ch MAO (k c thuc c ch MAO c hiu) c nguy c l
ln, kch ng, st cao, co git, co mch ngoi vi v tng huyt p nng. C ch: C
th c s tch t nhanh chng v qu mc serotonin.
X l: Khng nn dng cng, ch hai tun sau khi ngng thuc c ch MAO typ B
mi bt u iu tr bng thuc chng trm cm serotoninergic v t nht mt tun sau
khi ngng thuc chng trm cm mi bt u iu tr bng thuc c ch MAO.
Cyproheptadin
Phn tch: Gim tc dng dc l ca citalopram. C ch: Citalopram c hot tnh
serotonin, cn cyproheptadin l cht i khng serotonin. Tng tc c th xy ra t i
th th.
X l: Nu thy gim tc dng chng trm cm, nn xem xt ngng
cyproheptadin.
Ru
Phn tch: Tng tc dng an thn ca cht c ch ti thu nhn serotonin.
X l: Ch xem c cng ung ru khng, nht l ngi li xe v ngi s dng
my mc.
Thuc c ch MAO typ A
203
Phn tch: Qu liu serotonin, do hip ng cc tc dng dc l ca cc thuc.

C th xut hin hi chng serotonin, mc nng nh khc nhau, nhng c th dn
n t vong.
X l: Hi chng serotonin mang nhiu sc thi, vi cc triu chng kiu tm
thn (l ln, kch ng, thm ch hn m) vn ng (git rung c, run, tng hot
ng, cng ) thc vt (h hoc tng huyt p, nhp tim nhanh, run rt, ra m hi)
tiu ho (tiu chy). Phi hp ny cn trnh.
Methadon
liu.
Phn tch: Tng hm lng methadon trong huyt tng, km theo nguy c qu
X l: Theo di hm lng trong huyt tng v s xut hin cc du hiu qu

liu (ng g, l ln,). Gim liu, nu cn.
khng mong mun).
(ASAT, ALAT, phosphatase kim, bilirubin) hoc, nu c th, hon mt trong hai cch
iu tr. Xc minh l ngi bnh khng ung ru thng xuyn, v khng c tin s
vim gan virus. Cc triu chng lm sng chnh khng c hiu l bun nn, st, vng
da... Nu kt hp ban da, nga v hch to hng v bnh cn do thuc. Phn bit r,
tu theo kt qu th nghim sinh hc, nguy c xut hin vim gan tiu t bo khng hi
phc vi vim gan mt hi phc c khi ngng iu tr.
Barbituric; benzodiazepin; cht ch vn morphin; clonidin hoc thuc
tng t; interferon alpha ti t hp; khng histamin khng H1, an thn; thuc an
thn kinh cc loi; thuc c ch h thn kinh trung ng cc loi.
Phn tch: Tng tc dng an thn ca cht c ch ti thu nhp serotonin.
X l: Ch xem c cng ung ru, nht l ngi li xe v s dng my mc.
Carbamazepin
Phn tch: Tng hm lng carbamazepin trong huyt tng, km theo nguy c
qu liu.
X l: Theo di hm lng trong huyt tng v s xut hin cc du hiu qu
liu (ng g, l ln). Gim liu, nu cn.
Cimetidin
Phn tch: Nng trong huyt thanh v tc dng dc l ca citalopram v mt
s cht c ch ti nhp serotonin khc c th tng. C ch do cimetidin c ch chuyn
ho ca chng.
204
X l: Nu nghi c tng tc, c th phi iu chnh liu ca citalopram khi bt

u, khi ngng hoc thay i liu ca cimetidin. Cc cht i khng H 2 khc (th d
famotidin) c th khng c tng tc v c th xem xt lm thuc thay th cimetidin.
Cimetidin; citalopram; macrolid; marcrolid; tramadol; trazodon
Phn tch: Hi chng serotonin bao gm kch ng, tng trng lc c, run, git
rung c, l ln c th xy ra. C ch c th c s c ch ca chuyn ho citalopram.
X l: Nu khng trnh c phi hp ny, cn phi iu chnh liu ca
citalopram khi bt u, khi ngng hoc thay i liu ca macrolid. Theo di cht ch
ngi bnh.
Lithi
Phn tch: Nguy c xut hin hi chng tng tit serotonin kinh in. Tp hp cc
triu chng kiu tm thn (kch ng, l ln, thm ch hn m), vn ng (git rung
c, run, tng hot ng,) thc vt (h hoc tng huyt p, run rt, ra m hi ) tiu
ho (tiu chy).
X l: Bt buc phi theo di lm sng u n, khi khng trnh c phi hp
thuc.
Tramadol
Phn tch: Hi chng serotonin (kch thch h thn kinh trung ng, tng trng
lc c, run, git rung c, l ln) c th xy ra. C ch do tc dng serotoninergic c a
hai thuc c th hip ng.
X l: Theo di cht ch ngi bnh v tc dng c hi. Hi chng serotonin cn
c ch ngay, bao gm ngng thuc tng tit serotonin v chm sc h tr. Dng mt
thuc khng tit serotonin (th d cyproheptadin) c th c ch.
Trazodon
Phn tch: Nng trazodon trong huyt tng c th tng, dn n tng tc
dng dc l v tc dng c khi phi hp vi mt s cht c ch ti nhp serotonin
(th d citalopram). Hi chng serotonin (kch thch, tng trng lc c, run, gi t rung
c, l ln) c th xy ra. C ch do c th c s tch t nhanh v qu mc ca
serotonin trong h thn kinh trung ng. Mt s cht c ch ti nhp serotonin khc
cng c ch chuyn ho ca trazodon (CYP2D6).
X l: Nu khng trnh c phi hp ny, th bt u vi liu rt thp ca
citalopram hoc trazodon v theo di cht ch ngi bnh.
Thuc ung chng ng khng vitamin K
Phn tch: Tng tc dc ng hc, tng tc dng chng ng v nguy c chy
mu.
X l: iu chnh liu lc iu tr cng vi citalopram v khi ngng iu tr. Kim
tra u n t l chun quc t (INR) v thi gian prothrombin.
205
CLONIDIN HOC THUC TNG T

Thuc chng tng huyt p tc dng trung ng, c cc tnh cht alpha 2
adrenergic. Rilmenidin, l thuc chng tng huyt p chn lc trn cc th th
imidazolin;
khng c tc dng an thn vi liu thng thng.
CC THUC TRONG NHM

CLONIDIN vin nn 0,15 mg
Catapresan vin nn 0,15 mg
GUANFACIN vin nn 1 mg
Estulic vin nn 1 mg
RILMENIDIN vin nn 1 mg
Hyperium vin nn 1 mg
CH KHI CH NH THUC
Thi k cho con b: Cn theo di cht ch tr trong thi k b sa m.
nng.
Trm cm: Tng cc ri lon trm cm c t trc. Cn trnh khi trm cm
Thi k mang thai: Cha gp tc dng c hi, tuy nhin clonidin c i qua c
hng ro nhau - thai.
Cn theo di: mc 1
Suy thn: V 50% liu c bi xut di dng khng i qua ng nc tiu,
nn c nguy c tch lu clonidin.
Ngi cao tui: Trm cm c m t nht l ngi bnh cao tui. iu
chnh liu trnh tt huyt p qu mnh.
TNG TC THUC
Phn tch: Mt s kim sot huyt p v huyt p c th tng cao e do tnh
mng. C ch: C th c s c ch cc th th alpha 2 adrenergic trung ng b i
thuc chng trm cm ba vng, nhng cha xc nh dt khot.
X l: Trnh phi hp clonidin vi cc thuc chng trm cm ba vng. Nu c
th, bng cch dng cc thuc chng tng huyt p khc hoc cc thuc chng trm
cm khng ba vng.
206
Phn tch: Kh nng bin ng huyt p nhiu.

X l: Tng cng theo di huyt p ng mch. Nhn mnh tun th dng
thuc v gi gic dng thuc u n, khi thc hin liu php hai thuc. Cn cnh gic
ngi bnh cao tui.
Mianserin
Phn tch: Tng tc dc l: Ngoi s tng tc dng an thn, cn c i khng
th th adrenergic, do gim tc dng chng tng huyt p.
X l: Do c nguy c tht bi iu tr, nn thay i chin lc iu tr.
Ru
an thn. C th ghi nhn, vi mt vi sn phm, nht l trong tun u iu tr mt s
tc dng tm thn vn ng. Tng tc dc l. Cn lu l rilmenidin, vi liu thng
thng, khng lm tng tc dng c ch h thn kinh trung ng ca nhng thuc ny.
X l: Tt hn l khng nn phi hp hai thuc, v ngi k n khng c th ch
ng c ngi bnh ung ru. Nguy c an thn nguy him nht vi ngi li xe v
s dng my mc. Khuyn khng ung ru v khng t dng cc thuc hoc cc
ch phm c ru.
Thuc chn alpha
Phn tch: i khng dc l c th biu hin bng cch lm gim tc dng
chng tng huyt p ca clonidin (ging alpha) v tc dng ca cc thuc cng giao
cm alpha (phi hp khng hp l).
X l: Khng nn phi hp thuc do i khng dc l, c th dn n tht bi
iu tr, nu mc tiu chnh l iu tr tng huyt p.
Phn tch: Ch vn dc l c th th hin bng tng tc dng chng tng huyt
p ca clonidin (ging alpha) v ca cc thuc cng giao cm alpha.
X l: Mc tiu iu tr chnh phi l gim huyt p; cn trnh k n phi hp
ny v tu theo gi gic dng thuc c th dn n nhng bin ng v huyt p c hi
cho ngi bnh v cho vic tm kim cn bng huyt p.
Baclofen
X l: Theo di huyt p v iu chnh liu ca thuc chng tng huyt p la
chn ban u, trong khi iu tr v sau khi ngng iu tr phi hp. Thn tr ng v i
ngi bnh cao tui.
Benzodiazepin; carbamazepin; paroxetin; primidon hoc dn cht; thuc c
Phn tch: Tc dng hip ng c ch h thn kinh trung ng. Ch n ngi
li xe v ngi s dng my mc ngoi tr. Ch l rilmenidin, liu thng dng,
khng lm tng tc dng c ch h thn kinh trung ng ca nhng thuc ny.
207

Ngh n gim tnh to ngi li xe v s dng my mc. Khuyn khng ung ru,
Butyrophenon
Phn tch: C hai nguy c: Tng tc dng h huyt p, l mt tc dng khng
mong mun ca cc butyrophenon; tng tc dng c ch h thn kinh trung ng dn
n tng an thn. Tng tc dc l. Lu l rilmenidin, liu thng thng, khng
lm tng tc dng c ch h thn kinh trung ng ca nhng thuc ny.
X l: Lu nhng nguy c ny iu chnh liu ca hai thuc, nu cn phi
hp. Ngh n gim tnh to ngi li xe v ngi s dng my mc. Khuyn khng
nn ung ru v khng t dng thuc hoc cc ch phm c ru.
Carbamat hoc thuc
medifoxamin; phenothiazin
tng
t;
dantrolen;
dextropropoxyphen;
Phn tch: Tng tc dng c ch h thn kinh trung ng, dn n tng tc dng an
thn. Tng tc dc l. Lu l rilmenidin, liu thng dng, khng lm tng tc dng
c ch h thn kinh trung ng ca nhng thuc ny.
ru v khng t dng thuc hoc cc ch phm c ru.
Clozapin
Phn tch: Nguy c tng tc dng gim huyt p.
X l: Theo di huyt p ng mch v iu chnh liu ca thuc chng tng
huyt p la chn ban u, trong khi iu tr v khi ngng iu tr bng clozapin. Thn
trng vi ngi bnh cao tui.
Diazoxid
Phn tch: Phi hp hai thuc c tnh cht chng tng huyt p.
X l: Diazoxid gy tng glucose mu; nn cnh gic khi phi hp hai thuc, tu
theo mc tiu iu tr chnh. Nu cn phi hp, nn theo di u n huyt p ng
mch.
Furosemid hoc thuc tng t; reserpin; thuc li tiu gi kali; thuc li
tiu h kali mu
X l: Cn phi iu chnh liu lng, xc nh k hoch dng thuc v nhn
mnh vi ngi bnh v s tun th dng thuc. Lc bt u iu tr, khuyn ng i
bnh o (hoc nh o) u n huyt p ng mch cho ti khi t cn bng iu tr.
Glucocorticoid; mineralocorticoid (corticoid-khong); tetracosactid
Phn tch: Hiu lc ca thuc chng tng huyt p b gim, c l do tc dng gi
natri ca cc steroid.
208
X l: Nu cn phi hp, tng cng theo di huyt p ng mch, trong khi iu

tr v khi ngng mt trong hai thuc. C th phi iu chnh liu. Nhn mnh v k
hoch dng thuc v s tun th k hoch. c bit cnh gic ngi bnh cao tui.
Levodopa
Phn tch: Clonidin c m t l c th lm gim tc dng ca levodopa.
X l: C ch tng tc ny cha c bit r (kch thch cc th th alpha h
thn kinh trung ng hoc kch thch cc th th dopaminergic sau sinap). Nn ch
n nguy c ny trong qun l iu tr Parkinson v chuyn n Trung tm cnh gic
thuc khu vc nhng nhn xt cho php hiu r c ch hn.
Methyldopa
Phn tch: Phi hp cc thuc chng tng huyt p, tng nguy c h huyt p t
th ng quan trng. Cng tng c nhng tc dng c ch h thn kinh trung ng.
X l: Thng tin cho ngi bnh v phn chia cc liu trong ngy. Ch n
ngi li xe v vn hnh my mc. Khuyn ngi bnh khng ung ru, khng ung
nhng thuc c t dc ru.
Nicorandil; nitrat chng au tht ngc.
Phn tch: Phi hp vi bt k thuc chng tng huyt p c th lm tng nguy
c gim huyt p, i khi dn n sc.
X l: Tng cng theo di huyt p trong khi iu tr v sau khi ngng mt trong
hai thuc. c bit thn trng ngi bnh cao tui.
Thuc an thn kinh cc loi
Phn tch: Lu hai nguy c: Tng tc dng chng tng huyt p, l mt tc
dng khng mong mun ca cc thuc an thn kinh; tng tc dng c ch h thn kinh
trung ng dn n tng tc dng an thn. Tng tc dc l. Nn nh rng
rilmenidin, liu thng thng, khng lm tng tc dng c ch h thn kinh trung
ng ca nhng thuc ny.
X l: Ghi nhn nhng nguy c ny iu chnh liu ca 2 thuc, nu cn phi
nn ung ru v nu ngi bnh t dng thuc, cn kim tra l cc t d c ca
nhng thuc ny phi khng cha ru.
Thuc chn beta
Phn tch: Phi hp hai thuc chng tng huyt p, phi hp thc hin c v
mt dc l v tr liu.
X l: Nu cn phi hp, tng cng theo di huyt p ng mch trong khi v
khi ngng iu tr bng mt trong hai thuc. Ch khng ngng t ngt clonidin, v
nguy c tng huyt p ni s km vi kh nng chy mu no. Ngng clonidin rt t t,
nu cn thit. C khi phi iu chnh liu. Nhn mnh v k hoch dng thuc v s
tun th k hoch. c bit cnh gic ngi bnh cao tui.
209
Phn tch: Tng tc dng c ch h thn kinh trung ng, dn n tng tc dng an
thn. Tng tc dc lc. Lu l rilmenidin, vi liu thng dng, khng lm tng tc
dng c ch h thn kinh trung ng ca nhng thuc ny.
X l: Lu n nguy c ny iu chnh liu lng ca hai thuc. Ngh n
gim tnh to ngi li xe v ngi s dng my mc. Khuyn khng ung ru,
khng t dng thuc hoc ch phm cha ru.
Thuc c ch MAO typ B
Phn tch: S c ch c hiu mono amin oxydase typ B dn n ko di tc
dng ca levodopa, iu gii thch ti sao n thng cng c k n vi cht
ny. Cc tng tc cng ging nh ca levodopa v nn xem nhm thuc ny.
X l: Khng nn dng phi hp ny, do nguy c tht bi iu tr.
Sotalol
Phn tch: Phi hp hai thuc tc dng chng tng huyt p, phi hp c th
thc hin c v mt dc l v iu tr. Tuy nhin lu l thuc sotalol c dng
chng lon nhp tim nhiu hn l lm thuc chng tng huyt p.
X l: Nu cn phi hp thuc, tng cng theo di huyt p ng mch trong
khi iu tr v khi ngng mt trong hai thuc. Ch khng ngng t ngt clonidin, v
nguy c tng huyt p ni s km vi kh nng chy mu no. Ngng clonidin rt t t,
nu cn. iu chnh liu tu theo trng hp. Nhn mnh v k hoch dng thuc v
s tun th k hoch. c bit cnh gic vi ngi bnh cao tui.
amphetamin.
ngi bnh gp li thy thuc nu thy iu tr khng n nh.
Barbituric; benzamid; fluoxetin; fluvoxamin; khng histamin khng H1 an
thn
an thn. Tng tc dc l. Lu l rilmenidin vi liu thng dng, khng lm tng tc
dng c ch h thn kinh ca cc thuc ny.
ru, khng t dng thuc hoc cc ch phm c ru.
Cht ch vn morphin
Phn tch: Tng tc dng c ch h thn kinh trung ng, tc dng c ch h
hp v tc dng gim huyt p . Ngoi ra, nu c s ph thuc thuc, phi hp ny c
th lm tng nguy c ph thuc. Lu l rilmenidin, liu thng dng, khng lm
tng cc tc dng c ch h thn kinh trung ng ca cc thuc ny.
210

Ngh n gim tnh to ngi li xe v ngi vn hnh my mc. Theo di huyt p
trong khi phi hp hai thuc. Tu theo thuc dng, gim huyt p c th t hay nhi u.
iu chnh liu ca mt hoc c hai thuc tu trng hp. Xy d ng mt k hoch
dng thuc u n. Khng ung ru, khng t dng thuc hoc cc ch phm c
ru. Gp thy thuc gim liu mt hoc hai thuc nu thy chng mt khi bt u
iu tr. Tng cng theo di ngi bnh cao tui (nguy c ng) v khuyn h
chuyn dn dn t t th nm hoc ngi sang t th ng.
Citalopram
Phn tch: Tng tc dng an thn ca cht c ch ti thu nhp serotonin.
X l: Ch khng ng thi ung ru, nht l ngi li xe v s dng my.
Indometacin hoc dn cht; pyrazol; dn cht salicylat; thuc chng vim
khng steroid
Phn tch: Gim tc dng chng tng huyt p; cc thuc chng vim khng
steroid c ch tng hp prostaglandin gy gin mch thn v /hoc dn n gi mui
nc. Nguy c suy thn cp ngi bnh b mt nc.
X l: m bo cung cp nc cho ngi bnh, theo di chc nng thn (
thanh lc creatinin). Kim tra s n nh huyt p, c bit khi bt u i u tr. Th n
trng hn khi phi hp vi indometacin hoc dn cht salicylat liu cao. Khuyn ngi
bnh kim tra huyt p u n.
Methadon
Phn tch: Tng tc dng c ch h thn kinh trung ng, km an thn mnh c
bit c hi cho ngi li xe v s dng my mc.
X l: Ngi k n phi lu s tng tc dng an thn ny phi c ghi khi k
n cc thuc v cho li khuyn thch hp: trnh li xe, trnh vn hnh my mc, thng
bo cho ngi xung quanh bit mi nguy him.
Oxaflozan; viloxazin
an thn. Thng bo cho ngi xung quanh bit mi nguy him. Tng tc dc l. Lu
l rilmenidin, vi liu thng dng khng lm tng tc dng c ch h thn kinh trung
ng ca nhng thuc ny.
n gim tnh to ngi li xe v ngi s dng my mc. Khuyn khng ung ru
Phn tch: S dng ng thi hai thuc ny c th dn n nhng bin ng
huyt p quan trng. Ngoi ra cn thm tc dng c ch h thn kinh trung ng.
X l: Cc thuc c ch MAO him c s dng, cc tng tc c nhiu nhng
v him gp cc n thuc nn c t nhn xt v cnh gic thuc. Tuy nhin, c n tn
211
trng thi hn t 2 n 3 tun sau khi ngng thuc trc khi k n li thuc c ch
MAO.
CLORHEXIDIN
Thuc chng nhim khun lm gim tm thi s lng
vi sinh vt c trn b mt da-nim mc
CC THUC TRONG NHM
CHLORHEXIDIN dung dch bi da 20%
Cyteal dung dch bi da 20%
Eludril dung dch bi da 0,1g/100mL
CH KHI CH NH THUC
Thn trng: mc 2
Trng hp khc: Trnh tip xc vi no, mng no, ng tai khi b thng mng
nh.
212
CLOZAPIN
Thuc an thn kinh, dn cht ca dibenzodiazepin, dng trong iu tr tm thn
phn lit mn tnh nng, khng vi cc thuc an thn kinh khc. Clozapin c th gy
mt bch cu ht gy t vong trong 1-2% trng hp, nn cn c s theo di c bit
CC THUC TRONG NHM
CLOZAPIN vin nn 25 mg; 100 mg
Leponex vin nn 25 mg; 100 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
n ung -ru: Do tng tc gia thuc ny vi ru ethylic.
Glocom: Do tnh khng cholinergic ca thuc.
Bnh v mu: Nguy c gim bch cu ht nghim trng.
Ph i tuyn tin lit/ u tuyn tin lit: Do tnh khng cholinergic ca thuc.
Suy tim: Nguy c tng tc dng khng mong mun.
Suy gan: Trong suy gan nng, do chuyn ho ca thuc.
Suy thn: Trong suy thn nng, do chuyn ho ca thuc.
Thi k cho con b: Do thn trng, nn trnh.
Thi k mang thai: V thiu d liu, gii hn thi gian dng thuc. Theo di v
tiu ho v thn kinh tr s sinh.
TNG TC THUC
Ritonavir
Phn tch: Nguy c hip ng cc tc dng c v mu, km mt bch cu ht.
X l: Khng k n phi hp ny. Ngh cch thay th ritonavir
Carbamazepin
Phn tch: Tng tc dng c ch h thn kinh trung ng dn n tng tc dng
an thn. Tng tc dc l. Vi clozapin, tng nguy c mt bch cu ht.
X l: Lu tng tc ny iu chnh liu ca hai thuc, nu cn phi hp
ny. Ngh n gim tnh to ngi li xe v ngi s dng my mc. Khuyn khng
ung ru v khng t dng thuc hoc cc ch phm cha ru.
Amphotericin B
213
Phn tch: Phi hp amphotericin B tim vi cc cht c vi tu xng bt buc

phi tht thn trng. Nguy c thiu mu hoc cc ri lon huyt hc khc.
X l: Khi cn phi hp thuc, nn theo di cn thn huyt v tin hnh gim
liu, nu cn thit.
Azathioprin
ng, c th dn n mt bch cu ht. Ch dng clozapin n c cng c th mt
bch cu ht nghim trng, thm ch gy t vong (c tnh min dch).
X l: Nu cn phi hp, nn dng cc liu thp cho tng thuc. Khng g cho
php tin on s xut hin mt bch cu ht vi clozapin. Vic theo di cn th n
huyt , thc hin bnh thng khi dng mt thuc km t bo, vn c gi tr . Tuy
nhin ngi bnh phi c thng bo l nu b st nh, vim hng v lot ming, th
phi ngng iu tr bng clozapin.
Barbituric; carbamat hoc thuc tng t; oxaflozan; primidon hoc dn
cht; thuc c ch thn kinh trung ng cc loi
X l: Lu nguy c ny iu chnh liu ca hai thuc. Ngh n gim tnh to
ngi li xe v ngi s dng my mc. Khuyn khng ung ru v khng dng
thuc hoc cc ch phm c ru.
Benzamid; bepridil; bretylium; angiotensin; clonidin hoc thuc tng t;
diazoxyd; dihydropyridin; diltiazem; furosemid hoc thuc tng t; guanethidin
hoc thuc tng t; methyldopa; nitrat chng au tht ngc; reserpin; sotalol;
thuc an thn kinh cc loi; thuc chn beta; thuc li tiu gi kali; thuc li
tiu thi kali; verapamil; thuc c ch enzym chuyn dng
Phn tch: Nguy c lm tng tc dng gim huyt p .
huyt p la chn ban u, trong khi iu tr v khi ngng iu tr vi clozapin.
Butyrophenon
Phn tch: Tng tc dng gim huyt p ca nhng thuc ny.
X l: Nu cn phi hp, nn tng cng theo di huyt p ng mch, trong v
sau khi ngng iu tr mt trong hai thuc. iu chnh liu tu trng hp. Nhn mnh
v k hoch dng thuc v s tun th k hoch. c bit cnh gic ngi bnh cao
tui.
Carmustin hoc dn cht; cisplatin hoc dn cht; colchicin hoc dn
cht; cyclophosphamid hoc thuc tng t; dactinomycin; fluoro-5-uracil;
ganciclovir; interferon alpha ti t hp; levamisol; melphalan; methotrexat;
phenicol; thuc chng ung th cc loi
ng, c th dn n mt bch cu ht. Vi clozapin ch dng n c, cng c th
mt bch cu ht nghim trng, thm ch gy t vong (c tnh min dch).
214
X l: Trnh phi hp. Nu cn phi hp, dng cc liu thp cho mi thuc.
Khng g cho php tin on mt bch cu ht vi clozapin. S theo di cn thn huyt
, thc hin bnh thng khi s dng mt thuc km t bo, vn c gi tr. Tuy nhin
ngi bnh phi c thng bo l nu st nh, vim hng v lot ming th phi
ngng iu tr.
Disopyramid; phenothiazin; thuc khng histamin khng H1, an thn
Phn tch: Tng tc dng khng cholinergic do hip ng cc tc dng khng
mong mun. Nhng tc dng ny biu hin bng s tng nguy c b tiu tin, kh
ming v to bn.
X l: Cc bt tin ca loi thuc ny cn c lu . Nu phi hp ny, phi
c thc hin theo mc tiu iu tr, cn thng bo cho ngi bnh v nhng bt tin
ny. Trnh dng cho ngi c vn v tuyn tin lit v ngi b glocom.
Doxorubicin hoc dn cht; procarbazin; thiotepa; vincristin hoc thuc
tng t
ng, c th dn n mt bch cu ht. Ch dng clozapin n c cng c th b mt
X l: Nu cn phi hp, nn dng liu thp cho tng thuc. Khng g cho php
tin on s xut hin mt bch cu ht vi clozapin. Vic theo di cn thn huyt ,
thc hin bnh thng khi dng mt thuc km t bo, vn c gi tr. Tuy nhin, ngi
bnh phi c thng bo l nu st nh, vim hng v lot ming, th ph i ng ng
iu tr vi clozapin.
X l: Interleukin l thuc ch c th s dng c s chuyn khoa, v mc
nghim trng ca bnh. Cc tng tc phi c cn nhc v mi chc nng ca c
th phi c theo di thng xuyn. Bt buc phi theo di huyt .
Lithi
Phn tch: Nguy c tng c tnh thn kinh (ngt xu, l ln, lon vn ng...) do
c ch cha r.
X l: Nu cn phi hp, ch yu phi theo di lm sng. Khi xut hin cc triu
chng, thay i cch iu tr.
Mercaptopurin; penicilamin hoc thuc tng t
ng, c th dn n mt bch cu ht. Ch dng clozapin n c cng c th b mt
X l: Nu cn phi hp, nn dng cc liu thp cho tng thuc. Khng g cho
php tin on s xut hin mt bch cu ht vi clozapin. Vic theo di cn th n
nhin, ngi bnh phi c thng bo l nu st nh, vim hng v lot ming phi
ngng iu tr vi clozapin.
215
Phenytoin
Phn tch: Tng tc dc ng hc v chuyn ho thuc: tng chuyn ho
clozapin do cm ng enzym, c th dn n tht bi iu tr ca thuc hng thn.
X l: Lu n hu qu ca tng tc ngay khi bt u iu tr bng phenytoin;
nn bit rng s cm ng enzym ch biu hin 8-10 ngy sau lc bt u i u tr m
khng xy ra tc th.
Pentostatin
huyt hc nng, tu theo di thi gian iu tr.
X l: Phi hp cn c theo di v mt huyt hc, sau khi lu n bi cnh
iu tr.
Phn tch: Nguy c lm tng tc dng gim huyt p.
huyt p la chn ban u, trong khi iu tr v khi ngng iu tr phi hp.
Ru
ung ru v khng t dng thuc hoc cc ch phm
cha ru.
Zidovudin
Phn tch: Phi hp zidovudin vi cc cht c vi tu xng khc buc phi
thn trng. Nguy c thiu mu hoc cc ri lon huyt hc khc.
X l: Khi cn phi hp, theo di cn thn huyt v nu cn, phi gim liu.
Benzodiazepin
thn. Tng tc dc lc.
t dng thuc hoc cc ch phm c ru.
Phn tch: Tng cc tc dng khng cholinergic do hip ng tc dng khng
mong mun. Nhng tc dng ny th hin bng tng nguy c b tiu tin, kh ming v
to bn.
216
X l: Cn lu nhng bt tin ca loi thuc ny. Nu phi phi hp theo mc

tiu iu tr, thng bo cho ngi bnh v nhng bt tin ny. Trnh dng cho ngi c
bnh l v tuyn tin lit v ngi b tng nhn p.
COLCHICIN HOC DN CHT

Thuc chng gt, dng ch yu trong cn cp tnh ca bnh.
Thiocolchicosid c xut dng trong mt s co cng au
CC THUC TRONG NHM

COLCHICIN vin nn 1g
Colchicine Houd vin nn 1g
THIOCOLCHICOSID vin 4 mg; ng tim 4 mg/2mL
Coltramyl vin 4 mg; ng tim 4 mg/2mL
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: Thiocolchicosid qua c sa m, nn trnh dng thuc
ny cho ngi ang thi k cho con b.
Thi k mang thai: Colchicin gy qui thai nhiu loi ng vt, c l do c ch
s gin phn.
Thn trng: mc 2
Suy gan: Nguy c gim bi xut colchicin qua mt (con ng o thi chnh ca
thuc).
Suy thn: Nguy c c tnh tch lu.
TNG TC THUC
Cyclosporin
Phn tch: Tc dng khng mong mun nghim trng bao gm c tnh ng
tiu ho, gan, thn v thn kinh c c th xy ra khi dng cyclosporin cng vi colchicin.
C ch cha r.
X l: Theo di cht ch ngi bnh v nhng du hiu v triu chng c tnh ca
cyclosporin. Nu phi dng c hai thuc, iu chnh liu cho ph hp.

217
Asparaginase; azathioprin; carmustin hoc dn cht; cisplatin hoc dn

cht; cyclophosphamid hoc thuc tng t; doxorubicin hoc dn cht; fluoro5-uracil; melphalan; mercaptopurin; methotrexat; procarbazin; thiotepa; thuc
chng ung th cc loi; vincristin hoc thuc tng t
hm lng acid uric. Ngoi ra, tng nguy c gim bch cu v gim tiu cu do hip
X l: Nn trnh dng hai thuc trong cng thi gian, nu khng s thy iu tr
chng gt tht bi. Nn dng alopurinol (thuc c ch tng hp acid uric) hn l cc
thuc bi acid uric qua ng tit niu trnh cc bnh thn.
Clozapin
ng, c th dn n mt bch cu ht. Vi clozapin ch dng n c, cng c th b
mt bch cu ht nghim trng, thm ch gy t vong (c tnh min dch).
X l: Trnh phi hp. Nu cn phi hp, nn dng cc liu thp vi mi thuc.
Khng g cho php tin on s xut hin mt bch cu ht vi clozapin. Vic theo di
cn thn huyt , thc hin bnh thng khi dng mt thuc km t bo, vn c gi tr.
Tuy nhin ngi bnh cn c thng bo khi st nh, vim hng v lot ming, phi
ngng iu tr.
Dactinomycin
Phn tch: Nguy c lm tng nng acid uric trong huyt tng.
X l: C th cn phi iu chnh liu ca thuc chng gt khng ch tng
acid uric mu.
Diazoxid; furosemid hoc thuc tng t; thuc li tiu gi kali; thuc li
tiu thi kali
Phn tch: Nhng thuc ny lm tng acid uric mu v lm gim hiu qu iu tr
chng gt.
X l: Nn trnh dng hai thuc ng thi, nu khng s thy iu tr chng gt
tht bi.
Erythromycin
Phn tch: Tng nng colchicin trong huyt thanh km theo c tnh c th xy
ra. C ch, c l do c s c ch chuyn ho ca colchicin.
X l: Quan st p ng lm sng ca ngi bnh. C th cn phi gim liu
colchicin trong khi dng vi erythromycin. Theo di nng colchicin trong huyt thanh
c th c ch trong qun l ngi bnh.
Ganciclovir
X l: Nu c th, trnh phi hp. Nu cn phi hp, dng cc liu thp cho tng
thuc v theo di cn thn huyt . Phi hp ny phi do cc nh chuyn khoa thc
hin v cc phc iu tr thng phi c xc nh r.
218
X l: Interleukin l thuc ch c php dng ti c s chuyn khoa, v tnh
nghim trng ca bnh. Cc tng tc cn c cn nhc, v tt c cc chc nng
ca c th phi c theo di lin tc. Bt buc phi theo di huyt .
Levamisol
Phn tch: Tng nguy c gim bch cu v gim tiu cu, thm ch mt bch cu
ht do hip ng cc tc dng khng mong mun ca cc thuc.
X l: Nn trnh phi hp hai thuc, ngay c khi colchicin c dng lm thuc
chng gt ch khng phi lm thuc km t bo.
Pentostatin
Phn tch: Pentostatin c th lm tng hm lng acid uric. iu chnh liu ca
thuc chng gt c th cn kim sot tng acid uric mu.
X l: Nn dng alopurinol (cht c ch tng hp acid uric) hn l dng nhng
cht o thi acid uric, v c th gp nguy c bnh thn vi acid uric.
Ru
Phn tch: Tng c tnh tiu ho, nht l ngi nghin ru mn tnh. Ru
lm tng nng acid uric trong mu v do c th lm gim tc dng ca cc thuc
iu tr chng gt.
tr.
X l: V ch n ung, khuyn ngi bnh gt trnh ung ru trong khi iu
CORTICOID - KHONG
Hormon thng thn tng huyt p v khng niu (do gi natri)
CC THUC TRONG NHM

DESOXYCORTON ng tim 10mg/ 1 mL
Syncortyl ng tim 10 mg/ 1 mL
Syncosteron ng tim 10mg/ 1 mL
CH KHI CH NH THUC
Chng ch nh: mc 4
Tng huyt p ng mch: Do gi natri
219

Thi k cho con b; mang thai: Do thn trng, v cc tnh cht dc l ca
nhng thuc ny.
TNG TC THUC
Amiodaron; benzamid;
sparfloxacin; vincamin
bepridil;
halofantrin;
pentamidin;
sotalol;
Phn tch: Nguy c xut hin xon nh khi dng phi hp ny. H kali mu, nhp
tim chm v khong QT ko di t trc (ch thy c trn in tm ) l nhng yu
t thun li cho xut hin xon nh. Xon nh l mt kiu c bit ca nhp tht, c
thc) i khi tin trin n rung tht.
X l: Khng nn dng phi hp ny. S dng cc thuc khng d n n xon
nh. Nu cn phi hp, phi theo di thng xuyn khong QT v tin hnh kim tra
u n kali mu. Khuyn ngi bnh gp li bc s, nu thy mt nhc, yu c, co
cng c (du hiu ban u ca h kali mu).
Phn tch: Tng tc c ghi nhn duy nht vi mt thuc khng histamin khng
an thn: astemizol (Hismanal). H kali mu (nhng tiu chy ko di cng c th gy
mt nc v in gii) l mt yu t thun li cho xon nh. Nguy c tng khi cc
thuc gy h kali mu c phi hp vi nhng thuc c th gy xon nh khc. Xon
nh l mt kiu c bit ca nhp tht, c th xut hin tng cn rt ng n (vi giy,
mt thu: cm gic ngt m khng mt thc).
X l: Phi hp cn trnh. Nn thay i chin lc iu tr v chn cc thuc
khng gy xon nh. Nu phi gi phi hp ny, theo di kali mu v nu c n, b
sung kali.
Disopyramid; quinidin hoc dn cht
Phn tch: Nguy c xon nh do hip ng tc dng in sinh l, khi phi hp
thuc. H kali mu, nhp tim chm v khong QT ko di c t trc (in tm ) l
nhng yu t thun li cho xut hin xon nh. Xon nh l mt kiu c bi t ca
nhp tht c th xut hin tng cn rt ngn (vi giy, mt thu: cm gic ng t m
khng mt thc).
X l: Khng nn dng phi hp ny. Dng cc thuc khng gy xon nh. Nu
cn phi hp, phi theo di lin tc khong QT v tin hnh kim tra u n kali mu.
Khuyn ngi bnh gp li bc s nu thy mt nhc, yu c, co cng c... (du hiu
bo hiu h kali mu).
Macrolid
Phn tch: Tng tc ch c ghi nhn duy nht vi erythromycin tim tnh mch
trong h macrolid. Nguy c xut hin xon nh khi phi hp hai thuc. H kali mu,
nhp tim chm v khong QT ko di c t trc (in tm ) l nhng yu t thun
li cho xut hin xon nh. Xon nh l mt kiu c bit ca nhp tht, c th xut
220
hin tng cn rt ngn (vi giy, mt thu: cm gic ngt m khng mt thc). Cc
thuc gy h kali mu, corticoid - khong to thun li cho s xut hin xon nh khi
phi hp vi mt s thuc khng chng lon nhp (erythromycin tim tnh mch).
X l: Khng nn dng phi hp ny. Dng cc thuc khng gy xon nh. Nu
cn phi hp, phi theo di lin tc khong QT v tin hnh kim tra u n kali mu.
Khuyn ngi bnh gp li bc s nu thy mt nhc, yu c, co cng c... (du hiu
bo hiu h kali mu).
Amphotericin B
Phn tch: Tc dng h kali mu tng ln vi amphotericin B dng tim.
Amphotericin B rt t c hp thu khi ung hoc dng ti ch, trong cc iu kin bnh
thng.
X l: Theo di kali mu. nh gi cc nguy c tng tc tu thuc ng dng
amphotericin B.
Phn tch: Dng ng thi hai thuc c th lm tng nguy c xut hin ph.
Tng tc kiu dc lc.
X l: Cn nhc s cn thit phi k n phi hp hai thuc v, nu cn iu
chnh liu v theo di ion . Ch n vic s dng ln lt cc steroid ng ho (cc
vn ng vin th thao).
Clonidin hoc thuc tng t; diazoxyd; guanethidin hoc thuc tng t;
reserpin; thuc gin mch chng tng huyt p; thuc li tiu gi kali; thuc c
ch enzym chuyn dng angiotensin
Phn tch: Hiu lc ca thuc chng tng huyt p b gim, c l do tc dng gi
X l: Nu cn phi hp, phi tng cng theo di huyt p trong v khi ng ng
iu tr bng mt trong hai thuc. Tin hnh iu chnh liu, nu cn. Nhn mnh v
k hoch dng thuc v s tun th. c bit cn thn khi dng ngi bnh cao tui.
Asparaginase
Phn tch: Tng tc dng lm tng glucose mu v tng nguy c vim dy thn
kinh ngoi bin v ri lon to hng cu.
X l: Phi hp thuc phi c cc nh chuyn khoa qun l ti bnh vin. c
tnh s thp hn nu asparaginase c dng sau cc corticoid, ch khng phi l
dng trc hoc cng.
Barbituric; carbamazepin; phenytoin; primidon hoc dn cht; rifampicin
Phn tch: Tng d ho cc corticoid - khong bi cc thuc cm ng enzym. Cm
ng enzym ch th hin 10-12 ngy sau khi bt u iu tr.
X l: Cm ng enzym khng phi l mt hin tng tc thi. iu tr bng mt
thuc gy cm ng enzym trung hoc di hn phi ch n nguy c gim tc d ng
iu tr ca corticoid - khong. iu chnh liu ca corticoid -khong trong khi iu tr v
sau khi ngng iu tr cht cm ng.
221
Bretylium
Phn tch: Nguy c xut hin xon nh khi phi hp cc thuc ny. H kali mu,
nhp tim chm v khong QT di c t trc (in tm ) l nhng yu t thun l i
cho xut hin xon nh. Xon nh l mt kiu c bit ca nhp tht, c th xut hin
tng cn rt ngn (vi giy, mt thu: cm gic ngt m khng mt thc).
X l: Nu cn phi hp, phi phng nga h kali mu bng cch tng cng s
theo di v gim st in tm . Trng hp xut hin xon nh, khng dng thuc
chng lon nhp. Khuyn ngi bnh gp li thy thuc, nu thy mt nhc, yu c,
thm ch chut rt.
Cura cc loi
Phn tch: Nguy c tng chn thn kinh-c do h kali mu, nht l vi cc loi
cura khng kh cc.
X l: Cn nh lng kali mu trc khi dng loi cura khng kh cc.
Li tiu gy thi kali; furosemid hoc thuc tng t; glucocorticoid;
tetracosactid
Phn tch: Phi hp hai thuc gy h kali mu dn n tng nguy c h kali mu
v nguy c xut hin xon nh.
X l: Theo di kali mu v hiu chnh, nu cn, bng cc mui kali. H kali mu
th hin lm sng qua mt nhc, thm ch chut rt v i khi lon nhp tim. Ch n
s mt nc qu mc (khi c gng th lc hoc nng nhiu hoc tiu chy kh cha)
lm nng thm na s mt kali. Khi cn, khuyn b sung nht thi kali (chui, mn
hoc mui kali...).
Glycosid tr tim
Phn tch: Cc corticoid dng di ngy gy h kali mu, dn n yu c, c th
lm tng c tnh ca digitalis. Cc glycosid tr tim c ch Na +/K+ - ATPase lin quan
n chuyn vn ion natri v kali qua mng t bo c tim. C ch tc dng chnh xc
cn
cha
bit
r
hon
ton.
H
kali
mu
nng
( 3 mEq/lt) c th gy ngoi tm thu tht hoc nh v nhp nhanh tht hoc nh v c
ri lon nng v dn truyn nh - tht. ngi bnh s dng digitalis, cc r i lon
tng t xut hin c khi kali mu h t hn.
X l: Trc khi bt u iu tr ng thi hai thuc ny, cn phi nh lng kali
trong huyt thanh, hiu chnh h kali mu nu c v theo di u n kali mu. V lm
sng, h kali mu c th bt u bng yu c, co cng c v cho nhng triu chng
nng hn, th d lon nhp v lit h hp. Phi phng cc trng hp h kali mu do
ra m hi qu mc v tiu chy kh cha v dai dng.
Phn tch: Phi hp hai thuc gy h kali mu dn n tng nguy c h kali mu
nht l khi dng thuc nhun trng di ngy.
X l: Theo di kali mu v hiu chnh, nu cn, dng cc mui kali. H kali mu
th hin trn lm sng bng mt nhc, yu c thm ch chut rt v i khi lon nhp
tim. Ch n s mt nc qu mc (khi gng sc hoc khi nng nhiu hoc tiu chy
222
kh cha) lm tng hn na s mt kali. Khi cn, khuyn b sung nht thi kali (chui,
mn hoc mui kali).
Gluthetimid hoc thuc tng t
Phn tch: Aminogluthetimid l cht cm ng enzym. Thuc cm ng chuyn ho
mnh dexamethason (tr hydrocortison), lm gim tc dng ca cht ny.
X l: Lu tng tc dc ng hc ny tu theo mc tiu iu tr. Cn tnh n
thi gian iu tr bng corticoid. S cm ng enzym ch th hin dn dn sau nhiu ngy
iu tr. Tng tc ch c m t vi dexamethason.
Methyldopa
Phn tch: Tc dng chng tng huyt p c th b gim do cc corticoid- khong
gi nc v mui.
X l: iu chnh liu lng trong v sau khi iu tr bng corticoid. Thng tin
cho ngi bnh tng cng t theo di trong iu tr vi corticoid. Khuyn c k
hoch dng thuc u n trong thi gian iu tr. Khuyn ng i bnh g p l i bc s
khi thy nhng bin i quan trng v huyt p.
CYCLOPHOSPHAMID HOC THUC TNG T

Thuc chng ung th, km t bo, alkyl ho
CC THUC TRONG NHM

CYCLOPHOSHAMID bt pha tim 500 mg; 1000 mg
Endoxan bt pha tim 500 mg; 1000 mg
IFOSFAMID bt pha tim 1 g; 2 g
Holoxan bt pha tim 1 g; 2 g
CH KHI CH NH THUC
Ngi k n dng nhng thuc ny cho ngi bnh phi l cc thy thuc
chuyn khoa. V vy, cc chng ch nh phi c cn nhc, tu theo tnh trng ngi
bnh v phi c cc chuyn gia nh gi.
TNG TC THUC
Phn tch: Dng ng thi vi cc thuc c ch min dch lm tng nguy c xut
223
X l: Mc du cc trng hp c thng bo ch lin quan n lovastatin, nguy c

tim tng vn c c vi simvastatin v pravastatin. Phi hp cn trnh.
Vaccin sng gim c lc
X l: Khong cch cn tn trng gia 2 thuc l t 3 thng n 1 nm v tu
thuc vo cng ca s c ch min dch.
Phn tch: Dng ng thi alopurinol vi cyclophosphamid c th lm tng tc
dng c ch tu xng, do tng nguy c chy mu hoc nhim khun.
X l: Nu cn phi hp, theo di cht ch huyt .
Amphotericin B
Phn tch: Phi hp amphotericin B tim vi cc cht c vi tu khc bt buc phi
tht thn trng. Nguy c thiu mu hoc cc ri lon huyt hc khc.
X l: Khi cn phi hp, theo di cn thn huyt v gim liu, nu cn.
Azathioprin; carmustin hoc dn cht; dactinomycin; fluoro-5-uracil;
ganciclovir; interferon alpha ti t hp; levamisol; melphalan; mercaptopurin;
methotrexat; penicilamin hoc thuc tng t; pentostatin; procarbazin;
thiotepa; thuc chng ung th cc loi; vng; vincristin hoc thuc tng t
X l: Nu c th, trnh phi hp. Nu cn phi hp, dng cc liu thp cho tng
thuc v theo di cn thn huyt . Phi hp ny do cc nh chuyn khoa thc hin
v cc phc iu tr thng c xc nh r.
Phn tch: Tng c tnh ca cyclophosphamid do tng chuyn ho thuc thnh
cht chuyn ho alkyl ho ca cyclophosphamid (cm ng enzym).
X l: Theo di cht huyt v nh gi nguy c gy gim bch cu ca phi
hp. Cn lu n thi gian iu tr cn thit tng tc ny khng xy ra. Cm ng
enzym l mt hin tng th hin dn dn (t nht 10 ngy).
Cisplatin hoc dn cht; doxorubicin hoc dn cht
Phn tch: Phi hp vi cc cht c ch tu xng khc phi c lu .
X l: l mt iu tr c khi u bnh vin. Theo di huyt v chc
nng tim.
hm lng acid uric. Ngoi ra, c s tng nguy c gim bch cu v gim tiu cu do
hip ng tc dng khng mong mun ca cc thuc.
224
X l: Tt nht, nn trnh dng hai thuc cng thi gian nu khng iu tr chng
gt s tht bi. Nn dng alopurinol (cht c ch tng hp acid uric) hn l cc thuc
thi acid uric trnh cc bnh thn.
Clozapin
ng, c th dn n mt bch cu ht. Vi clozapin ch dng n
c cng c th gy mt bch cu ht nng, thm ch gy t vong (c tnh min
dch).
X l: Trnh phi hp. Nu cn phi hp, nn dng cc li u th p c a t ng
thuc. Khng c g cho php tin on s xu t hi n m t b ch c u h t v i clozapin.
Vic theo di cn thn huyt , thc hi n bnh th ng khi s d ng m t thu c km
t bo, vn c gi tr. Tuy nhin ng i b nh ph i c thng bo l khi c s t nh ,
vim hng v lot ming th phi ng ng i u tr.
Glycosid tr tim
Phn tch: Phi hp vi thuc km t bo dn n gim hp thu cc d n cht
digitalis khong 50% do tn hi nim mc rut c hi phc.
X l: Theo di cn thn hm lng cc thuc digitalis trong huyt thanh trong
sut qu trnh iu tr. Tng liu ca digoxin nu cn thit.
X l: Interleukin ch c th s dng c s chuyn khoa, v mc nghim
trng ca bnh. Cc tng tc phi c cn nhc, v mi chc nng ca c th phi
c theo di thng xuyn. Theo di huyt l bt buc.
Phenicol
ng, c th dn n mt bch cu ht. Ch dng n c phenicol cng c th b mt
bch cu ht nng, thm ch gy t vong(c tnh min dch).
X l: Nu cn phi hp, nn dng cc liu thp cho mi thuc. Khng c g cho
php tin on s xut hin mt bch cu ht vi cc phenicol. Vic theo di cn thn
nhin ngi bnh phi c thng bo khi c st nh, vim hng v lot mi ng, th
phi ngng iu tr vi cc phenicol.
Zidovudin
Phn tch: Phi hp zidovudin vi cc thuc c vi tu xng buc phi rt thn
trng. Nguy c thiu mu hoc cc ri lon huyt hc khc.
X l: Khi cn phi hp, nn theo di cn thn huyt v nu cn, thc hin
gim liu.
Ciclosporin
225
Phn tch: Phi hp ca hai thuc c tnh c ch min dch. Do s c ch ny

qu quan trng, c th c nguy c xut hin u lympho gi.
X l: S phi hp hai cht c ch min dch ny phi c suy xt v t ng
quan nguy c/ li ch phi c cn nhc tu theo mc tiu iu tr. Ch c tin hnh
ti c s chuyn khoa vi s theo di cht ch ngi bnh.
CYCLOSERIN
Khng sinh chng lao
CC THUC TRONG NHM

CYCLOSERIN nang 125 mg; 250 mg
Seromycin nang 125 mg; 250 mg
TNG TC THUC
Phn tch: Nguy c tng tc dng khng mong mun ca cycloserin trn h thn
kinh trung ng khi hai thuc c dng ng thi vi nhau (ng g, kh ming, chng
mt).
X l: Cycloserin ch c sn cc khoa dc bnh vin. Tng tc ny lm xut
hin cc tc dng c hi kh chu. Cn theo di lm sng ng i bnh v tu tr ng
hp, iu chnh liu ca isoniazid, thm ch c th xem xt li s cn thit phi hp hai
thuc chng lao ny.
Phenytoin
Phn tch: C th cycloserin c ch s chuyn ho ca phenytoin gan.
X l: Tng tc ny phi c xc nhn v khuyn nn ch v kim tra hm
lng ca phenytoin. Nu thy c bin ng, chuyn cc nhn xt cho Trung tm cnh
gic thuc ca vng.
DANAZOL
Cht c ch tng hp v gii phng
cc gonadotrophin tuyn yn (FSH v LH)
CC THUC TRONG NHM
226
DANAZOL nang 200 mg

Danatrol nang 200 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: Do nguy c nam tnh ho tr s sinh.
Thi k mang thai: Do nguy c tc dng nam tnh ho bo thai.
Thn trng: mc 2
Suy gan: Khi suy gan nng, c nguy c gim chuyn ho.
Cn theo di: mc 1
i tho ng: Do tc dng tng glucose mu ca thuc ny.
ng kinh: Gim ngng gy ng kinh.
Suy tim/ suy thn: Do nguy c gi nc - in gii
Trng hp khc: Chng au na u.
TNG TC THUC
Biguanid; insulin; sulfamid h glucose mu
Phn tch: Danazol lm tng glucose mu v tng khng insulin.
X l: Nu phi hp, phi theo di cht ch glucose mu. Khuyn ngi bnh
tng cng t theo di. Tin hnh iu chnh liu khi bt u, khi ang v khi ngng
iu tr bng danazol.
Carbamazepin
Phn tch: Nng carbamazepin trong huyt thanh c th tng nhiu, dn n
tng tc dng dc l v c tnh. C ch: do danazol c ch chuyn ho ca
carbamazepin.
X l: Nu c th, nn trnh phi hp ny. Khi dng c hai thuc, theo di hm
lng carbamazepin trong huyt thanh v quan st nhng du hiu v c tnh ngi
bnh sau khi bt u iu tr bng danazol. ngi bnh n nh vi
carbamazepin, c th phi iu chnh liu khi bt u hoc khi ngng danazol.
Ciclosporin
Phn tch: Tng nng ciclosporin trong huyt tng cng vi nguy c xut hin
tc dng c vi thn khi phi hp vi danazol. S tng hm lng trong huyt thanh
227
ny xut hin sau nhiu ngy iu tr. C ch c th do c ch chuyn ho ca

ciclosporin.
X l: Theo di cn thn hm lng ciclosporin, bilirubin v creatinin trong huyt
thanh khi iu tr v khi ngng danazol. iu chnh liu ca ciclosporin hoc danazol
nu cn thit.
Tacrolimus
Phn tch: Tng nng tacrolimus trong huyt thanh cng vi xut hin run v
tng creatinin huyt thanh, c l do c ch chuyn ho tacrolimus. Tng tc d c
ng hc v chuyn ho thuc.
X l: Nn gim liu tacrolimus v theo di chc nng thn qua vic nh lng
creatinin trong mu. Vic theo di nng tacrolimus trong huyt tng c thc hin
trong v sau khi ngng iu tr.
Phn tch: Tng cc tc dng chng ng do gim tng hp cc yu t ng mu
gan. Nguy c chy mu. Tng tc ny ch c thng bo vi warfarin (Coumadine).
X l: Nu cn phi hp, theo di thi gian prothrombin v/hoc t l chun ha
quc t lc bt u, khi ang v sau khi iu tr bng danazol. iu chnh liu.
DANTROLEN
Thuc th gin c khng c tc dng cura
CC THUC TRONG NHM
DANTROLEN nang 100 mg; l bt pha tim 20 mg
Dantrium nang 100 mg
Dantrium l bt pha tim 20 mg
CH KHI CH NH THUC
Thi k mang thai: V thiu d liu.
Suy tim: Dantrolen c th gy vim mng ngoi tim hoc tit dch mng phi.
Suy gan: l thuc c vi gan dn n vim gan tiu t bo, gy t vong
trong nhng iu tr di ngy v vi liu cao. Theo di cht ch v u n
aminotransferase (transaminase) v bilirubin. Cn trnh khi suy gan nng.
Suy h hp; hen: Dantrolen c th dn n c ch h hp c th km vi tit
dch mng phi.
TNG TC THUC
228
Bepridil; diltiazem; verapamil

Phn tch: Cc trng hp rung tht gy cht, thy thng xuyn sc vt. Do
thn trng, chng ch nh phi hp ny (bepridil, diltiazem, verapamil), ngay c khi
ngi, tuy rng mt s ngi bnh dng mt vi phi hp m cha thy c bt li.
X l: Khng chuc ly nguy c nu khng b tr mi phng tin theo di v
can thip ngay (khoa hi sc).
Baclofen; benzamid; benzodiazepin; thuc c ch thn kinh trung ng
khc nhau
thn. Tng tc dc l.
n gim tnh to ngi li xe v ngi s dng my mc. Khuyn khng ung ru
v khng t dng cc ch phm cha ru.
Dihydropyridin
Phn tch: Cc trng hp rung tht gy cht, thy thng xuyn sc vt. Do
thn trng, khng nn phi hp vi cc dihydropyridin, ngay c khi ngi, d r ng
mt s ngi bnh dng mt vi phi hp m khng thy c bt li.
X l: Khng chuc ly nguy c nu khng b tr mi phng tin theo di v
can thip ngay (khoa hi sc).
Ru
thn. C th ghi nhn vi mt vi thuc, mt s tc dng tm thn vn ng nht l
trong tun u iu tr. Tng tc dc lc hc.
X l: Tt nht, khng nn phi hp hai thuc, v ngi k n khng th kim tra
c ngi bnh dng ru. Nguy c an thn c bit nguy him cho ngi li xe v
s dng my mc. Khuyn khng ung ru v khng t dng cc ch phm cha
ru.
Tacrin
Phn tch: Nguy c tng c tnh gan.
X l: Nu cn, tng cng theo di gan. Trnh cc phi hp c nguy c cho
ngi cao tui.
Amineptin; carmustin hoc dn cht; dactinomycin; estrogen hoc thuc
trnh thai estroprogestogen; fluvoxamin; griseofulvin; isoniazid hoc thuc
tng t; macrolid; mercaptopurin; methotrexat; natri valproat hoc dn cht;
progabid; rifampicin; thuc chng nm dn xut imidazol; vng
khng mong mun).
229
X l: Khi phi hp hai thuc c vi gan, nn theo di cht ch chc nng gan
(ASAT, ALAT, phosphatase kim, bilirubin), hoc nu c th, hon mt trong hai thuc.
Kim tra l ngi bnh khng ung ru thng xuyn, v khng c tin s vim gan
virus. Nhng triu chng lm sng chnh khng c hiu l bun nn, st, vng da...
Nu c phi hp ban da, nga v hch to, hng v bnh cn do thuc. Cn phn bit
hi phc vi vim gan mt c hi phc khi ngng iu tr.
Butyrophenon
thn. Tng tc dc lc hc.
X l: Lu nguy c ny iu chnh liu ca hai thuc nu cn phi hp. Ngh
n s gim tnh to ngi li xe v ngi s dng my mc. Khuyn khng ung
Carbamazepin; gluthetimid hoc thuc tng t; thuc an thn kinh khc
nhau
X l: Lu nguy c ny iu chnh liu ca hai thuc. Ngh n s gim tnh
to ngi li xe v ngi s dng my mc. Khuyn khng ung ru v khng t
dng thuc hoc cc ch phm c ru.
thn. Tng tc dc l. Lu l rilmenidin, vi liu thng dng, khng lm tng tc
dng c ch thn kinh trung ng ca nhng thuc ny.
Phn tch: Mc tiu chnh l iu tr ung th biu m thn dng tuyn. Interleukin
cng c vi gan. Vy l phi hp hai thuc c tim nng c
vi gan.
X l: Ch c th tin hnh iu tr ny ti c s chuyn khoa. Khi dng interleukin
cn c s theo di thng xuyn. Trng hp ny nn cn nhc tu theo tnh tr ng
chung ca ngi bnh. Khi phi hp hai thuc c vi gan, cn theo di cht ch chc
nng gan (ASAT, ALAT, phosphatase kim, bilirubin), hoc hon mt trong hai thuc,
nu c th c.
Niridazol
Phn tch: Phi hp hai thuc c vi gan. Niridazol cng c c vi thn kinh. Nguy
c xut hin co git, ri lon tm thn v c vi gan khi phi hp thuc.
X l: Khi phi hp hai thuc c vi gan, hoc theo di cht ch chc nng gan
(ASAT, ALAT, phosphatase kim, bilirubin), hoc, nu c th, hon mt trong hai thuc.
Kim tra ngi bnh khng ung ru thng xuyn, khng c tin s vim gan virus.
230
Cc triu chng lm sng chnh khng c hiu l bun nn, st, vng da... Nu c
phi hp ban da, nga v hch to, hng v bnh cn do thuc. Cn phn bit r, tu
theo kt qu xt nghim sinh hc, nguy c xut hin vim gan tiu t bo khng h i
phc vi vim gan mt hi phc c khi ngng thuc.
Paracetamol
Phn tch: Phi hp hai thuc c tim nng c vi gan, nht l khi dng
paracetamol iu tr di ngy v trn 4-5 gam/ ngy.
X l: Khi phi hp hai thuc c vi gan, hoc theo di cht ch chc nng gan
(ASAT, ALAT, phosphatase kim, bilirubin) hoc hon nu c th mt trong hai thuc.
Kim tra ngi bnh khng ung ru thng xuyn v khng c tin s vim gan
virus. Cc triu chng lm sng chnh khng c hiu l bun nn, st, vng da... Khi
phi hp nu thy b ban da, nga, v hch to th hng v bnh cn do thuc. Cn
phn bit r, tu theo kt qu cc test sinh hc, nguy c xut hin vim gan tiu t bo
khng hi phc vi vim gan mt hi phc c khi ngng iu tr.
amphetamin.
X l: Lu tng tc dc l ny xc nh mc tiu iu tr chnh. Khuyn
ngi bnh gp li bc s nu thy iu tr t ra khng n nh.
thn. Tng tc dc lc.
DAPSON
Thuc tr phong, dn cht sulfon c tc dng
chng trc khun Hansen
CC THUC TRONG NHM
DAPSON vin nn 50 mg
DDS vin nn 50 mg
CH KHI CH NH THUC
Thi k cho con b/thi k mang thai: V thiu d liu.
Thiu ht G6PD: Kim tra cht ch huyt hc.
231
Bnh v mu: Nu gim bch cu trung tnh, th ngng iu tr.

Suy gan: Dng liu thp hn v theo di u n chc nng gan.
Suy thn: iu chnh liu tu theo mc suy thn v theo di u n chc
nng thn.
TNG TC THUC
Zalcitabin
Phn tch: C khi xut hin bnh thn kinh ngoi vi.
Didanosin
Phn tch: C th tht bi iu tr vi dapson, dn n tng nhim khun (th d
vim phi do Pneumocystis carinii). C ch: Dapson rt kh tan pH trung tnh. m
citrat phosphat trong didanosin c th cn tr s ho tan ca dapson, lm gim s
hp thu dapson.
X l: Ung dapson trc didanosin t 2 gi tr ln.
Zidovudin
Phn tch: Tng c tnh vi tu xng.
X l: Kim tra u n huyt .
DEFEROXAMIN
Tc nhn dng chelat ho cc cation ho tr 3,
ch yu l ion st III v ion nhm
CC THUC TRONG NHM
DEFEROXAMIN MESYLAT l bt pha tim 500 mg
Desferal l bt pha tim 500 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Suy thn: Suy thn nng khng thm phn.
Trng hp khc: Qu mn vi deferoxamin. Nhim khun tin trin (chng ch
nh tng i).
232
Thi k cho con b: Thiu d liu nn cn thn trng.

Thi k mang thai: Thiu d liu ph n, nhng c tc dng gy qui thai
sc vt.
TNG TC THUC
Acid ascorbic
Phn tch: Dng acid ascorbic vi liu hng ngy (trn 250mg) v deferoxamin c
th lm tn hi kh nng chelat ho ca deferoxamin v do tng c tnh ca st
i vi m, c bit tim, c th dn n mt b tim.
X l: Nn thn trng ngi bnh c iu tr vi deferoxamin, c bit vi
ngi bnh cao tui v khng c k n vitamin C dng ng thi. Khuyn khng t
dng vitamin C khi ang iu tr vi deferoxamin.
DESMOPRESSIN
Thuc tng t hormon khng niu t nhin (vasopressin)
CC THUC TRONG NHM
DESMOPRESSIN ng tim 1 mcg
Minirin ng tim 1 mcg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai: Nguy c nghim trng ri lon cn bng nc-in gii (ng
c nc).
Thn trng: mc 2
Thi k cho con b: Desmopresson t qua c sa m; hp thu rt t qua
ng tiu ho tr ang b.
Cn theo di: mc 1
Tr em: tr i dm, khng ung sau khi dng thuc phng nga, c khi
ng c nc.
Tng huyt p: Nguy c tng huyt p ng mch khi dng desmopressin liu
cao.
Ngi cao tui: Gim liu, c bit khi dng thuc bng ng tim.
Trng hp khc: Suy thng thn: cn phi cha suy v thng thn trc khi
iu tr. Bnh Von Willebrand: theo di yu t VIII.
TNG TC THUC
233

Carbamazepin
Phn tch: Desmopressin l cht tng t hormon khng niu t nhin l
vasopressin. Gim tc dng khng niu do h natri mu gy ra bi carbamazepin.
sinh hc v lm sng.
Fibrat; indometacin hoc dn cht
Phn tch: Tng tc dng khng niu.
sinh hc v lm sng.
Sulfamid lm h glucose mu
Phn tch: Tc dng cha sng t. Gim tc dng khng niu nhn thy vi
glibenclamid; tng tc dng nhn thy vi chlorpropamid.
sinh hc v lm sng.
DEXTRAN
Cht thay th huyt tng dng trong cc trng thi sc chy mu
do chn thng hoc do nhim c v nhim khun
CC THUC TRONG NHM
DEXTRAN dung dch 10% Dextran 40.000
Rheomacrodex dung dch 10% Dextran 40.000
CH KHI CH NH THUC
Thi k mang thai: Khng c dng d phng gim au lc hoc gy t
ngoi mng cng, do c nguy c t vong hoc di chng thn kinh nng cho tr s sinh.
Trng hp khc: Qu ti tun hon, gim ng mu, qu mn vi thuc trong
h, tng th tch mu.
TNG TC THUC
Heparin; ticlopidin
Phn tch: Dextran l cht c ch tiu cu. Vi cc thuc c tnh cht chng ng
v chng kt tp tiu cu, phi trnh hoc kim sot tht tt nguy c chy mu.
234
X l: Khuyn khng nn phi hp nhng thuc ny vi nhau do kh qun l s

gim ng mu mong mun, v nguy c chy mu i km.
Pentoxyfylin; thuc tiu huyt khi
Phn tch: Dextran l cht c ch tiu cu. Vi nhng thuc c tnh chng ng
v chng kt tp tiu cu, phi trnh hoc kim sot tht tt nguy c chy mu.
X l: Khuyn khng nn phi hp nhng thuc ny vi nhau, do kh qun l tt
s gim ng mu mong mun, v nguy c chy mu i km.
235
DEXTROPROPOXYPHEN
Thuc gim au
CC THUC TRONG NHM
DEXTROPROPOXYPHEN nang (150 mg dextropropoxyphen)
Antalvic nang (150 mg dextropropoxyphen)
Di-antalvic nang 30mg phi hp vi 400mg paracetamol
CH KHI CH NH THUC
Chng ch nh: mc 4
Trm cm: Cn trnh ngi bnh c xu hng t vn
Thi k mang thai: Khuyn khng dng khi thai n k hn (nguy c cai nghin
tr s sinh).
Thi k cho con b: Do thiu d liu.
Tr em: Chng ch nh dng dextropropoxyphen tr em di 15 tui.
Suy thn: do chuyn ho ca thuc.
Thn trng: mc 2
n ung; ru: Trnh cc ung c ru.
TNG TC THUC
Ritonavir
Phn tch: Ritonavir c i lc mnh vi isoenzym 3A4 ca cc cytochrom P450,
bng c ch cnh tranh, lm gim chuyn ho ca nhng thuc c chuyn ho
mnh bi cytochrom P450. Nh vy c s tng nng ca nhng thuc ny trong
huyt tng v nguy c tng c tnh. Nguy c c ch h hp mnh (m t vi
dextropropoxyphen: Antalvic). Tng tc dc ng hc v chuyn ho thuc.
X l: Khng k n phi hp ny.
Barbituric; fluoxetin; genthetimid hoc thuc tng t; medifoxamin;
phenothiazin; primidon hoc dn cht; thuc an thn kinh cc loi; thuc c
ch MAO khng chn lc
thn. Tng tc dc l.
ngi li xe v ngi s dng my mc. Khuyn khng ung ru v khng t
236
Benzodiazepin
nn ung ru v khng t dng thuc v ch phm c ru.
Ru
thn. C th ghi nhn vi mt vi sn phm, mt s tc dng tm thn vn ng, nht
l trong tun u iu tr. Tng tc dc lc hc.
X l: Tt nht, khng phi hp hai thuc, v ngi k n khng th lc no
cng kim sot c ngi bnh ung ru. Nguy c an thn nguy him nht ngi
li xe v ngi s dng my mc. Khuyn khng ung ru v khng t dng thuc
hoc ch phm c ru.
Baclofen; benzamid; butyrophenon; carbamat hoc thuc tng t;
carbamazepin; thuc chng ng kinh khng barbituric; thuc c ch h thn
kinh trung ng cc loi
an thn. Tng tc dc lc hc.
ung ru v khng t dng thuc hoc cc ch phm
c ru.
Bepridil; bromocriptin hoc thuc tng t; cht c ch men chuyn;
diazoxyd; dihydropyridin; diltiazem; levodopa; lidocain v thuc tng t;
methyldopa; quinidin hoc dn cht; sotalol; thuc chn beta; thuc li tiu gi
kali; thuc li tiu gim kali mu; thuc gin mch chng tng huyt p.
Phn tch: Tc dng h huyt p nh ca dextropropoxyphen, cng vi cc thuc
h huyt p khc, c tng tc dng h huyt p v tng nguy c h huyt p t th
ng.
X l: Phi theo di huyt p trong khi phi hp hai thuc (trong khi i u tr v
sau khi ngng mt trong hai thuc). Tu theo thuc dng h huyt p c th nng hay
nh. Nu thy chng mt khi bt u iu tr, khuyn ngi bnh gp li bc s iu tr
iu chnh liu ca mt hoc hai thuc tu theo tnh hnh.
thn. Tng tc dc lc. Lu l rilmenidin, liu thng thng, khng lm tng tc
dng c ch thn kinh trung ng ca nhng thuc ny.
237

Thuc c ch MAO typ B
Phn tch: S c ch c hiu monoamin oxydase typ B dn n ko di tc
dng ca levodopa, iu gii thch s cng k n vi cht ny. Cc tng tc nh
vy cng chnh l cc tng tc ca levodopa v ngi c nn xem h thuc ny.
X l: Khng nn dng phi hp ny, v tnh n nguy c tht bi iu tr.
Nicotin
Phn tch: Nicotin c tnh cm ng enzym, nn c th kch thch chuyn ho ca
mt s thuc v dn n gim tc dng iu tr.
X l: Hy thn trng vi nhng thuc c phm vi iu tr hp trong khi iu tr
thay th nicotin v tu trng hp, nn xem li liu lng trong v sau iu tr. Nn nh
rng cm ng enzym l hin tng ch xut hin sau mt s ngy, ngc li vi c ch
enzym l hin tng tc thi.

amphetamin.
ngi bnh gp li thy thuc, nu thy iu tr t ra khng n nh
Fluvoxamin; mianserin; paroxetin; thuc chng trm cm ba vng hoc
thuc tng t; thuc khng histamin khng H1 an thn
thn. Tng tc dc l.
X l: Lu tng tc ny iu chnh liu ca hai thuc. Ngh n s gi m
Methadon
Phn tch: Tng tc dng c ch thn kinh trung ng km an thn mnh, c hi
c bit cho ngi li xe v s dng my mc.
X l: Ngi k n lu s tng tc dng an thn ny cho li khuyn thch
hp: trnh li xe hoc vn hnh my mc; bo cho ngi xung quanh bi t mi nguy
him...
Thuc ch vn ca morphin
238
Phn tch: Tng cc tc dng c ch thn kinh trung ng, c ch h hp v h

huyt p. Hn na, nu c ph thuc thuc, phi hp hai thuc ny c th lm tng
nguy c ph thuc.
X l: Nu cn phi hp hai thuc, ghi nhn nguy c ny khi gy m v la chn
liu. Khuyn ngi bnh bo cho thy thuc gy m bit cc thuc ang dng.
Oxaflozan; viloxazin
thn. Tng tc dc l.
Ngh n s gim tnh to ngi li xe v ngi s dng my mc. Khuyn khng
nn ung ru v khng t dng thuc hoc ch phm
c ru.
DIACERHEIN
Thuc c tnh cht chng vim, c ch tc dng cha r,
nhng khc vi cc thuc chng vim khng steroid
CC THUC TRONG NHM
DIACEREIN nang 50 mg
Artrodar nang 50 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: Cc dn xut anthraquinon bi tit c vo sa m.
Tr em: Do thiu d liu, chng ch nh cho tr em di 15 tui.
Thi k mang thai: Cc d tt thai c m t sc vt. Khng dng thuc
trong nhng thng u thai k v cn thiu d liu.
nng.
Suy gan: Tnh n chuyn ho ca thuc, chng ch nh dng trong suy gan
239
Suy thn: Liu phi gim xung mt na ngi suy thn nng ( thanh lc
creatinin <30mL/pht).
TNG TC THUC
Phn tch: Gim hp thu diacerhein, c th dn n gim tc dng iu tr.
X l: Khuyn ngi bnh ung mi thuc cch nhau t nht 2 gi.
DIAZOXID
Thuc chng tng huyt p v gy tng glucose mu
ch s dng c s chuyn khoa
CC THUC TRONG NHM
DIAZOXID
Hyperstat ng tim 15 mg/mL
CH KHI CH NH THUC
Chng ch nh: mc 4
Tng huyt p: Diazoxid, ngoi tnh cht lm tng glucose mu, cn chng tng
huyt p v khng niu, c th dn n gi nc v in gii do nh hng n
iu tr chng tng huyt p.
Suy mch vnh: Do tc dng trn cc si c trn, diazoxid gy gin mch ton
th km vi gim huyt p v nhp tim nhanh phn x, do chng ch nh dng
ngi suy mch vnh.
Trng hp khc: Nhy cm vi cc benzothiadiazin (sulfamid li niu). Va x
ng mch.
Tiu ng: Diazoxid gy tng glucose mu. Ngoi ra, thuc cn lm gim tit
insulin cc t bo beta o Langerhans. Tng glucose mu km theo tng acid lactic
mu v hao ht glycogen gan.
Thi k mang thai: Khng nn dng trong 3 thng u ca thai k.
Thn trng: mc 2
Suy thn: Do tnh cht khng niu (gim bi niu v bi xut in gii).
TNG TC THUC
240
Biguanid
Phn tch: Diazoxid l thuc chng tng huyt p khn cp dng tim tnh mch
(gin tiu ng mch v gim sc cn ngoi vi). Thuc gy tng glucose mu v c
s dng iu tr mt s trng hp gim glucose mu. i khng dc l trn s
iu ho glucose mu. C th dng phi hp hiu chnh qu liu diazoxid.
X l: Vic s dng tu thuc mc tiu iu tr. C th phi hp cha qu liu
diazoxid. Diazoxid c dng ch yu c s bnh vin lm thuc chng tng huyt
p khn cp hoc hiu chnh mt s thuc h glucose mu.
Phenytoin
Phn tch: Hm lng phenytoin trong huyt thanh c th gim, dn n gim tc
dng chng co git ca thuc ny. C ch cha r. Tuy nhin, c th diazoxid lm tng
chuyn ho ca phenytoin.
X l: Theo di hm lng ca phenytoin trong huyt thanh v theo di ng i
bnh v s gim tc dng hoc tng c tnh ca phenytoin khi a thm hoc rt b
diazoxid trong phc iu tr. iu chnh liu ca phenytoin theo nhu cu.
Phn tch: Amphetamin l thuc cng giao cm trc tip, nn cng c th lm
tng huyt p. Phi hp vi cc thuc chng tng huyt p dn n tc dng i
khng v rt kh t cn bng huyt p.
X l: ngi bnh tng huyt p, nn trnh k n cc amphetamin.
Cht ch vn morphin
ng.
Phn tch: Tng tc dng lm h huyt p v tng nguy c h huyt p t th
X l: Theo di huyt p trong khi phi hp hai thuc. Tu theo thuc, gim huyt
p c th nhiu hay t. Tu tnh hnh, iu chnh liu ca mt hoc hai thuc. Xy dng
mt k hoch dng thuc u n. Khuyn ngi bnh nu thy chng mt khi bt
u iu tr, gp li bc s iu tr tu trng hp, iu chnh liu ca mt hoc hai
thuc. Tng cng theo di ngi cao tui (nguy c ng) v khuyn h khi t th
nm hoc ngi m chuyn sang t th ng th phi t t.
Clonidin hoc thuc tng t; methyldopa; thuc gin mch chng tng
huyt p; thuc li niu gi kali
Phn tch: Phi hp hai cht chng tng huyt p.
X l: Diazoxid gy tng glucose mu, nn cnh gic khi phi hp hai thuc tu
theo mc tiu iu tr chnh cn t. Nu cn phi hp, phi theo di huyt p u
n.
Clozapin
Phn tch: Nguy c tng tc dng lm h huyt p .
241
X l: Theo di huyt p v iu chnh liu ca thuc chng tng huyt p chnh

la chn trong v sau khi ngng iu tr vi clozapin. Thn trng, c bit ng i
bnh cao tui.
Phn tch: Tng acid uric mu v lm gim tc dng iu tr chng gt.
X l: Nn trnh phi hp hai thuc trong cng thi gian, nu khng th iu tr
chng gt s tht bi.
Dextropropoxyphen
Phn tch: Do dextropropoxyphen lm gim huyt p nh, nn khi kt hp vi cc
thuc gim huyt p khc, c th tng tc dng lm gim huyt p v tng nguy c h
huyt p t th ng.
X l: Phi theo di huyt p trong khi phi hp hai thuc (trong khi i u tr v
sau khi ngng mt trong hai thuc). Tu theo thuc, gim huyt p c th nng nhi u
hay t. Tu trng hp, iu chnh liu ca mt hoc hai thuc. Xy dng mt k hoch
dng thuc u n. Khuyn ngi bnh nu b chng mt khi bt u iu tr, nn
gp li bc s iu tr tu tnh hnh, iu chnh liu ca mt hoc hai thu c. Tng
cng theo di ngi bnh cao tui (nguy c ng) v khuyn h, khi t th nm
hoc ngi m chuyn sang t th ng th phi t t.
Phn tch: Tng tc dc lc gia mt thuc gy h glucose mu v mt thuc
gy tng glucose mu. i khng dc l.
X l: Trong trng hp tiu ng cha c cn bng v glucose mu, phi
hp ny l chng ch nh. Vic dng diazoxid thng ch thc hin ti c s chuyn
khoa c kh nng theo di lin tc.
Mineralocorticoid (corticoid - khong)
Phn tch: Hiu qu ca thuc chng tng huyt p b gim, c l do cc steroid
gy gi natri.
X l: Nu cn phi hp, tng cng theo di huyt p trong v sau khi ngng
iu tr bng mt trong hai thuc. iu chnh liu, tu theo tnh hnh. Nhn mnh v k
hoch dng thuc v s tun th k hoch. c bit cnh gic khi dng vi ngi
bnh cao tui.
Phenothiazin
Phn tch: Tc dng tng glucose mu ca diazoxid c th tng. Khng r tc dng
ny tn ti bao lu mt khi ngng cho promazin. C ch cha r.
X l: Nn theo di thng xuyn nng glucose trong mu nu dng phi hp
hai thuc ny. Nu c th, dng mt phenothiazin khc t tim nng gy tng glucose
mu hn thay cho promazin.
Thuc cng giao cm alpha-beta
Phn tch: Tc dng chng tng huyt p c th gim khi dng ng thi vi cc
thuc cng giao cm.
242
X l: Theo di huyt p phi thng xuyn. Tt c ph thuc vo bi cnh iu

tr v dng bo ch dng. Nu c th, phi trnh phi hp ngn nga nguy c
quan trng v thay i huyt p.
Phn tch: Dng ng thi hai thuc c th dn n bin ng ln v huyt p.
X l: t khi s dng cc thuc c ch MAO, tng tc th nhiu nhng vic k
n th him, nn c t cc nhn xt v cnh gic thuc. Tuy nhin cn tn tr ng th i
hn t 2 n 3 tun sau khi ngng dng thuc, mi k n li mt thuc c ch MAO.
Phn tch: L tng tc i khng. Cc thuc cng giao cm beta gy tng
huyt p, v vy c th gii thch ti sao cc tc dng chng tng huyt p c th gim
khi dng diazaxid cng vi cc thuc cng giao cm.
X l: Theo di u n huyt p. Thng bo cho ngi bnh v nguy c bi n
i huyt p. Xy dng mt k hoch dng thuc u n v lu n dng thuc
dng nh gi mc bin i huyt p (dng cc thuc cng giao cm beta
trong hen hoc trong e do non).
Thuc li tiu gim kali; furosemid hoc thuc tng t
Phn tch: Tng tc 3 khu: 1. Tng tc dng lm tng glucose mu;
2. Tng tc dng lm tng acid uric mu;
3. Tng tc dng lm tng huyt p.
X l: Ch thc hin phi hp ny ti bnh vin. Tu theo mc tiu iu tr v sinh
bnh l ca ngi bnh, lu 3 tc dng trn theo di lm sng v sinh hc thch
hp.
Phn tch: Do lin kt mnh vi protein, diazoxid c th y cc khng vitamin K,
c bit l acenocoumarol (Sintrom), ra khi protein huyt tng. Nguy c chy mu.
X l: Phi hp thng ch thc hin c s bnh vin. Cn iu chnh liu tu
theo t l chun ha quc t (INR) v thi gian prothrombin. Cn tng cng theo di
t l chun ha quc t (INR) hoc thi gian prothrombin khi bt u, khi ang v khi
kt thc iu tr bng diazoxid.
Dn cht salicylat; indometacin hoc dn cht; pyrazol; thuc chng vim
khng steroid.
Phn tch: Gim tc dng chng tng huyt p; cc thuc chng vim khng steroid
c ch tng hp prostaglandin thn l cht c tc dng gin mch v/ hoc dn n gi
nc v in gii. Nguy c suy thn cp ngi b mt nc.
X l: Xc minh l ngi bnh c tip nc tt, theo di chc nng thn (
thanh lc creatinin), kim tra s n nh huyt p, c bit khi bt u i u tr. Tng
tc ny c th c hu qu trn tnh ton vn ca chc nng thn v huyt p, c bit
243
vi indometacin hoc cc dn cht salicylat liu cao. Khuyn ngi bnh theo di huyt
p u n.
Phn tch: Dng ng thi thuc chng tng huyt p hoc thuc c th dn n
gim huyt p cng vi cc thuc gy m barbituric c th gy gim huyt p nng.
X l: Khuyn ngi bnh bo cho thy thuc gy m bit cc thuc dng.
DIDANOSIN
Thuc chng virus dn cht ca inosin, dng trong nhim HIV lm thuc
la chn hng u hoc phi hp vi zidovudin
CC THUC TRONG NHM
DIDANOSIN vin nn 25 mg; 50 mg; 100 mg; 150 mg
Videx vin nn 25 mg; 50 mg; 100 mg; 150 mg
CH KHI CH NH THUC
Thi k cho con b: Thiu d liu
Thi k mang thai: Thiu d liu ngi.
Thn trng: mc 2
Tr em: Thiu d liu tr em di 3 thng tui.
Suy gan: Theo di enzym gan.
Trng hp khc: Bnh thn kinh ngoi vi v vim tu.
Cn theo di: mc 1
Bnh gt: Nguy c xut hin cn gt ngi bnh c bm cht d mc.
TNG TC THUC
Ganciclovir
Phn tch: Tng c tnh ca didanosin (bnh thn kinh, tiu chy, vim tu) do
tng nng ca thuc ny trong huyt tng. Ngoi ra, thy c hin tng suy tu
mt vi ngi bnh.
244
X l: Nu khng th trnh c phi hp thuc, kim tra l c s theo di huyt

hc, m s lng v cng thc mu; theo di lm sng: tiu chy, bnh thn kinh
ngoi vi; theo di tu: lipase huyt thanh.
Quinidin
Phn tch: Cc mui magnesi c trong cc t dc ca dng ung didanosin dn
n tng hm lng quinidin trong huyt tng v nguy c qu liu.
X l: Nu khng th trnh c phi hp, iu chnh k hoch dng thuc hoc
xem xt li iu tr.
Asparaginase;
azathioprin;
estrogen
hoc
thuc
trnh
thai
estroprogestogen; furosemid hoc thuc tng t; methyldopa; natri valproat
hoc dn cht; nitrofuran; pentamidin; ru; sulfamid khng khun; tetracyclin;
thuc li niu thi kali.
Phn tch: Hip ng cc tc dng khng mong mun: tng nguy c (do thuc)
xut hin vim tu.
X l: Theo di lm sng v nu cn, theo di sinh hc chc nng tu (amylase
mu v nc tiu).
Cht khng acid
Phn tch: Tng nguy c cc tc dng khng mong mun lin quan n didanosin.
Cc thuc khng acid lm tng pH d dy v do lm chm ging ho didanosin.
Tng hp thu v tng c nng ca didanosin trong huyt tng.
X l: Theo di lm sng v sinh hc cc tc dng khng mong mun lin quan
n didanosin: theo di huyt hc (cng thc mu), theo di lm sng: tiu chy, bnh
thn kinh ngoi vi; theo di tu: lipase huyt thanh.
Phn tch: Vin nn didanosin cha mt khng acid. C nguy c gim hp thu
cisplatin qua ng tiu ho, tu theo s tng pH d dy.
X l: Khuyn ngi bnh cch t nht 2 gi gia cc ln ung hai thuc.
Dapson
Phn tch: C th tht bi iu tr vi dapson, dn n tng nhim khun (th d
vim phi do Pneumocystis carinii). C ch: Dapson rt kh tan pH trung tnh. Cht
m citrat-phosphat trong didanosin c th cn tr s ha tan ca dapson, lm gim s
hp thu thuc ny.
X l: Ung dapson trc didanosin t 2 gi tr ln.
Indinavir
Phn tch: Tc dng iu tr ca indinavir c th gim. C ch: cht m trong
didanosin c th lm gim s hp thu indinavir.
X l: Ung hai thuc ny cch nhau 1 gi vo lc i.
245
Phn tch: Vin nn didanosin cha cht m c nguy c lm gim hp thu

isoniazid qua ng tiu ho, tu theo s tng pH d dy.
Lithi
Phn tch: Vin nn didanosin cha cht m c nguy c lm gim hp thu lithi
qua ng tiu ho, tu theo s tng pH d dy.
Pentamidin
Phn tch: Tng nguy c xut hin vim tu, do hip ng cc tc dng khng
mong mun. Tng tc dc lc hc.
X l: Thng xuyn theo di lm sng, nh lng amylase trong mu.
Phenicol
Phn tch: Vin nn didanosin cha cht m, c nguy c lm gim hp thu cc
phenicol qua ng tiu ho, tu theo s tng pH d dy.
Phenytoin
Phn tch: Vin nn didanosin cha cht m c nguy c lm gim hp thu
phenytoin qua ng tiu ho, tu theo pH d dy.
Pyrimethamin; tetracyclin
Phn tch: Cht m citrat trong t dc ca dng didanosin ung c th lm gim
hp thu nhng thuc phi hp ny, dn n gim hiu lc ca chng.
X l: Ung nhng thuc ny trc didanosin 2 gi hoc sau 6 gi.
Quinolon
Phn tch: Tc dng dc l ca quinolon c th gim. C ch: Cc cation
magnesi v nhm trong cht m c trong vin nn didanosin lm gim s hp thu
ng tiu ho ca cc quinolon, thng qua c ch chelat ho.
X l: Nu khng trnh c vic phi hp thuc, phi ung quinolon t nht 2
gi trc hoc 6 gi sau didanosin.
Phn tch: Tc dng iu tr ca cc thuc chng nm imidazol c th gim. C
ch do cht m trong vin nn didanosin lm gim s hp thu ca cc thuc chng
nm ny.
X l: Ung thuc chng nm imidazol t nht 2 gi trc khi ung didanosin.
Phn tch: Vin nn didanosin cha cht m c nguy c gim hp thu vincristin
qua ng tiu ho, tu theo pH d dy.
246
Zalcitabin
Phn tch: Tng nguy c xut hin bnh thn kinh ngoi bin v vim tu, do hip
ng cc tc dng khng mong mun. Tng tc dc lc hc.
X l: Thng xuyn theo di lm sng, nh lng amylase mu.
Ranitidin
Phn tch: Tc dng dc l ca didanosin c th tng, cn tc dng ca ranitidin
c th gim. C ch: S c ch sn xut acid d dy bi ranitidin c th lm tng sinh
kh dng ca didanosin.
X l: C l khng phi iu chnh g trong iu tr.
DIHYDROPYRIDIN (dn cht)

Thuc c ch dng calci qua mng,
dng trong chng au tht ngc v bnh tng huyt p
CC THUC TRONG NHM
AMLODIPIN vin nn 5 mg; 10 mg; nang 5 mg
Amlocor 5, vin nn 5 mg
Amlocor 10, vin nn 10 mg
Amlor nang 5 mg
Amtim nang 5 mg
Amlopress 5, vin nn 5 mg
Amlopress 10, vin nn 10 mg
Lodimax vin nn 5 mg; 10mg
Lykamilox vin nn 5mg
FELODIPIN vin nn 5 mg; 10 mg; vin nn tc dng chm 5 mg
Logimax vin nn tc dng chm 5 mg
Plendil vin nn 5 mg
Plendil vin nn 5 mg
Plendil ER vin nn 10 mg
ISRADIPIN dung dch tim 1 mg/ 10 mL
Lomir dung dch tim 1 mg/ 10 mL
LACIDIPIN vin nn 2 mg
Lacipil vin nn 2 mg
247
MANIDIPIN vin nn 20 mg
Madiplot 20, vin nn 20 mg
NICARDIPIN nang 40 mg
Vasodin nang 40 mg
NIFEDIPIN vin nn 10 mg; 20 mg; 30 mg; nang 5 mg; 10 mg
Adalat vin nn 10 mg; nang 5 mg
Adalat LA vin nn 30 mg
Alat nang 10 mg
Apo-Nifed PA nang 20mg
Calanif nang 5 mg
Cardipin vin nn 20 mg
Nifedipin vin nn 10 mg; 20 mg
Nifehexal Retard nang 20mg
NIMODIPIN vin nn 30 mg; dung dch tim truyn 10 mg/50 mL
Bredin vin nn 30 mg
Nimotop dung dch tim truyn 10 mg/50 mL
Nimotop vin nn 30 mg
NISOLDIPIN vin nn 5 mg
Norvase vin nn 5 mg; 10mg
Syscor vin nn 5 mg
NITRENDIPIN vin nn 10 mg
Baypress vin nn 10 mg
Nidrel vin nn 10 mg; 20mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: Cc thuc ny qua c sa m.
Thi k mang thai: Nifedipin, nitrendipin, felodipin gy qui thai mt s loi
ng vt. Nu dng nhng thuc ny, cn phi dng cch trnh thai hiu qu cho ph
n thi k sinh .
Trng hp khc: Qu mn vi dihydropyridin.
TNG TC THUC
Ciclosporin
248
Phn tch: Phi hp nifedipin-ciclosporin c s dng iu tr tng huyt p

do ciclosporin gy ra, thm ch cn bo v chng nhim c thn do ciclosporin. Nhng
cc tc dng khng mong mun ca nifedipin c th tng ( bng, ban da) v tng
nguy c ph i li c ghi nhn. Ch , khi phi hp vi nicardipin, hm lng
ciclosporin trong huyt thanh c th tng gp i, thm ch gp ba. Cn c thm cc
nhn xt khc i vi cc dihydropyridin khc.
X l: Cn trnh phi hp. Vi nicardipin, nn gim khong mt na li u
ciclosporin v theo di tht cn thn hm lng ciclosporin trong huyt thanh v chc
nng thn ( thanh lc creatinin). Nu cc dihydropyridin khc c dng, nn theo
di nng ciclosporin trong mu, v chuyn cc nhn xt n trung tm cnh gic
thuc. Lu l ciclosporin bin ng mnh gia cc c th ngi bnh v vic theo di
phi u n.
Dantrolen
Phn tch: Cc trng hp rung tht gy t vong c thy sc vt. Do thn
trng, cn trnh phi hp vi cc dihydropyridin ngi bnh.
X l: Khng chuc ly nguy c, nu khng b tr mi phng tin theo di v
can thip tc khc (khoa hi sc).
Diltiazem
Phn tch: Diltiazem lm tng nng ca nifedipin trong huyt tng, cn
nifedipin lm tng nng ca diltiazem trong huyt tng. Tc dng dc c hc v
tc dng c ca nifedipin hoc ca diltiazem c th tng. C ch: c l do gim thanh
lc gan. Tng tc xy ra nhanh.
X l: Theo di ngi bnh v tng tc dng ph ca nifedipin hoc ca diltiazem
v iu chnh liu nu cn thit.
Disopyramid; flecainid hoc thuc tng t; quinidin hoc dn cht
Phn tch: Phi hp dihydropyridin vi mt vi thuc chng lon nhp khc c th
dn n nhp tim chm qu mc.
X l: Khng nn dng nhng thuc ny trong vng 48 gi trc hoc 24 gi sau
khi dng cc cht i khng calci c tnh cht gim lc co c. Nu phi thc hi n phi
hp ny, nn theo di in tm .
Ritonavir
Phn tch: Ritonavir c i lc cao vi isoenzym 3A 4 ca cytochrom P450. C nguy
c cnh tranh mnh gia ritonavir v cc thuc c chuyn ho hoc nghi c
chuyn ho bi isoenzym ny. S cnh tranh ny s gy gim chuyn ho ca thuc
phi hp vi ritonavir v c nguy c tng ng k nng ca chng trong huyt
tng. Nguy c h huyt p v ph ngoi vi, i vi cc dn cht dihydropyridin
(nifedipin v nicardipin). Tng tc dc ng hc v chuyn ho thuc.
X l: Theo di cht ch biu hin nhim c v gim liu ca thuc chn calci.
Barbituric
249
Phn tch: Nng nifedipin trong huyt thanh gim, gy gim hiu lc ca
thuc. C ch: Tng chuyn ho ca nifedipin do cm ng enzym.
X l: iu chnh liu nifedipin tu theo p ng. C th cn phi dng nifedipin
vi liu cao hn.
Calci
Phn tch: Phi hp c th s dng iu tr qu liu do thuc chn calci v
ngc li. Tc dng dc l t c ch yu vi calci tim tnh mch, calci ung t c
hoc khng c tc dng. Nh vy, phi hp thuc lm gim tc dng ca cc thuc
chn calci.
verapamil gy ra. C th dng phi hp ny iu tr qu liu do thuc chn calci,
hoc rung tim do calci gluconat gy ra.
Clozapin
huyt p k n ban u, trong v sau khi ngng iu tr vi clozapin. Thn trng c
bit ngi bnh cao tui.
Dextropropoxyphen
Phn tch: Dextropropoxyphen c tc dng h huyt p nh. Vi cc thuc h
huyt p khc, tng tc dng h huyt p v tng nguy c h huyt p t th ng.
X l: Cn phi theo di huyt p trong khi phi hp (trong khi iu tr v sau khi
ngng mt trong hai thuc). Tu thuc dng, h huyt p c th nng nh khc
nhau. Tu trng hp, iu chnh liu ca mt hoc c hai thuc. Xy dng k hoch
dng thuc u n. Khuyn ngi bnh, nu thy chng mt lc u iu tr, gp li
bc s iu tr tu trng hp iu chnh liu ca mt hoc hai thuc. Tng cng
theo di ngi bnh cao tui (nguy c ng) v khuyn h, khi t th nm hoc ngi
chuyn sang t th ng phi t t.
Glucocorticoid; indometacin hoc dn
tetracosactid; thuc chng vim khng steroid
cht;
pyrazol;
salicylat;
Phn tch: Gim tc dng chng tng huyt p; cc thuc chng vim c ch
tng hp thn prostaglandin l cht gy gin mch v/ hoc dn n gi mui v
nc. Nguy c suy thn cp ngi mt nc.
X l: Cn cung cp y nc cho ngi bnh, theo di chc nng thn (
thanh lc creatinin). Kim tra s n nh huyt p ng mch, c bit khi bt u iu
tr. Thn trng c bit khi phi hp vi indometacin hoc cc dn cht salicylat li u
cao. Khuyn ngi bnh t theo di u n huyt p.
Nicorandil
Phn tch: Phi hp vi bt k thuc no c tnh cht chng tng huyt p (trong
c nicorandil) c th lm tng nguy c h huyt p, i khi dn n chong.
X l: Theo di huyt p ng mch trong v khi ngng mt trong hai thuc. Ch
c bit ngi bnh cao tui.
250
Nitrat chng au tht ngc; phenothiazin; thuc an thn kinh khc nhau;
thuc ch vn morphin; thuc chn alpha; thuc gin mch lm h huyt p
X l: Theo di huyt p trong khi phi hp hai thuc. Tu sn phm, h huyt p
c th nng nhiu hay t. Tu trng hp, iu chnh liu ca mt hoc hai thuc. Xy
dng k hoch dng thuc u n. Khuyn ngi bnh nu thy chng mt lc bt
u iu tr, nn gp li bc s iu tr iu chnh liu ca mt hoc hai thuc, tu
theo trng hp. Tng cng theo di ngi bnh cao tui (nguy c ng) v khuyn
h, khi t th nm hoc ngi m chuyn sang t th ng, phi t t.
Phenytoin
Phn tch: Nng phenytoin trong huyt tng c th tng, lm tng nguy c
c tnh. C ch cha r.
X l: Gim st c tnh ca phenytoin bnh nhn v theo di nng ca
phenytoin khi bt u v khi ngng nifedipin. iu chnh liu ca phenytoin n u c n
thit.
Phn tch: S dng ng thi vi dihydropyridin c th dn n thay i huyt p
nhiu.
X l: Cc thuc c ch MAO t c s dng, tng tc li nhiu v him c
k n, nn t c cc nhn xt v cnh gic thuc. Tuy nhin nn thn trng gi
khong cch t 2 n 3 tun sau khi ngng dihydropyridin trc khi k n li thuc c
ch MAO.
Rifampicin
Phn tch: Tc dng iu tr ca nifedipin c th gim. C ch do chuyn ho ca
nifedipin thnh rut (cytochrom P450 3A4) c th tng do rifampicin.
X l: Theo di huyt p hoc triu chng au tht ngc ngi bnh. iu
chnh liu ca nifedipin cho ph hp hoc xem xt dng mt thuc chng tng huyt p
khc thay th.
Saquinavir
Phn tch: Do hin tng cnh tranh khu cytochrom P450, saquinavir c th lm
gim chuyn ho ca cc dihydropyridin km hu qu l tng nng ca chng trong
huyt tng v tng c tnh.
X l: Theo di cht ch ngi bnh v s xut hin tc dng c.
Sotalol
Phn tch: Tng tc dng h huyt p. Tuy nhin sotalol c dng lm thuc
chng lon nhp nhiu hn l thuc lm h huyt p. C th phi hp dihydropyridin v
thuc chn beta, vi iu kin l chn ng cht dihydropyridin nhng cng phi ch
nh cho ng (xem thuc chn beta).
251
X l: Him khi sotalol c k n lm thuc h huyt p, tuy nhin mc tiu

iu tr c th l cha c tng huyt p v ri lon nhp. Trong trng hp ny, nn xy
dng k hoch dng thuc. Lc bt u iu tr, cn o u n huyt p ng mch
cho ti khi t cn bng iu tr.
Tacrolimus
Phn tch: Nng tacrolimus trong mu c th tng, dn n tng nguy c c
tnh. C ch c l do nifedipin c ch chuyn ho ca tacrolimus gan.
X l: Theo di chc nng thn v nng tacrolimus trong mu trong khi dng
phi hp nifedipin v tacrolimus v khi ngng nifedipin. iu chnh liu ca tacrolimus
nu cn.
Thuc chn beta
Phn tch: Mc du c s tng tc dng h huyt p, vn gp phi hp ny. Tuy
nhin, nn cnh gic, do c thm tnh cht gim lc co c (k c di dng thuc nh
mt vi cht chn beta) ngi suy tim c kim sot hay khng. ng i suy mch
vnh, gin mch do dihydropyridin gy nn c th dn n nhp tim nhanh phn x va
phi bi thuc chn beta.
X l: Tnh n bi cnh sinh l bnh hc ca ngi bnh. Tt c ph thuc vo
mc tiu iu tr chnh (au tht ngc hoc tng huyt p) v thi gian iu tr vi thuc
ny hoc thuc kia. C th c tht bi trong iu tr tng huyt p.
Thuc chng lot khng H2 typ cimetidin
Phn tch: Tc dng ca nifedipin c th tng. C ch c l do chuyn ho ca
nifedipin gan b gim do cimetidin c ch cc oxydase gan (cytochrom P 450) lm nhim
v chuyn ho mt s thuc. Tng tc xy ra chm.
X l: Theo di bnh nhn v nhng tc dng bin i ca nifedipin khi bt u,
khi ngng hoc khi thay i liu ca cimetidin. iu chnh liu ca nifedipin cho ph
hp.
Phn tch: Tng tc dng h huyt p ca nhng thuc ny. H huyt p l mt
tc dng khng mong mun ca cc thuc chng trm cm ba vng.
X l: Nu cn phi hp ny, th tng cng theo di huyt p, trong v khi
ngng iu tr vi mt trong hai thuc. iu chnh liu, tu tnh hnh. Nhn mnh n
k hoch dng thuc v s tun th. c bit cnh gic ngi bnh cao tui.
Phn tch: C th gia tng h huyt p, mc du cc thuc chn calci c th c
ch ngn nga nhp tim nhanh trn tht, tng huyt p v co tht mch vnh trong
khi phu thut.
X l: Tng tc cn c thy thuc gy m x l tu theo cc thng s theo di
thi im can thip.
252
DILTIAZEM
Thuc c ch dng calci qua mng, dng trong chng au tht ngc
CC THUC TRONG NHM
DILTIAZEM vin nn 60 mg
Tildiem vin nn 60 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: Thuc qua c sa m.
Thi k mang thai: Diltiazem gy qui thai mt s ng vt. Cn phi p dng
trnh thai hiu qu, khi iu tr bng thuc ny.
Cn nhc nguy c/ li ch mc 3
Suy tim: Diltiazem l cht i khng calci, lm gim lc co c tim. Thuc c nguy
c lm suy tim mt b.
Trng hp khc: Bloc nh-tht hoc nhp tim chm nng.
Thn trng: mc 2
t.
Suy gan: Mt s him trng hp tng nht thi cc transaminase c m
Ngi cao tui: V tc dng lm chm nhp tim, cn s dng thn trng
diltiazem ngi cao tui.
TNG TC THUC
Dantrolen
Phn tch: Nhiu trng hp rung tht gy cht thng xuyn c thy trn sc
vt. Do thn trng, chng ch nh phi hp (bepridil, diltiazem, verapamil) v trnh phi
hp dihydropyridin, ngay c mt s ngi bnh m phi hp ny cng khng thy c
tai bin no.
X l: Khng phi hp, nu khng c phng tin theo di v can thip ngay
(khoa hi sc).
Amiodaron
Phn tch: Amiodaron c th lm tng chng chm nhp tim do mt vi thuc chn
beta, diltiazem hoc verapamil gy ra. Ri lon nhp xoang v bloc nh - tht c th xut
hin, nht l ngi bnh c tin s ri lon nhp xoang.
253
X l: Nu phi thc hin phi hp thuc ny, cn gim liu v theo di in tm

. Amiodaron c na i l 28 ngy, nn tc dng ca tng tc c th cn th hi n
nhiu tun sau khi ngng iu tr.
Dihydropyridin
Phn tch: Tng tc dng chng lon nhp v tc dng khng mong mun ca
nhng thuc ny. Cc dihydropyridin gy nhp tim chm km r nt hn diltiazem nhiu,
thm ch cn gy nhp tim nhanh. Tuy nhin phi hp hai thuc s d n n tc d ng
chm nhp tim rt r. Phi hp khng hp l gia hai thuc thuc cng mt nhm.
X l: Phi hp cn trnh ny ch c th c thy thuc chuyn khoa thc hin
khi c phng tin theo di in tm . Thc vy, phi hp cc thuc chng lon nhp
thng rt t nh, i hi phi tng cng theo di lm sng v in tm . Thng tin
cho thy thuc khng chuyn khoa tim v nguy c chm nhp tim qu mc, khi phi hp
diltiazem hoc verapamil. Nguy c lon nhp vi cc dihydropyridin ch yu c gy ra
bi chng nhp tim nhanh phn x ca thuc gin mch.
Disopyramid
Phn tch: Diltiazem, c tnh cht gim lc co c (gy nhp tim chm), khi phi
hp vi disopyramid, c th dn n nhp tim chm qu mc.
X l: Khuyn khng dng disopyramid trong vng 48 gi trc hoc trong vng
24 gi sau khi dng cc cht i khng calci c tnh cht gim lc co c. Nu phi thc
hin phi hp ny, nn theo di in tm .
Cc cht c ch HMG-CoA reductase
Phn tch: Nng trong huyt tng ca mt s cht c ch HMG-CoA
reductase (nh atorvastatin, lovastatin...) c th tng, lm tng nguy c c tnh (th d
tiu c vn, vim c). C ch c th c s c ch chuyn ho (CYP3A4) ca cht c
ch HMG-CoA reductase.
X l: Nu vic dng diltiazem cng vi cc thuc trn l khng trnh c,
khuyn ngi bnh phn nh cho thy thuc khi c b au, nhy cm au hoc yu.
Pravastatin l thuc t tng tc nht, nn c th s dng lm thuc thay th tng i
an ton.
Calci
Phn tch: C th dng phi hp ny iu tr qu liu thuc chn calci hoc
ngc li. Tc dng dc l t c ch yu vi calci tim tnh mch. Nh vy calci
tim tnh mch lm gim tc dng ca cc thuc chn calci.
X l: Phi hp ny c s dng kim sot h huyt p v nhp tim chm
do verapamil. C th dng phi hp iu tr qu liu thuc chn calci, hoc rung tim
do calci gluconat gy nn. Calci ung khng c hoc t c tc dng.
Carbamazepin
Phn tch: Nng carbamazepin trong huyt thanh c th tng v c tnh ca
carbamazepin c th xy ra, tuy nhin gi thuyt ny cha c xc minh.
254
X l: Theo di nng ca carbamazepin trong huyt thanh v quan st ngi

bnh v cc du hiu c hoc mt tc dng ca carbamazepin khi thm diltiazem
hoc ngng thuc ny trong phc iu tr. Cn iu chnh liu ca carbamazepin khi
ngng diltiazem.
Ciclosporin
Phn tch: Tng nng ciclosporin trong huyt thanh, do mt nhm cytochrom
P450 b c ch.
X l: Nu cn phi hp ny, theo di cn thn nng ciclosporin trong huyt
thanh v iu chnh liu ciclosporin lc u v lc cui iu tr vi diltiazem, hoc
verapamil. Lu l nng ciclosporin trong huyt thanh bin ng nhiu gia cc c
th bnh nhn v s theo di phi u n.
Clozapin
huyt p k n ban u, trong v sau khi ngng iu tr bng clozapin. Cn thn
trng c bit ngi bnh cao tui.
Corticosteroid (methylprednisolon)
Phn tch: Tc dng dc l v c tnh ca methylprednisolon c th tng.
Tng tc xy ra chm. C ch do chuyn ho ca methyl prednisolon (CYP 3A4) c th
b c ch. Ngoi ra, c ch P-glycoprotein c th gp phn vo tng tc.
X l: Cn theo di cn thn p ng ca ngi bnh i vi methylprednisolon
khi phi hp vi diltiazem. iu chnh liu methylprednisolon nu cn.
Dextropropoxyphen
Phn tch: Dextropropoxyphen c tc dng h huyt p nh. Vi cc thuc h
huyt p khc, c s tng tc dng lm h huyt p v tng nguy c h huyt p th
ng.
X l: Cn theo di huyt p trong khi phi hp hai thuc (trong v sau khi ngng
mt trong hai thuc). Tu thuc, h huyt p c th nng hay nh. Tu tnh hnh, i u
chnh liu ca mt hoc hai thuc. Xy dng k hoch dng thuc u n. Khuyn
ngi bnh nu b chng mt lc u iu tr, nn gp li thy thuc iu tr nu
cn, iu chnh liu ca mt hoc hai thuc. Tng cng theo di ng i bnh cao
tui (nguy c ng) v khuyn h khi t th nm hoc ngi m chuyn sang t th
ng phi t t.
Glycosid tr tim
Phn tch: Diltiazem c th lm tng nng ca digoxin, c th dn n c
tnh ca digoxin. Tuy nhin, trong mt s nghin cu khc khng thy c nh hng g
n nng digoxin. C ch hnh nh diltiazem lm gim s thanh lc ca digoxin
thn hoc ngoi thn.
X l: Theo di nng trong huyt thanh cc digoxin bnh nhn ang dng
diltiazem. Nu thy tng nng digoxin hoc c du hiu c, th c th phi gim
liu digoxin.
255
Insulin
Phn tch: Tc dng h glucose mu ca insulin c th b gim. Tng tc xy ra
nhanh. C ch cha r.
X l: Khng cn phi c thn trng c bit. Nu nghi c tng tc, cn nhc
xem c cn phi tng liu insulin. Cn theo di glucose mu.
Lithi
Phn tch: Tng tc cn bn ci. Thng bo nhng trng hp c tng hoc
gim nng lithi trong huyt thanh, dn n c thn kinh, biu hin di dng bun
nn, nn, tiu chy, mt iu vn, run...
X l: Trc s tri ngc ny, quan trng l theo di lithi mu chnh xc khi bt
u, khi ang v sau khi iu tr bng diltiazem. Chuyn cc nhn xt n Trung tm
cnh gic thuc nu c.
Phn tch: Diltiazem v verapamil l nhng cht c ch mt s cytochrom P450 v
c th dn n tng nng ca thuc phi hp trong huyt thanh v gy c tnh ca
thuc ny.
X l: Lu tng tc dc ng hc ny; nn theo di cn thn nng trong
huyt thanh ca thuc c phm vi iu tr hp.
Nicorandil; thuc chn alpha; thuc gin mch lm h huyt p thuc ch
vn morphin
Phn tch: Tng tc dng lm h huyt p v tng nguy c h huyt p th ng.
X l: Theo di huyt p trong khi phi hp hai thuc. Tu thuc s d ng, h
huyt p c th nng t hay nhiu. Tu trng hp, iu chnh liu ca mt hoc hai
thuc. Xy dng k hoch dng thuc u n. Khuyn ngi bnh nu b chng mt
lc bt u iu tr, nn gp li thy thuc iu tr iu chnh liu ca mt hoc hai
thuc, tu theo trng hp. Tng cng theo di ngi bnh cao tui (nguy c ng)
v khuyn h, khi ang t th nm hoc ngi m chuyn sang t th ng, phi t
t.
Saquinavir
Phn tch: Do cnh tranh cytochrom P450, saquinavir c th lm gim chuyn
ho ca nhng thuc c chuyn ho bi cytochrom P450, km theo hu qu l tng
nng ca chng trong huyt tng v tng c tnh. Diltiazem cng l mt trong s
thuc ny.
X l: Theo di cht ch ngi bnh v s xut hin tc dng c.
Sotalol
Phn tch: Do tc dng gim lc co c r nt ca nhng thuc ny, c nguy c
chm nhp tim qu mc, bnh nt xoang, ri lon dn truyn xoang v nh tht v suy
tim.
X l: Ch c th k n phi hp thuc nu c th theo di in tm u
n, c bit ngi bnh cao tui v lc u iu tr. Cn ch khi ng ng hai
thuc ngi suy mch vnh.
256

trng.
Phn tch: Dng ng thi vi diltiazem c th dn n bin i huyt p quan
X l: Him khi s dng cc thuc c ch MAO, cc tng tc th nhiu v cc

n thuc li him gp, nn c t cc nhn xt v cnh gic thuc. Tuy nhin, nn gi
mt khong thi gian t 2 n 3 tun sau khi ngng diltiazem, trc khi bt u k n
li thuc c ch MAO.
Tacrolimus
Phn tch: Nng tacrolimus c th tng, gy tng c tnh. C ch: do chuyn
ho tacrolimus gan b c ch.
X l: Nn gim liu tacrolimus v theo di chc nng thn qua vic nh lng
creatinin mu. Theo di nng tacrolimus trong huyt tng trong khi iu tr v sau
khi ngng.
Phn tch: Tc dng dc l v c tnh ca theophylin c th tng. C ch: c
th do chuyn ho ca theophylin b c ch bi diltiazem.
X l: Theo di nng ca theophylin trong huyt tng v c tnh ngi
bnh. iu chnh liu cho ph hp.
Thuc chn beta
Phn tch: Tc dng dc l ca mt s thuc chn beta c th tng. Nhp tim
chm triu chng c th xy ra. C ch: c th c s c ch chuyn ho oxy ho ca
thuc chn beta v hip ng tc dng dc l.
X l: Nu nghi c tng tc, cn nhc gim liu ca thuc chn beta. Nu nhp
tim chm, c th phi dng thuc khc thay th.
Phn tch: Tc dng iu tr v tc dng c ca diltiazem c th tng do cc
cht khng histamin H2. C ch: sinh kh dng ca diltiazem c th tng do gim thoi
bin khi qua gan ln u.
X l: Gim liu ca diltiazem nu c du hiu c tnh
X l: Nu cn phi hp ny, th tng cng theo di huyt p ng mch trong
v khi ngng iu tr mt trong hai thuc. iu chnh liu tu trng hp. Nhn mnh
v k hoch dng thuc v s tun th. c bit cnh gic ngi cao tui.
Phn tch: S dng thuc chng tng huyt p hoc thuc c th dn n
h huyt p ng thi vi cc thuc gy m barbituric c th gy h huyt p nng.
X l: Khuyn ngi bnh bo cho ngi gy m bit cc thuc ang dng.
257

Phn tch: C th tng h huyt p, mc du cc thuc chn calci c th c ch
ngn nga nhp tim nhanh trn tht, tng huyt p v co tht mch vnh trong khi
phu thut.
X l: Tng tc do thy thuc gy m x l tu theo cc thng s theo di thi
im phu thut.
DIPYRIDAMOL
Thuc gin mch vnh chng kt t tiu cu
CC THUC TRONG NHM
DIPYRIDAMOL vin nn 150 mg
Cleridium vin nn 150 mg
CH KHI CH NH THUC
Thi k cho con b/ mang thai: Nn trnh v cn thiu d liu.
TNG TC THUC
Heparin
Phn tch: Phi hp vi bt k thuc no c tnh cht chng kt tp tiu cu hoc
chng ng mu u lm tng nguy c chy mu.
X l: Tuy phi hp ny vn c th thc hin, nhng buc phi theo di bng cc
th nghim ng mu thch hp (thi gian Howell, thi gian cephalin kaolin) trong v
sau khi iu tr bng heparin. Tt nht l tm mt gii php iu tr khc.
Ticlopidin
chng ng mu, lm tng nguy c chy mu. Hin nay tng tc ny hnh nh khng
c tha nhn, khng c nhn xt lm sng no xc nhn nguy c chy mu.
X l: Tuy phi hp ny vn c th thc hin, nhng buc phi theo di cht ch
bng nhng th nghim ng mu thch hp trong v sau khi iu tr bng ticlopidin
hoc dipyridamol.
chng ng mu u lm tng nguy c chy mu. Hin nay, tng tc ny hnh nh
khng c tha nhn, khng c nhn xt lm sng no xc nhn nguy c chy mu.
258
X l: Tuy phi hp ny vn c th thc hin nhng do thn trng, i hi phi

theo di cht ch bng cc th nghim ng mu thch hp (thi gian Quick, t l
chun ha quc t - INR).
Adenosin
Phn tch: Tc dng dc l ca adenosin c th tng do dipyridamol, nn khi
tim nhanh adenosin c liu c th gy nhp tim chm nghim trng. Tng tc xy ra
nhanh. C ch do chuyn ho hoc vn chuyn adenosin c th b c ch.
X l: Do na i ca adenosin ngn, nn khng cn phi thn trng, c bit
khi dng adenosin gy tc dng ging nh gng sc trong khi lm hin hnh tim, cn
phi gim tc truyn ban u. iu chnh liu adenosin tu theo p ng.
Indometacin hoc dn cht; pyrazol; salicylat; thuc chng vim khng
steroid
chng ng mu, cng lm tng nguy c chy mu. Hin nay tng tc ny hnh nh
khng c tha nhn, khng c nhn xt lm sng no xc nhn nguy c chy mu.
X l: Tuy phi hp ny vn c th thc hin, nhng buc phi theo di cht ch
bng nhng th nghim ng mu thch hp trong v sau khi iu tr bng cc thuc
chng vim khng steroid.
Thuc tiu huyt khi
chng ng mu, cng lm tng nguy c chy mu.
X l: Ni chung, k n v dng cc thuc tiu huyt khi l do cc thy thuc
chuyn khoa (chuyn khoa tim v thy thuc cp cu) v phm vi iu tr ca nhng
thuc ny hp v cch dng t nh. Nu phi hp ny cn thit, buc phi theo di
bng nhng th nghim ng mu thch hp (thi gian Howell v thi gian cephalin kaolin). Tt nht, nn tm mt gii php iu tr khc, nu c th c.
259
DISOPYRAMID
Thuc chng lon nhp c tc dng n nh mng
(nhm Ia ca Vaughan - Williams)
CC THUC TRONG NHM
DISOPYRAMID nang100 mg
Rytmodan nang100 mg
CH KHI CH NH THUC
Thi k cho con b: Disopyramid c pht hin trong sa m, nn trnh cho
con b, do tnh cht dc l ca thuc.
Thi k mang thai: Disopyramid qua hng ro nhau thai, ngi ta bit
disopyramid c th kch thch co t cung.
Suy tim: Tc dng gim lc co c v do tc dng gy suy gim c tim ca
disopyramid tng ln ngi suy tim, km theo nguy c tru tim hoc ri lon nhp nng
thm. Chng ch nh trong trng hp bloc nh-tht 2 v 3.
Trng hp khc: Ko di khong QT. Blc nh - nht v blc nhnh hon ton
l nhng chng ch nh dng disopyramid.
Thn trng: mc 2
Glcm/ ph i tuyn tin lit/ u tuyn tin lit : Disopyramid c nhng tc
dng khng mong mun kiu atropin. Thuc c th dn n b tiu tin cp ngi ph
i tuyn tin lit v ri lon iu tit trong trng hp glocom.
Suy thn: Tng c tnh vi c tim do chm o thi km theo nguy c tc dng
suy gim trn tim v h huyt p .
Bnh nhc c: Nguy c ri lon nng thm
Cn theo di: mc 1
Ngi cao tui: Tai bin h glucose mu c thng bo ch yu ngi
cao tui, do phi theo di glucose mu nhm ngi bnh ny.
TNG TC THUC
Amiodaron; bretylium; bepridil; vincamin
Phn tch: Tng nguy c xon nh do hip ng tc dng: h kali mu, nhp tim
chm v khong QT di c t trc (ch thy trn in tm ) l nhng yu t thun
li cho xut hin xon nh. Xon nh l mt dng nhp tht c bit, c th xut hin
X l: Chng ch nh v khng c k n v pht thuc cho phi hp c tim
nng gy cht ny.
Benzamid
260
Phn tch: Duy nht sultoprid trong nhm benzamid c th c nguy c. Mi thuc
gim lc co c (gy nhp tim chm) nh disopyramid u c th dn n tng nguy c
ri lon nhp tht, nht l xon nh, do thm cc tnh cht in sinh l ca sultoprid.
Cisaprid
nh. C ch: c th do cng tc dng ko di khong QT.
X l: Chng ch nh dng cisaprid cho bnh nhn ang dng thuc chng lon
nhp nhm IA v nhm III.
Phn tch: Tng tc ch c m t vi astemizol (Hismanal), mt khng
histamin khng H1 c coi l khng an thn; tng nguy c xut hin xon nh. Xon
nh l mt dng c bit ca nhp tht, c th xut hin tng cn rt ng n (vi giy,
mt thu: cm gic ngt m khng mt thc), i khi tin tri n n rung th t ch t
ngi.
X l: Chng ch nh phi hp. Nn chn mt khng histamin khc khng an
thn, khng gy xon nh (cetirizin, loratadin).
Macrolid
Phn tch: Tng nguy c xon nh, do hip ng tc dng, c m t ch ring
vi erythromycin tim tnh mch. H kali mu, nhp tim chm v khong QT di c t
trc (ch thy trn in tm ) l nhng yu t thun li cho xut hin xon nh.
Xon nh l mt kiu nhp tht c bit, c th xut hin tng cn rt ngn (vi giy,
mt thu: cm gic ngt m khng mt thc). Trong nhm macrolid, ch c
erythromycin, c bit l dng tim tnh mch, c th dn n ri lon nhp tim (ko di
khong QT, ngoi tm thu tht, xon nh, blc nh - tht).
X l: Chng ch nh v khng c k n phi hp c tim nng gy cht ny.
Ngay c khi dng mt mnh, erythromycin tim tnh mch c th dn n cc ri lon
nhp tim. Khuyn khng nn tim nhanh c liu, m truyn tnh mch lin tc hoc chia
nh, thi gian truyn mi ln t nht 60 pht.
Quinidin hoc dn cht
Phn tch: Phi hp hai thuc chng lon nhp cng mt nhm. Phi hp khng
hp l.
Sparfloxacin
nh. C ch cha r.
X l: Chng ch nh dng sparfloxacin cho bnh nhn ang dng thuc chng
lon nhp nhm IA v nhm III. Cc khng sinh quinolon khc m khng ko di khong
QT hoc khng b chuyn ho bi isozym CYP 3A4 c th l nhng thuc thay th ph
hp. Trnh dng gatifloxacin v moxifloxacin bnh nhn dng cc thuc chng lon
nhp nhm IA hoc nhm III.
261
Thioridazin
nh. C ch do c th hip ng ko di khong QT.
X l: Chng ch nh dng thioridazin bnh nhn ang dng mt s thuc
chng lon nhp bao gm disopyramid.
Verapamil
Phn tch: Hai thuc u c tc dng gim lc co c nn c nguy c tng tc
dng chng lon nhp v tc dng khng mong mun ca nhng thuc ny. Mt s
trng hp t vong c m t.
X l: Disopyramid khng c dng trong vng 48 gi trc hoc trong vng 24
gi sau khi dng verapamil, do cc tnh cht gim lc co c ca nhng thuc ny.
Ziprasidon
nh. C ch do c th hip ng hoc cng hp ko di khong QT.
X l: Chng ch nh dng ziprasidon bnh nhn ang dng mt s thuc
chng lon nhp bao gm disopyramid.
262
Dihydropyridin
Phn tch: Khi phi hp cc dihydropyridin c tnh cht gim lc co c (gy nhp
tim chm) vi mt vi thuc chng lon nhp, c th dn n nhp tim chm qu mc.
X l: Khuyn khng nn dng nhng thuc ny trong vng 48 gi trc hoc
trong vng 24 gi sau khi dng cc cht i khng calci c tnh cht gi m l c co c .
Nu phi hp ny cn phi thc hin, nn theo di in tm . Nn bi t r ng mt s
dihydropyridin gim lc co c nhiu hay t.
Diltiazem
Phn tch: Khi phi hp diltiazem, c tnh cht gim lc co c (gy nhp tim chm)
vi disopyramid, c th dn n nhp tim chm qu mc.
X l: Khuyn khng nn dng disopyramid trong vng 48 gi trc hoc trong
vng 24 gi sau khi dng cht i khng calci c tnh cht gim lc co c. Nu ph i
hp ny cn phi thc hin, nn theo di in tm .
Halofantrin; mineralocorticoid; pentamidin; thuc nhun trng kch thch
Phn tch: Nguy c xon nh, khi phi hp thuc, do cng hp cc tc dng in
sinh l. H kali mu, nhp tim chm v khong QT di c trc (ch thy trn in tm
) l nhng yu t thun li cho xut hin xon nh. Xon nh l mt kiu nhp tht
c bit, c th xut hin tng cn rt ngn (vi giy, mt thu: cm gic ngt m
khng mt thc).
X l: Khng nn dng phi hp ny. Dng cc thuc khng dn n xon nh.
Nu cn phi hp, b tr theo di thng xuyn khong QT v kim tra u n kali
mu. Nhc ngi bnh gp li bc s khi thy cc triu chng h kali mu: mt nhc,
yu c, chut rt.
Phn tch: Dng lu di thuc nhun trng lm trn (tng t nh tiu chy nng)
c th gy h kali mu.
X l: Nu cn phi hp thuc nhun trng lm trn vi disopyramid, phng nga
h kali mu bng cch cung cp kali v nu cn, tu theo lm sng, theo di in tm
(nguy c h kali mu xy ra t hn so vi thuc nhun trng kch thch). Khuyn
ngi bnh gp li bc s khi thy cc triu chng h kali mu: mt nhc, yu c,
chut rt.
Amphotericin -B
Phn tch: Nguy c xon nh, khi phi hp vi amphotericin B tim. H kali mu,
nhp tim chm v khong QT di c t trc (ch thy trn in tm ) l nhng yu t
to thun li cho xut hin xon nh. Xon nh l mt kiu nhp tht c bit, c th
xut hin tng cn rt ngn (vi giy, mt thu: cm gic ngt m khng mt thc) v
t ng mt i.
X l: Nu phi hp amphotericin B tim vi disopyramid l cn thit, c th ngn
nga h kali mu bng cch tng cng gim st ngi bnh v theo di in tm .
263
Trng hp xut hin xon nh, khng dng thuc chng lon nhp. Khuyn ng i
bnh gp li bc s khi thy cc triu chng h kali mu: mt nhc, yu c, chut rt.
Phn tch: Do cm ng enzym, c s gim nng ca disopyramid trong huyt
thanh ti mc khng c hiu lc.
X l: Theo di in tm , lm sng, nng thuc chng lon nhp trong
huyt thanh v nu cn, iu chnh liu.
Cc cht cholinergic
Phn tch: Cc tnh cht khng cholinergic ca disopyramid c th nh hng n
tc dng cholinergic cn tm kim.
X l: Lu nguy c tht bi hoc gim tc dng iu tr, nu mc tiu iu tr
chnh i hi phi k n thuc tc dng cholinergic. Hi ngi bnh khi lp l i n
thuc iu tr. Tc dng khng cholinergic c th yu hoc va (dng ti ch: Thuc r
mt).
Clozapin
Phn tch: Tng tnh cht khng cholinergic do hip ng tc dng khng mong
mun. Nhng tc dng ny th hin bng tng nguy c b tiu tin, kh mi ng v to
bn.
X l: Phi lu n nhng tc dng ph ca loi thuc ny. Nu phi thc hin
phi hp ny theo mc tiu iu tr, bo cho ngi bnh v nhng tc dng khng
mong mun c th gp. Trnh dng cho ngi c vn v tuyn tin lit v ngi b
glocom.
Flecainid hoc thuc tng t; lidocain v thuc tng t; mexiletin
Phn tch: Cc phi hp vi thuc chng lon nhp thuc nhm khc trong phn
loi Vaughan -Williams, cn c tng cng theo di (in tm ), nht l vi
disopyramid.
X l: Phi hp cc thuc chng lon nhp vi nhau cn c s chuyn khoa, k
c trong ni b chuyn khoa tim v phi c phng tin theo di (khoa hi sc tim).
Furosemid hoc thuc tng t; glucocorticoid; tetracosactid; thuc li
tiu thi kali
Phn tch: Nguy c xon nh khi phi hp cc thuc ny. H kali mu, nhp tim
chm v khong QT di c t trc (ch thy trn in tm ) l nhng yu t thun
li cho xut hin xon nh. Xon nh l mt kiu nhp tht c bit, c th xut hi n
tng cn ngn (vi giy, mt thu: cm gic ngt m khng mt thc).
X l: Nu cn phi hp, phi ngn nga h kali mu bng cch tng cng
gim st ngi bnh v theo di in tm . Trng hp xut hin xon nh, khng
dng thuc chng lon nhp. Khuyn ngi bnh gp li bc s khi thy cc triu chng
h kali mu: mt nhc, yu c, chut rt.
Gluthetimid hoc thuc tng t; medifoxamin
Phn tch: Tng tnh cht khng cholinergic, kiu kh ming, b tiu tin v to
bn.
264
X l: Phi lu cc tc dng ph ca loi thuc ny. Nu phi hp ny phi

thc hin theo mc tiu iu tr, thng bo cho ngi bnh v nhng tc dng khng
mong mun c th c. Trnh dng cho ngi c vn v tuyn tin lit v ng i
bnh glocom.
Sotalol
Phn tch: Tng tc dng ca cc thuc chn beta. Nguy c xut hin cc ri
lon v tnh co, gim tn s v gim dn truyn tim.
n.
X l: Vi phi hp ny, tng cng theo di lm sng cng vi in tm u

Cimetidin
Phn tch: Nng disopyramid trong huyt tng c th tng, lm tng tc dng
dc l v tc dng ph. C ch do cimetidin c th lm tng s hp thu ca
disopyramid.
X l: Nu nghi c tng tc ny, c th cn phi gim liu ca disopyramid.
Phenothiazin; thuc khng cholinergic; thuc chng trm cm ba vng
hoc thuc tng t
Phn tch: Tng tc dng khng cholinergic, do hip ng cc tc dng khng
mong mun. Nhng tc dng ny biu hin bng tng nguy c b tiu tin, kh mi ng
v to bn.
X l: Phi lu cc tc dng ph ca loi thuc ny. Nu phi hp ny phi
thc hin theo mc tiu iu tr, bo cho ngi bnh v nhng tc dng ph ny. Trnh
dng cho ngi c vn v tuyn tin lit v ngi b glocom.
Thuc chn beta
Phn tch: Tng tc dng ca thuc chn beta (k c di dng thuc nh mt).
Nguy c xut hin ri lon v tnh co c, gim tn s v gim dn truyn tim.
X l: Vi phi hp ny, tng cng theo di lm sng v in tm u n.
Thuc khng histamin khng H1 an thn
Phn tch: Tng tnh cht khng cholinergic i vi phn ln cc thuc khng H 1
(mt s nm trong nhm phenothiazin), kiu kh ming, b ti u ti n v to bn. Nn
nh rng ketotifen (Zaditen) v oxadomid (Tinset)hnh nh khng c tc dng khng
cholinergic. Cn theo di.
X l: Phi lu cc bt tin ca loi thuc ny. Nu phi hp ny ph i thc
hin theo mc tiu iu tr, thng bo cho ng i bnh v cc tc d ng khng mong
mun c th c. Trnh dng cho ngi c vn v tuyn
tin lit v ngi b glocom. Cn nhc nguy c tu theo dng bo ch dng (dng
ti ch), ch n thuc nh mt; cng theo di c vic t dng thuc.
DISULFIRAM
Thuc c ch enzym c dng trong liu trnh cai ru
265
CC THUC TRONG NHM

DISULFIRAM
Esperal vin nn 250 mg; 500mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Ru: Disulfiram c ch chuyn ho ca ru do chn alcol dehydrogenase,
dn n tch lu acetaldehyd gy ra tc dng antabuse (gin mch, nn, ra m hi,
l ln) sau khi dng ung c ru.
i tho ng: V vim nhiu dy thn kinh do disulfiram gy ra.
ng kinh: V c th b ri lon thn kinh (nhc u, hoang tng, kch thch).
Thi k mang thai: Cha chng minh c tnh v hi.
Suy mch vnh: Disulfiram c th dn n h huyt p km vi nguy c tru tim
mch.
Suy gan: c tnh vi tim v mt ca disulfiram tng trong suy gan.
Suy tim: Disulfiram c th dn n h huyt p km vi nguy c tru tim mch.
TNG TC THUC
Phn tch: Nguy c tch lu tc dng khng mong mun (vim nhiu dy thn
kinh, vim dy thn kinh th gic).
X l: Do mc nng ca tc dng khng mong mun, chn mt gii php iu
tr khc.
Metronidazol
Phn tch: Ung disulfiram cng vi metronidazol c th gy lon tm thn cp
hoc trng thi l ln. Bnh no cp tng xy ra vi disulfiram dng n c. C
ch: c l do tc dng dopaminergic qu mc.
X l: Nu xy ra tnh trng lon tm thn cp hoc l ln khi ang dng
disulfiram cng vi metronidazol, th phi ngng mt hoc c hai thuc. Theo di bnh
nhn cht ch, trnh dng phi hp.
Nitroimidazol
Phn tch: Nguy c mc tnh trng l ln c th l do c ch aldehyd
dehydrogenase hoc cc enzym khc (nh vy gn vi tc dng antabuse).
X l: Do mc nng ca cc tc dng khng mong mun, chn mt gii php
iu tr khc.
266
Phenytoin
Phn tch: Disulfiram c ch chuyn ho ca phenytoin gan dn n tng nng
phenytoin trong huyt tng. Phi hp c th dn n ri lon tm thn v mt phi
hp vn ng.
X l: o nng phenytoin trong huyt tng v iu chnh liu, thm ch
ngng dng disulfiram. Nng phenytoin trung bnh c mt tc dng iu tr ti u
khong 5 n 15mg/lt, tu theo phng php nh lng.
Ru
Phn tch: bng, tng h hp, gin mch nhiu, nhp tim nhanh, st, bun
nn, nn, i khi h huyt p v tru tim mch. T vong cng tng xy ra. C ch:
do disulfiram c ch aldehyd dehydrogenase l enzym chu trch nhim oxy ho
acetaldehyd thnh acetyl-CoA, gy tch lu acetaldehyd.
X l: Bnh nhn dng disulfiram khng c ung cc sn phm c ru.
Theophylin
Phn tch: Tc dng dc l v c tnh ca theophylin c th tng. C ch: do
disulfiram c ch c hai con ng hydroxyl ho v kh methyl ca chuyn ho
theophylin.
X l: Theo di nng ca theophylin trong huyt thanh v gim st ngi bnh
v c tnh ca theophylin hoc gim tc dng ca theophylin nu thm hoc ngng
disulfiram. iu chnh liu ca theophylin cho ph hp.
Zalcitabin
Phn tch: C th xut hin vim dy thn kinh ngoi vi.
Cc benzodiazepin
Phn tch: C th tng tc dng c ch h thn kinh trung ng. C ch:
disulfiram c th c ch chuyn ho gan ca nhng benzodiazepin no chu qu trnh
oxy ho.
X l: Nu tc dng c ch h thn kinh trung ng tng trong khi ung cc
thuc ny cng vi nhau, th cn gim liu ca benzodiazepin.
Oxaflozan
Phn tch: Tc dng antabuse do c ru trong ch phm oxaflozan dng git.
X l: Trnh ung ru cng vi disulfiram. Trng hp t dng thuc hoc
dng thuc theo li khuyn, phi phng mi ch phm c ru. Khng phi h p
chng vi disulfiram, n cc tc dng khng mong mun c th xut hi n (xem
tng tc ru -disulfiram).
Thuc ung chng ng
Phn tch: Disulfiram c th lm tng tc dng chng ng ca warfarin. C ch
cha r.
267
X l: Theo di cc thng s chng ng v iu chnh liu lng ca warfarin

theo nhu cu.
268
DOXAPRAM
Thuc hi sc h hp
CC THUC TRONG NHM
DOXAPRAM ng tim 60mg/3mL
Dopram ng tim 60mg/3mL
CH KHI CH NH THUC
ng kinh: Do kch thch h thn kinh trung ng.
Tng huyt p: Tng huyt p nng.
Suy h hp; hen: Hen cp khi c suy thng kh nng.
Thn trng: mc 2
Cng tuyn gip/ suy tim/ suy mch vnh: Doxapram gii phng
catecholamin.
Trng hp khc: U t bo a crom: Doxapram gii phng catecholamin.
TNG TC THUC
Phn tch: Ngng thuc gy m lm c tim nhy cm vi catecholamin, hoc
doxapram lm tng gii phng catecholamin.
X l: Gi khong cch t nht 10 pht trc khi dng doxapram.
DOXORUBICIN HOC DN CHT

Khng sinh km t bo, thuc nhm anthracyclin
CC THUC TRONG NHM
DOXORUBICIN ng tim 2mg/mL; 10mg/5 mL; 50mg/25 mL
Doxorubicin Ebewe ng tim 2mg/mL; 10mg/5 mL; 50mg/25 mL
CH KHI CH NH THUC
Phi l thy thuc chuyn khoa mi k n nhng thuc ny cho ngi bnh. V
vy, cc chng ch nh cn c cn nhc tu theo tnh trng ngi bnh v phi
c thy thuc chuyn khoa nh gi.
TNG TC THUC
269

Actinomycin D
Phn tch: Nguy c tng c tnh v mu do c ch tu xng, do hip ng tc
dng, c th dn n mt bch cu ht; mt khc c mt s trng hp bnh c
tim c m t.
X l: Nu phi hp ny cn thit, nn dng liu thp cho mi thuc. Theo di
cn thn huyt . Tng liu ca doxorubicin c khuyn co khng vt qu
450mg/m2 din tch c th.

X l: Mc du cc trng hp c thng bo ch lin quan n lovastatin,
nhng nguy c tim n c vi simvastatin v pravastatin. Cn trnh phi hp ny.
Vaccin sng gim c lc
Phn tch: Nguy c mc nhim khun tng ng vi vaccin, do tc dng c ch
X l: Khong cch cn tn trng gia hai thuc l t ba thng n mt nm, tu
theo mc c ch min dch.
Alopurinol hoc dn cht ; colchicin hoc dn cht
Phn tch: S dng ng thi mt thuc km t bo v mt thuc chng gt lm
tng nng acid uric. Ngoi ra, tng nguy c gim bch cu v gim tiu cu do cng
hp tc dng khng mong mun ca cc thuc.
X l: Tt nht nn trnh phi hp hai thuc trong cng thi gian, nu khng s
thy iu tr chng gt tht bi. Nn dng alopurinol (c ch sinh tng hp acid uric)
hn l dng cc thuc o thi acid uric, trnh cc bnh thn.
Amphotericin B
Phn tch: Phi hp amphotericin B tim vi cc thuc c vi tu xng bt
buc phi rt thn trng. Nguy c thiu mu hoc ri lon huyt hc khc.
X l: Nu cn phi hp thuc, phi theo di cn thn huyt v, nu cn, tin
hnh gim liu.
Azathioprin; carmustin hoc dn cht; cisplatin hoc dn cht;
fluorouracil; ganciclovir; interferon alpha ti t hp; levamisol; melphalan;
mercaptopurin; methotrexat; penicilamin hoc thuc tng t; pentostatin;
procarbazin; thiotepa; thuc chng ung th cc loi; vincristin hoc thuc tng
t
270
Phn tch: Nguy c tng c tnh v mu, do c ch tu xng, do cng hp tc

dng c th dn n mt bch cu ht.
X l: Nu c th, nn trnh phi hp. Nu cn phi hp, dng liu thp cho mi
thuc v theo di cn thn huyt . Phi hp ny do cc thy thuc chuyn khoa thc
hin v cc s iu tr thng c nh r rng.
Barbiturat
Phn tch: thanh lc ca doxorubicin trong huyt tng c th tng, do tc
dng iu tr ca thuc ny c th b gim. C ch: do chuyn ho ca doxorubicin
gan c th tng do barbiturat, thng qua cm ng enzym microsom gan.
X l: Khi cc thuc ny c dng phi hp, phi theo di bnh nhn. Nu cn,
phi iu chnh theo hng tng liu ca doxorubicin.
Ciclosporin
dch ny qu mnh, c nguy c pht trin u lympho gi.
X l: Khi mun phi hp hai cht c ch min dch ny phi suy ngh, v cn
nhc tng quan nguy c/li ch tu theo mc tiu iu tr. Phi hp ny ch c tin
hnh ti c s chuyn khoa c s theo di cht ch ngi bnh.
Clozapin
Phn tch: Nguy c tng c tnh v mu, do c ch tu xng, do tc dng cng
hp, c th dn n mt bch cu ht. Ch dng n c clozapin cng c th mt
bch cu ht nng, thm ch cht ngi (c tnh min dch).
X l: Nu cn phi hp, dng cc liu thp cho mi thuc. Khng g cho php
tin on s xut hin mt bch cu ht vi clozapin. Vic theo di cn thn huyt
thng thc hin khi dng thuc km t bo, vn c gi tr. Tuy nhin, ngi bnh phi
c thng bo l nu c st nh, vim hng v lot ming phi ng ng iu tr v i
clozapin.
Phn tch: Phi hp vi cc thuc c ch tu xng khc phi c lu .
X l: iu tr phi c bt u ti c s bnh vin. Theo di huyt v chc
nng tim.
Glycosid tr tim
Phn tch: Phi hp vi thuc km t bo dn n km hp thu digitalis khong
50% do tn thng nim mc rut c hi phc.
X l: Theo di cn thn hm lng cc thuc digitalis trong huyt thanh trong
sut qu trnh iu tr. Tng liu ca thuc digitalis nu cn thit.
Phn tch: Mc tiu chnh l iu tr ung th t bo biu m dng tuyn
(adenocarcinome) ca thn. Phi hp hai thuc c tim nng c vi gan, c vi tim
v c ch tu xng.
271
X l: iu tr ch c tin hnh ti c s chuyn khoa. Khi dng interleukin, cn

c s theo di thng xuyn. Trong trng hp ny, phi cn nhc tu theo tnh trng
chung ca ngi bnh. Khi phi hp hai thuc c c tnh vi gan, tim, v c ch tu
xng, cn phi theo di cht ch huyt v chc nng gan (ASAT, ALAT,
phosphatase kim, bilirubin) hoc hon mt trong hai thuc, nu c th c.
Niridazol
Phn tch: Phi hp hai thuc c vi gan. Niridazol cn c c tnh thn kinh.
Nguy c xut hin co git, ri lon tm thn v c tnh vi gan trong trng hp phi
hp.
(ASAT, ALAT, phosphatase kim, bilirubin) hoc, nu c th hon mt trong hai thuc.
Xc minh l ngi bnh khng ung ru thng xuyn v khng c tin s vim gan
do virus. Cc triu chng lm sng chnh khng c hiu gm bun nn, st, vng da...
Nu c phi hp ban da, nga v hch to, th c kh nng l do thuc. Cn phn bit
hi phc vi vim gan mt hi phc c khi ngng iu tr.
Paracetamol
Phn tch: Paracetamol dng di hn vi liu cao trn 6 gam / ngy (tu theo th
trng) c vi gan (vim gan kiu tiu t bo). Khi phi hp vi mt thuc c vi gan
khc, nguy c c vi gan tng.
(ASAT, ALAT, phosphatase kim, bilirubin), hoc phi hon mt trong hai liu trnh, nu
c th c. Xc minh l ngi bnh khng ung ru thng xuyn v khng c tin
s vim gan do virus. Cc triu chng lm sng chnh khng c hiu nh: bun nn,
st, vng da... Nu c phi hp ban da, nga v hch to, th c kh nng do thuc. Cn
phn bit r, tu theo kt qu xt nghim sinh hc, nguy c xut hin vim gan tiu t
bo khng hi phc vi vim gan mt hi phc c khi ngng iu tr.
Phenicol
Phn tch: Nguy c tng c tnh v mu, do c ch tu xng, do hip ng tc
dng, c th dn n mt bch cu ht. Ch dng ring phenicol cng c th mt bch
cu ht nng, thm ch cht ngi (c tnh min dch).
X l: Nu cn phi hp, dng liu thp cho mi thuc. Khng g cho php tin
on s xut hin mt bch cu ht vi cc phenicol. Vic theo di cn thn huyt ,
thng thc hin khi s dng mt thuc km t bo, vn c gi tr. Tuy nhin ng i
bnh phi c thng bo l khi c st nh, vim hng v lot ming phi ng ng i u
tr bng phenicol.
Quinolon
Phn tch: Tc dng khng khun ca cc quinolon c th gim. C ch: ho liu
php vi cc thuc chng ung th c th lm gim s hp thu ca quinolon do nh
hng n nim mc ng tiu ho.
X l: Theo di p ng ca ngi bnh vi iu tr quinolon v iu chnh liu
cho ph hp.
Rifampicin
272
Phn tch: Phi hp hai thuc c tim nng c vi gan (cng hp cc tc dng
khng mong mun).
X l: Khi phi hp hai thuc c vi gan, theo di cht ch chc nng gan
(ASAT, ALAT, phosphatase kim, bilirubin), hoc phi hon, nu c th, mt trong hai
liu trnh. Xc minh l ngi bnh khng ung ru thng xuyn v khng c tin s
vim gan do virus. Cc triu chng lm sng chnh khng c hiu gm: bun nn, st,
vng da. Nu c phi hp ban da, nga v hch to, th c kh nng l do thuc. Cn
phn bit r, tu theo kt qu xt nghim sinh hc, nguy c xut hin vim gan tiu t
bo khng hi phc vi vim gan mt hi phc c khi ngng iu tr.
Tacrolimus
Phn tch: Tng nng ca thuc chng ung th trong t bo v tng tc dng
ca thuc, do c ch glycoprotein P. Protein ny cho php t bo khng vi cc iu
tr, bng cch hot ng nh mt bm ph thuc ATP c th o thi thuc ra khi t
bo. Tc dng ny c nhn thy in vitro, v hin nay cha c khai thc trong lm
sng.
X l: Tng tc ny hnh nh khng c ngha lm sng ngay, nhng cn phi
tnh n trong trng hp khng vi iu tr.
Zidovudin
Phn tch: Phi hp zidovudin vi cc cht c vi tu xng khc buc phi tht
thn trng. Nguy c thiu mu hoc cc ri lon huyt hc khc.
cn.
X l: Nu cn phi hp, theo di cn thn huyt v tin hnh gim liu, nu
c t CLOSTRIDIUM BOTULINUM
Do Clostridium botulinum sn sinh, c t ny c ch gii phng acetylcholin
ch ni thn kinh c, gy lit. c dng trong iu tr co tht mi,
co c na mt, vo c co c
CC THUC TRONG NHM

c t ca CLOSTRIDIUM BOTULINUM dung dch tim 100 n v; 500 n v
Botox dung dch tim 100 n v
Dysport dung dch tim 500 n v
CH KHI CH DNH THUC
Chng ch nh: mc 4
Nhc c: Do c ch tc dng, nguy c phong b thn kinh c l ng k.
Thn trng: mc 2
273
Thi k cho con b - thi k mang thai: Do khng c thng tin.

Cc trng hp khc: Cc bnh mt c nguyn nhn thn kinh.
TNG TC THUC
Aminosid tim hay dng ti ch
Phn tch: Nguy c tng cc tc dng "ging cura" ca aminosid hoc ngc li,
ca cht phi hp. c t Clostridium botulinum, do c ch acetylcholin ch ni thn
kinh - c, gy lit c.
X l: K n c t Clostridium botulinum dnh ring cho cc bc s chuyn khoa
trong mt s trng hp him v xc nh. Khi phi hp iu tr bng khng sinh
aminosid, phi tnh ti nguy c ny trong la chn liu c t Clostridium botulinum.
Khuyn ngi bnh gp li thy thuc khi thy nguy c ny.
Cc thuc ging cura
Phn tch: Tng tc dng dc l ca c t Clostridium botulinum (lit do c ch
gii phng acetylcholin ch ni thn kinh-c).
X l: Trnh k n c hai cht cng mt lc. Nu cn phi hp, phi tnh n
tng tc ny xc nh liu lng.
DNG C TRNH THAI

Vng trnh thai hoc dng c t trong t cung l mt vt l a vo trong t
cung ngi ph n gy kch ng ti ch, c s ca mt phn ng tc thi ca mng
trong
t cung. Chnh vim gy mt lot phn ng dy truyn ngn s lm t ca trng
CC DNG C TRONG NHM
Dng c t t cung
Gynefix
Gyne-T 200
ML Cu
Progestasert
Sering Nova
Sering T
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai: ang mang thai hoc tin s mang thai ngoi t cung.
274
Trng hp khc: D tt t cung, nhim khun t cung, u, bnh Wilson (vi cc

dng c bng ng).
TNG TC THUC
Phn tch: Cc vng trnh thai, gy vim nim mc t cung, lm tng nguy c
chy mu trong.
X l: Thng bo cho ngi bnh l c nguy c chy mu v lu n nguy c
ny trong vic la chn cch trnh thai, v khuyn h gp thy thuc ngay trong trng
hp chy mu.
steroid
Phn tch: Dng thuc chng vim khng steroid (nht l aspirin) lm tng nguy
c tht bi ca vng trnh thai (c ch vim).
X l: Mc du trong y vn cn tranh ci v nguy c, nn trnh k n thu c
chng vim ngi dng cch trnh thai ny. Nu vic k n thuc chng vim khng
lm
gim
hiu
qu
trnh
thai
ca
vng
trnh
thai,
thng
bo cho Trung tm cnh gic thuc. Tng tc ny cn c cung cp thm t liu.
ERGOTAMIN HOC DN CHT

Alcaloid nm ca g dng vi tnh cht tr hoc vn mch
v khng serotonin (dihydroergotamin)
CC THUC TRONG NHM
DIHYDROERGOTAMIN dung dch phun mi 1mL/4 mg; dung dch ung git
50 mL/100 mg; vin nn 5 mg; nang 3 mg.
Diergo-Spray dung dch phun mi 4 mg / 1 mL
Ikaran dung dch ung git 100 mg / 50 mL
Seglor lyoc vin nn 5 mg
Tamik nang 3 mg
CH KHI CH NH THUC
275
Thi k mang thai: Ergotamin lm tng trng lc c t cung, tng tn s co v

rt ngn giai on dui c. Dihydroergotamin lm tng trng lc c t cung yu hn
r rt. Kh nng tr c s dng trong kim sot chy mu sau .
Suy mch vnh: Tng huyt p tnh mch do ergotamin lm tng nhu cu
chuyn ho ca c tim, c nguy c dn n cn au tht ngc trong tr ng hp c
bm cht d mc.
Suy gan: Mc du chuyn ho ca ergotamin cn cha r, ngi ta bit rng suy
gan lm tng c tnh v nguy c ng c ergotin cp (thiu mu cc b ng mch lin
quan n tc dng co mch ngoi vi). Dihydroergotamin t co mch hn, nn nguy c
thp hn.
Thn trng: mc 2
Thi k cho con b: Ergotamin lm gim tit sa bng cch c ch tit prolactin,
v qua c sa m km theo nguy c ng c (tiu chy, nn, ri lon huyt p) cho
tr ang b.
Tr em: Cn trnh dng ergotamin cho tr em do c c tnh vi tim mch.
Tng huyt p: Ergotamin lm tng huyt p do tc dng co mch trc tip, mc
du lu lng tim gim.
Suy thn: Do chm o thi, suy thn to thun li cho nguy c thiu mu cc
b ng mch.
Cn theo di: mc 1
i.
Cng gip: Trng hp cng gip, tc dng ca ergotamin ko di v khuch
TNG TC THUC
Macrolid
Phn tch: Nguy c tai bin thiu mu cc b nng cc u chi, c th dn n
hoi t, do c ch chuyn ho ergotamin gan (hin nay cha c m t vi
spiramycin)
X l: Bt buc phi ht sc thn trng, v thng bo chnh thc p dng cho mi
thuc macrolid, ngi k n phi trnh nhng phi hp ny. Chng ch nh phi hp
vi tt c cc macrolid, tr spiramycin.
Mt s dn cht hydrogen ho khc ca nm ca g (dihydroergocornin,
dihydroergocristin, dihydroergotoxin) khng lin quan n tng tc ny.
Sumatriptan
Phn tch: Hai thuc ny c th c k n ring r trong bi cnh migren kh
cha. Ngi b migren cng c th khng bit nn trn ln hai thuc. l t ng
tc dc lc v phi hp hai thuc co mch, nht l khi dng sumatriptan dng tim.
X l: Phi hp ny chng ch nh v nguy c xut hin co mch vnh v / hoc
phi. Thay i cch iu tr. Thng bo cho ngi bnh migren khng phi hp hai
thuc (dihydroergotamin c th c trong t thuc gia nh).
276
Thuc c ch protease (amprenavir, indinavir)

Phn tch: C th tng nguy c nhim c nm ca g (nh co mch ngoi bin,
thiu mu cc b u chi). Tng tc xy ra chm. C ch: do thuc c ch protease
c th cn tr chuyn ho ergotamin gan (CYP3A4).
X l: Chng ch nh phi hp thuc c ch protease vi alkaloid nm ca g.
Thuc c ch NNRT (non-nucleoside reverse transcriptase): gm c
delavirdine, efavirenz
Phn tch: C th tng nguy c nhim c nm ca g (nh co mch ngoi bin,
thiu mu cc b u chi). Tng tc xy ra chm. C ch do thuc c ch NNRT c
th c ch chuyn ho ergotamin gan (CYP3A4).
X l: Chng ch nh phi hp hai thuc.
Phn tch: Phi hp cc thuc co mch, nguy c c t kch pht tng huyt p
vi cc alcaloid nm ca g c tnh cht co mch.
X l: Cn trnh phi hp. Thay i cch iu tr.
Nitrat (amyl nitrit, nitroglycerin)
Phn tch: Sinh kh dng ca dihydroergotamin dng ung c th tng, lm
tng huyt p tm thu trung bnh th ng. Tnh i khng v tc d ng gi a
dihydroergotamin v nitroglycerin c th lm gim tc dng chng au th t ng c. C
ch: Nitroglycerin do thng qua lm tng lu lng mu ni tng, nn lm gim chuyn
ho bc u ca dihydroergotamin, do lm tng sinh kh dng dihydroergotamin
chng li gin mch ca ng mch vnh.
X l: Nng trong huyt tng ca dihydroergotamin tng, nn c th gy
nhim c nm ca g. Liu lng dihydroergotamin c th phi gim. Theo di ngi
bnh v khuyn ngi bnh ch pht hin nhng du hiu thiu mu cc b ngoi
bin.
Phn tch: Vi ephedrin, adrenalin v dopamin, nguy c thiu mu cc b ngoi
vi, hoi th v c tng huyt p nng (mt s him trng hp tai bin mch mu no
c m t) khi chng c phi hp vi ergotamin, dihydroergotamin, methysergid.
X l: Trnh phi hp ny v cc hu qu nghim trng c th xy ra.
Thuc chn beta; sotalol
Phn tch: l hai thuc co mch ngoi vi; gp phi hp ny trong nhng
trng hp migren kh cha. C thng bo v mt s him trng hp thiu mu cc
b ngoi vi nng km vi hoi th, phi ct ct. Phi theo di rt cn thn cc phi
hp vi propranolol, oxprenolol. Methylsergid cng c th c lin quan.
X l: C th phi hp c, nhng cn theo di lm sng, nht l khi bt u v
trong nhng tun u iu tr. Ngng iu tr ngay tc khc nu thy c du hiu bo
277
ng. Hi ngi bnh thng xuyn v nhng cm gic tun hon km cc u chi,
nu c.
278
ESTROGEN HOC THUC NGA THAI ESTROPROGESTOGEN

Trong nhm ny c nhng thuc nga thai estroprogestogen
v cc thuc cha estrogen liu cao hn
CC THUC TRONG NHM
ESTRADIOL dung dch tim 5mg; gel 0,1%; cao dn 2 mg/l; 4 mg/l; 8 mg/ l
Benzo-estradiol, dung dch tim 5mg
Benzo-Gynoestryl, dung dch tim 5mg/mL
Estreva, gel 0,1%
Estraderm TTS 100, cao dn 8 mg/l
Vagifem vin nn 0,025 mg
ETHINYL ESTRADIOL vin nn 50 mcg
Ethinyl Oestradiol vin nn 50 mcg
Mikrofollin forte vin nn 50 mcg
ESTRIOL kem t m o 1 mg; vin t m o 0,5 mg; vin nn 1 mg; 2
mg
Ovestin kem t m o 1 mg
Ovestin vin t m o 0,5 mg
Ovestin vin nn 1 mg; 2 mg
ESTROGEL lin hp vin nn 0,625 mg; 1,25 mg; 2,5 mg; 5 mg; 10 mg
Plentiva vin nn 2,5 mg
Plentiva vin nn 5mg
Plentiva Cycle vin nn 10 mg
Plentiva Cycle vin nn 5mg
Prempak - C vin nn 0,625mg
Prempak vin nn 1,25mg
HYDROXY-ESTRON vin nn 0,1mg
Colpormon vin nn 0,1mg
PROMESTRIEN vin t m o 10mg; kem bi 1%; nang 10mg
Colposeptine vin t m o 10mg
Colpotrophine kem bi 1%
Colpotrophine nang 10mg
279
Cc vin nga thai c ethinyl-ETRADIOL

Diane-35 vin nn 35 mcg + 2 mg cyproteron
Evra thuc dn qua da 600 mcg + 6 mg norelgetromin
Gynera vin bao ng 30 mcg + 75 mcg gestoden
Marvelon vin nn 30 mcg + 150 mcg desogestrel
Mercilon vin nn 20 mcg + 150 mcg desogestrel
New-choice vin nn 30 mcg + 125 mcg levonorgestrel
Novynette vin nn bao 20 mcg + 150 mcg desogestrel
Regulon vin nn bao 30 mcg + 150 mcg desogestrel
Rigevidon vin nn 30 mcg + 150 mcg levonorgestrel
Trigegol
6 vin vng 30 mcg + 50 mcg levonorgestrel
5 vin hng 40 mcg + 75 mcg levonorgestrel

10 vin trng 30 mcg + 125 mcg levonorgestrel
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: Estrogen qua c sa m c th gy chng to v (c hi
phc) tr trai ang b sa m. Ngoi ra chng lm gim tit sa. Chng ch nh
dng trong thi k cho con b.
Thi k mang thai: t tc dng trn s pht trin trc khi sinh. Mt vi trng
hp d tt tim v chn tay, c thng bo sau khi dng liu cao trong hai thng u,
v vy trnh dng estrogen trong thi k ny. Dng diethylstilboestrol nguy hi m (nguy
c ung th tuyn, c t cung v m o)
Tng huyt p: Cc oestrogen gy gi mui v nc nn c th lm tng huyt
p ng mch nng thm.
Suy mch vnh: Cc oestrogen c th lm tng nguy c huyt khi tc mch, tai
bin mch mu no v nhi mu c tim do tng lipid mu, thay i chuyn ho glucid
v nhiu yu t ng mu.
Suy gan: C th bin i mt s chc nng gan. Chm o thi bilirubin t bo
gan do c ch cnh tranh km vi nguy c vng da. U tuyn gan c m t ph
n ung thuc nga thai.
Suy thn: Lu n cc tc dng khng mong mun (gi mui v nc).
Lon chuyn ho porphyrin: Cc estrogen gy tng tng hp porphyrin gan
do cm ng ALA-synthetase. Chng c th gy cn lon chuyn ho porphyrin cp.
Trng hp khc: Chng ch nh dng cc estroprogestogen trong nhng
trng hp u c tnh tuyn v, t cung v u tuyn yn, do c th lm nng thm nhng
bnh ny. Chng ch nh tng i trong tng lipid mu. C bnh hoc tin s huyt
khi tc mch, bnh van tim, ri lon nhp tim gy huyt khi, bnh no ngu n g c
280
mch mu, bnh mt ngun gc mch mu, chy mu ph khoa ngun gc khng r,
tng prolactin mu, tit nhiu sa, x cng tai, vim m lin kt.
Tiu ng: Cc estrogen t nhin (estradiol, estron) lm gim glucose mu, cn
cc estrogen tng hp (diethylstilboestrol, ethinylestradiol) c tc dng gy tiu ng.
Tc dng ny ph thuc liu dng.
Trng hp khc: Tng lipid mu, bo ph, u tuyn v lnh tnh, lon dng t
cung, lc mng trong t cung, tin s si khng m.
Cn theo di: mc 1
Trm cm: Suy nhc v khuynh hng trm cm.
Suy h hp; hen: V nguy c huyt khi tc mch.
TNG TC THUC
Methyldopa
Phn tch: Tng huyt p do ung thuc nga thai gy ra thng khng vi iu
tr bng methyldopa. C ch cha r.
X l: Trong trng hp ny khng ch huyt p rt kh, thm ch khng th
c. Thay i cch iu tr.
cholesterol. Bng cch lp li cn bng nhng thnh phn ca mt, thuc c th gp
phn thoi trin si mt cha cholesterol. Bng cch phc hp acid ursodesoxycholic
(cholestyramin v khng acid) hoc bng cch lm tng bo ho ca mt (estrogen,
progestogen, fibrat, neomycin ung), c s gim tc dng ca acid ursodesoxycholic.
X l: iu tr bng acid ursodesoxycholic phi lu di (t 6 thng n 1 nm).
Nn trnh tht bi iu tr v khng phi hp vi cc thuc lm gim hiu qu ca acid
chenodesoxycholic, tr khi ch iu tr ng thi trong thi gian rt ngn.
Barbituric; carbamazepin; gluthetimid hoc thuc tng t; griseofulvin;
phenytoin; primidon hoc dn cht; rifabutin
Phn tch: Tng chuyn ho cc estroprogestogen gan, do cm ng enzym, do
c nguy c th thai.
liu cao hoc khuyn dng phng php nga thai khc, nu iu tr bng barbituric
ko di. Cn nh cm ng enzym khng bao gi l mt hin tng tc thi.
Phn tch: Bromocriptin l cht ch vn dopaminergic, c ch prolactin. Phi hp
c th dn n v kinh v / hoc tit t sa, nh hng n tc dng ca bromocriptin.
281
X l: Khng nn dng phi hp ny, nht l nhng ngi bnh iu tr v kinh

hoc gim tit sa.
Modafinil
Phn tch: Modafinil l mt sn phm mi, c coi c tim nng cm ng
enzym. Vi vai tr , n c th kch thch chuyn ho ca cc thuc nga thai
estroprogestogen, c bit l loi liu thp.
X l: Chng ch nh phi hp. Thay i phng php nga thai, v iu tr vi
modafinil l mt iu tr di ngy.
Rifampicin
Phn tch: Tng chuyn ho cc progestogen gan, do cm ng enzym, do c
nguy c th thai.
liu cao hoc khuyn dng phng php nga thai khc, nu iu tr bng rifampicin
ko di. Nn nh cm ng enzym khng bao gi l mt hin tng tc thi
Ritonavir
Phn tch: Gim din tch di ng cong (AUC) ca thuc estroprogestogen. C
ch cha r. Nguy c th thai.
X l: Nn dng mt phng php nga thai khc.
Tacrin
Phn tch: Nguy c tng c tnh vi gan.
X l: Nu cn, tng cng theo di gan. Trnh cc phi hp c nguy c ngi
cao tui.
Tamoxifen
Phn tch: i khng dc l gia mt khng estrogen v mt estrogen.
X l: Thng dng tamoxifen c s chuyn khoa; phi hp ny t ra khng
hp l v mt iu tr.
Amineptin; carmustin hoc dn cht; dantrolen; fluvoxamin; isoniazid hoc
thuc tng t; macrolid; methotrexat; natri valproat hoc dn cht; progabid;
thuc chng nm dn xut imidazol
Phn tch: Phi hp nhng thuc c tim nng c vi gan (cng hp cc tc
dng khng mong mun).
(ASAT, ALAT, phosphatase kim, bilirubin) hoc nu c th, hon mt trong hai li u
trnh. Xc minh l ngi bnh khng ung ru thng xuyn v khng c tin s vim
gan do virus. Cc triu chng lm sng chnh khng c hiu: bun nn, st, vng da.
Nu c phi hp ban da, nga v hch to, th c kh nng do thuc. Nn phn bit tu
282
Benzodiazepin
Phn tch: Cc estrogen c th c ch cc enzym tham gia oxy ho cc
benzodiazepin gan (chlorazepat, flurazepam, diazepam, triazolam), do ko di na
i ca chng. iu ny cn bn ci i vi cc benzodiazepin chu qu trnh lin h p
glucuronic. Nguy c tng tc dng ca benzodiazepin lu di.
X l: C th phi gim liu benzodizepin nhng ph n ang dng thuc nga
thai di hn. Ch khi li xe, vn hnh my mc hoc cn phi tnh to.
Thuc chn beta
Phn tch: C th c s c ch ca estrogen i vi cc enzym microsom gan
lm nhim v xc tc cho chuyn ho mt s thuc chn beta khi qua gan ln u
(acebutolol, alprenolol, betaxolol, labetalol, metoprolol, oxprenolol, propranolol, timolol).
Cc thuc chn beta khc c tng tc t hn.
X l: Nguy c tng tc dng ca mt s thuc chn beta. Phi hp cn c
theo di lm sng.
Cholestyramin
Phn tch: Gim hp thu cc estrogen v thuc nga thai estroprogestogen qua
ng tiu ho do c th b gn bi cholestyramin.
X l: Nu k n hai thuc, khuyn dng cc estrogen v thuc nga thai
estroprogestogen trc hai gi hoc sau 4 gi khi dng cholestyramin.
Didanosin
Phn tch: Hip ng cc tc dng khng mong mun. Tng nguy c xut hin
vim tu do thuc
X l: Theo di lm sng v nu cn, khi b au bng, khuyn theo di sinh hc
chc nng tu (amylase mu v amylase nc tiu)
Glucocorticoid
Phn tch: Tng tc dng v c tnh ca mt s glucocorticoid (prednison v
prednisolon) do chm chuyn ho, khi chng c dng cng vi cc thuc nga thai
ung.
X l: Phi theo di bnh nhn v tc dng v c tnh ca corticoid trnh qu
liu. Nn gim liu nu cn thit.
Phn tch: Tng huyt p do cc thuc nga thai ung gy ra thng khng vi
iu tr bng guanethidin. C ch cha bit r.
X l: Khng ch huyt p trong trng hp ny rt kh, thm ch khng th
c. Thay i cch iu tr. Trnh methyldopa cng v l do nh vy.
Hormon tuyn gip
283
Phn tch: Nng trong huyt thanh ca thyroxin t do c th b gim, lm tng

nng huyt thanh thyrotropin v lm tng nhu cu hormon gip. Tng tc x y ra
chm. C ch: Thay i nng huyt thanh ca thyroxin v thyrotropin do dng
estrogen c th do tng nng huyt thanh ca globulin gn vo thyroxin ph n b
suy tuyn gip.
X l: n b suy tuyn gip, nh lng nng trong huyt thanh ca
thyrotropin khong 12 tun sau khi bt u dng estrogen v iu chnh li u hormon
gip nu cn.
Phn tch: C th c nhng bin i khng hng nh ca glucose mu v tnh
cht gy tng nh glucose mu ca estroprogestogen; c th thy gim tc dng ca
insulin.
X l: Thng tin cho ngi bnh v kh nng bin i glucose mu ny. i u
chnh liu insulin theo p ng sinh hc.
Phn tch: Nguy c tit nhiu sa (ch thng bo vi flunarizin, Sibelium)
X l: Theo di lm sng. Thng tin cho ngi bnh.
Nelfinavir
Phn tch: Gim din tch di ng cong (AUC) ca estroprogestogen, c ch
cha r. Nguy c th thai.
X l: xut cch nga thai khc
Penicilin; tetracyclin
Phn tch: Do lm gim h vi khun ng rut, iu tr khng sinh c th lm
gim ti hp thu cc steroid trong chu trnh rut-gan. Nguy c gim tc dng
estroprogestogen. Khng tin on c.
X l: Nguy c ny tu thuc vo thi gian iu tr v nhng tn hi n h vi
khun ng rut. Tuy nhin cn phi xem xt nguy c ny, nu xut hin tiu chy
ph n ang dng estroprogestogen cng thi gian.
Tetracosactid
Phn tch: Cc estrogen c th gy cn tr chuyn ho v lin kt protein ca cc
glucocorticoid, lm tng na i o thi km vi nguy c tng tc dng iu tr v c
tnh ca cc glucocorticoid.
X l: Vn cn phi xc nhn tng tc dc ng hc ny bng cch nhn xt
lm sng. Ngi k n vn phi ch liu lng ca glucocorticoid v cn nhc nguy
c tu theo cc liu estrogen dng.
Phn tch: S dng cc du v c cng vi cc estroprogestogen lm gim hp
thu v gim tc dng ca estroprogestogen.
284
X l: Hu qu ca tng tc ny c th trnh bng cch khuyn ngi bnh

dng nhng thuc ny xa nhau nhiu gi (2 gi trc hoc 4 gi sau khi dng du v
c).
Ciclosporin
Phn tch: Nng ca ciclosporin trong tun hon c th tng, do gim o thi
gan v tng creatinin v transaminase trong mu.
X l: Lu cc nguy c ny v tin hnh nh lng ciclosporin mu thng
xuyn (do c s bin ng nhiu gia cc c th), c bit ph n ang dng thuc
nga thai ung. Vic k n ciclosporin do thy thuc chuyn khoa m nhim.
285
Lansoprazol
Phn tch: Tng tc dc ng hc. Phi thn trng vi cc thuc c chuyn
ho bi cytochrom P450, v c nguy c gim tc dng ca nhng sn phm ny do cm
ng enzym, nn c th dn n tht bi iu tr.
X l: Lansoprazol l thuc tng i mi, nn cn thiu cc nhn xt lm sng.
Xem xt nguy c trong bi cnh iu tr v tht bi trong vic dng estroprogestogen
liu thp c th gy tc hi cho ph n dng thuc. Do thn trng, nn cn thay i
cht c ch bm proton hoc thuc chng lot.
Pyzazol
Phn tch: Phenylbutazon l cht cm ng enzym. Dng di ngy, c th c gim
tc dng ca cc estrogen v cc thuc nga thai estroprogestogen do cm ng
enzym, lm tng d ho cc thuc ny gan.
X l: Tu theo thi gian iu tr ph n ang dng thuc estroprogestogen liu
thp, thay i thuc chng vim.
ETHAMBUTOL
Thuc chng lao
CC THUC TRONG NHM
ETHAMBUTOL vin nn 400 mg; vin nn bao phim 400 mg
Combutol vin nn 400 mg
Dexambutol vin nn 400 mg + 150 mg INH
Lybutol vin nn 400 mg
Mycobutol vin nn 400 mg
Servambutol vin nn bao phim 400 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai: Tc dng gy qui thai sc vt.
Suy thn: Trng hp suy thn, thuc c th b gi li v tng nguy c vim dy
thn kinh th gic.
Trng hp khc: Vim dy thn kinh th gic: cn khm mt trc, ri u n
sau trong qu trnh iu tr. Ngng thuc ngay nu c bt k du hiu vim dy thn
kinh th gic no. Qu mn vi thuc.
286
TNG TC THUC
Phn tch: Gim hp thu ethambutol qua ng tiu ho bi cht khng acid.
X l: Cn ung hai thuc cch nhau t nht hai gi. Nn nh rng cc khng acid
thng ung 1 gi 30 pht sau cc ba n, v n ung l ngun gc tng tit dch d
dy.
287
ETHOSUXIMID
Thuc dng ch yu kim sot cn ng kinh nh
CC THUC TRONG NHM
ETHOSUXIMID nang mm 250 mg
Zarontin nang mm 250mg
CH KHI CH NH THUC
Thi k cho con b: Khng c d liu.
Thi k mang thai: V c c tnh sinh qui thai ng vt, nn k thuc khc
cho ph n ang tui sinh hoc ang mang thai.
Cc trng hp khc: Mn cm vi thuc trong h.
Cn theo di: mc 1
Suy gan/ suy thn: V c thng bo v tn thng gan v thn, nn cn gim
st cc chc nng gan v thn, khi c suy mt trong hai c quan .
TNG TC THUC
Ru
an thn gy bun ng. Mt s thuc trong h c th gy mt s tc d ng tm thn vn ng, nht l trong tun iu tr u tin. Tng tc dc lc hc.
X l: Khng nn ung ru (hoc ch phm c ru) khi dng thuc ny. Nguy
c gy an thn bun ng, c bit nguy him ngi li xe hoc vn hnh my.
Tacrin
X l: Nu cn kt hp, tng cng gim st chc nng gan. Trnh nhng phi
hp c nguy c ngi cao tui.
Baclofen; benzamid; carbamat hoc thuc tng t; dextropropoxyphen;
thuc c ch thn kinh trung ng cc loi; reserpin
thn gy bun ng. Tng tc kiu dc lc.
X l: iu chnh liu ca hai thuc, nu cn phi hp thuc. Ch ti gim tnh
to ngi li xe hoc vn hnh my. Khuyn khng ung ru v khng dng cc
ch phm c ru.
288
Benzodiazepin; gluthetimid hoc thuc tng t; interferon alpha ti t hp;

medifoxamin; paroxetin; phenothiazin; primidon hoc dn cht; pocarbazin
an thn bun ng. Tng tc kiu dc lc.
X l: Ch ti gim tnh to ngi li xe hoc vn hnh my. Khuyn khng
ung ru v khng dng cc ch phm c ru.
Carbamazepin
an thn bun ng. Hn na, nng ethosuximid b gim trong huyt tng, c th do
cm ng enzym.
X l: iu chnh liu ca hai thuc, nu cn phi hp. Ch ti gim tnh to
ngi li xe hoc vn hnh my. Khuyn khng ung ru, khng dng ch phm c
ru. Gim st lm sng hiu qu ca iu tr ng kinh ; iu chnh liu, nu cn, tu
thuc cc nng trong huyt tng.
an thn bun ng. Tng tc kiu dc lc. Cn nh rng, vi liu thng thng,
rilmenidin khng lm tng tc dng c ch h thn kinh trung ng ca cc thuc .
X l: Phi ch ti gim tnh to ngi li xe hoc vn hnh my. Khuyn
khng ung ru, khng dng cc ch phm c ru.
Isoniazid
Phn tch: Lm tng nng trong huyt tng ca ethosuximid (tng nguy c
c tnh). Isoniazid c th c ch chuyn ho ca ethosuximid, lm cho thuc ny tch
lu li v gy nhim c. Tng tc xy ra chm, c th do isoniazid c ch chuyn
ho ca ethosuximid.
X l: nn thn trng gim st lm sng khi phi hp, v tm quan trng ca
tng tc ny cha r rng.
Lamotrigin
Phn tch: Nng trong huyt thanh ca lamotrigin c th b gim, lm gim tc
dng iu tr. Ethosuximid c th gy cm ng enzym, lm tng nhanh chuyn ha ca
lamotrigin. Tng tc xy ra mun.
X l: C th cn phi iu chnh liu lamotrigin khi bt u iu tr, lc ng ng
hoc thay i liu ethosuximid. Theo di p ng lm sng v iu chnh liu lamotrigin
nu cn.
an thn bun ng. Hn na, cn thy bin i nng trong huyt tng (tng hoc
gim).
X l: iu chnh liu ca hai thuc, nu cn phi hp. Ch ti gim tnh to
ngi li xe hoc vn hnh my. Khuyn khng ung ru v khng dng cc ch
phm c ru. Nu cn, phi gim st nng ca hai thuc trong huyt thanh.
289

Phn tch: Thuc chng trm cm ba vng lm h thp ngng gy ng kinh, v
vy c nguy c xut hin cn co git ngi bnh c iu tr bng thuc chng
ng kinh ny.
X l: Lu nguy c ny v iu chnh liu lng, nu cn.
Phn tch: Tng tc dng c ch h thn kinh trung ng, tng c ch h hp v
lm h huyt p. Hn na, nu b ph thuc thuc, phi hp hai th thuc c th
tng thm nguy c nghin thuc.
X l: iu chnh liu ca hai thuc, nu cn phi hp thuc. Ch ti gim tnh
to ngi li xe hoc vn hnh my. Khuyn khng ung ru, v khng dng cc
ch phm c ru.
Thuc iu tr st rt
Mefloquin: i khng tc dng chng co git
Cloroquin, hydroxycloroquin: i khi lm gim ngng gy co git. Nh sn xut
mefloquin khuyn co khng dng thuc ny d phng cho ngi b ng kinh, v
ch dng khi tht cn iu tr st rt.
290
Thuc ung nga thai

Phn tch: Lm gim tc dng nga thai, c th dn n v k hoch. Cc thuc
chng ng kinh c th gy cm ng enzym, lm tng chuyn ho v thanh lc ca
cc steroid nga thai, do lm gim tc dng nga thai.
X l: Dng bin php nga thai khc thay th.
amphetamin.
ngi bnh gp li thy thuc, nu thy hiu qu iu tr khng
r rt.
Barbituric; dantrolen; khng histamin khng H1 c tnh an thn bun ng;
oxaflozan; thuc chng trm cm: fluvoxamin; fluoxetin; viloxazin
an thn bun ng. Tng tc kiu dc lc.
X l: Phi ch ti gim tnh to ngi li xe hoc vn hnh my. Khuyn
khng ung ru v khng dng cc ch phm c ru.
Methadon
Phn tch: Tng tc dng c ch h thn kinh trung ng gy an thn bun ng
mnh, c bit nguy him cho ngi li xe hoc vn hnh my.
X l: Phi lu n tng tc dng an thn bun ng v khuyn khng c li
xe, khng c vn hnh my.
ETRETINAT (dn cht)

Dn cht ca vitamin A, dng trong mt vi bnh da (bnh vy nn v trng c
nng)
trc lp sng da. Cc tng tc khi dng nhng dng thuc ti ch ch ng
lu khi chng c bi vi lng ln (tc dng ton thn)
CC THUC TRONG NHM

ACITRETIN nang 10 mg, 25 mg
Soriatane nang 10 mg, 25 mg
ISOTRETINOIN gel bi da 0,05%; nang mm 5 mg, 10 mg, 20 mg
291
Isotrex gel bi da 0,05%

Roaccutane nang mm 5 mg; 10 mg; 20 mg
TRETINOIN kem bi da 0,05%; 0,025%; 0,1%; dung dch dng ngoi 0,1%
Alten kem bi da 0,05%
Effederm kem bi da 0,05%
Locacid kem bi da 0,05%
Locacid dung dch dng ngoi 0,1%
Retacnyl 0,05 kem bi da 0,025%
Renova kem bi da 0,05%
Stieva A kem bi da 0,1%
CHNG CH NH V THN TRNG KHI S DNG
Chng ch nh: mc 4
Thi k cho con b: Do thuc qua c sa m
Thi k mang thai: Sn phm ny gy qui thai. ph n tui sinh , thuc
cn c phi hp vi mt liu trnh nga thai hiu lc. Liu trnh ny phi tip tc t
nht 12 thng sau khi ngng iu tr bnh da.
Tr em; tr ang b: Do nguy c nh hng n s tng trng, ngi k n
phi cn nhc tng quan li ch/ nguy c.
Suy gan: Do c vi gan
Suy thn: Do c vi thn.
Trng hp khc: Qu liu vitamin A. Ri lon chuyn ho lipid.
Cn theo di: mc 1
Tiu ng/ suy mch vnh: Theo di cholesterol v triglycerid mu.
TNG TC THUC
Phn tch: Gim tc dng ca cc thuc nga thai progestogen liu thp km vi
nguy c tht bi nga thai chng no iu tr cng ko di.
X l: Chng ch nh dng phi hp ny. Nn nh rng do tc dng gy qui thai
ca thuc ngi, khi k n etretinat hoc dn cht, cn c bin php nga thai c
bit hiu lc. Trong trng hp ny, nn thay thuc nga thai progestogen liu thp
bng mt thuc estroprogestogen hoc chn mt phng php nga thai khc trong
thi gian iu tr etretinat.
292
Tetracyclin
Phn tch: Phi hp hai thuc c th dn n xut hin nhc u, chng mt, ri
lon th gic do tng p lc trong s (hip ng tc dng tng p lc trong s ca tng
thuc).
X l: Chng ch nh phi hp ny v cn tm mt gii php iu tr khng sinh
khc (hng v mt s macrolid).
Vitamin A
Phn tch: Nguy c qu liu vitamin A do tc dng cng hp, c th dn n ri
lon pht trin xng nht l tr em.
X l: Phi hp ny bt hp l, nguy c qu liu vitamin A. Nu xt thy cn phi
hp, theo di cht ch hm lng vitamin A trong huyt tng v theo di cc tc dng
khng mong mun (ri lon th gic khi bt u). Bo cho ngi bnh bit t theo
di cc tc dng khng mong mun (ri lon th gic khi bt u).
Methotrexat
Phn tch: Phi hp cc thuc c tim nng c vi gan (cng hp cc tc dng
khng mong mun)
X l: Khi phi hp hai thuc c vi gan, cn theo di cht ch chc nng gan
(ASAT, ALAT, phosphatase kim, bilirubin), hoc nu c th, hon mt trong hai liu
trnh. Xc minh l ngi bnh khng ung ru thng xuyn v khng c tin s vim
Nu c phi hp ban da, nga v hch to, th c kh nng do thuc. Phn bit r, tu
Ru
Phn tch: Ring tng sn phm ny u lm tng triglycerid mu.
X l: Xc minh l ngi bnh khng ung ru trong sut qa trnh iu tr.
Theo di cht ch nng triglycerid nu vn cn nghi ng.
EUCALYPTOL
Thuc (lm mt sung huyt) ng thng kh trn, chit t Eucalyptus
CC THUC TRONG NHM
EUCALYPTOL
293
Bch h hot lc, cao xoa

Cao ng th, cao xoa
Du c l Bo Long, du nc xoa
Du c l Hiu Con kh, du nc xoa
Du gi Bo Long, du nc xoa
Du gi Con Rng, du nc xoa
Du gi Hng Dng, du nc xoa
Du gi Hong , du nc xoa
Du gi Honh Sn, du nc xoa
Du gi Loan, du nc xoa
Du gi nu Thin L, du nc xoa
Du gi Nhn Ho, du nc xoa
Du gi P, du nc xoa
Du gi Song Yn, du nc xoa
Du gi Thin Tho, du nc xoa
Du gi Trng Sn, du nc xoa
Du gi Trng Sa, du nc xoa
Du gi VIM 1, du nc xoa
Du gi xanh K Ln, du nc xoa
Du Ho An, du nc xoa
Du khu phong song ln, du nc xoa
Du khuynh dip OPC, du nc xoa
Du nng Bnh Quan, du nc xoa
Du nng Cu Long, du nc xoa
Du nng Gi Kim, du nc xoa
Du nng Hiu Khang Ninh, du nc xoa
Du nng Kim Long, du nc xoa
Du nng khuynh dip, du nc xoa
Du nng Lc , du nc xoa
Du nng Qung , du nc xoa
Du nng Rng Vng, du nc xoa
Du nng Thin Pht, du nc xoa
Du nng Trng Th, du nc xoa
294
Du Thin An, du nc xoa

ng ht Hi u
ng ht hiu Con Voi
ng ht Mentha
Eucalyptil ng tim 2mL; 0,34 mL
Eucalyptine Ie Brun nang mm
Eucalyptol nang mm
Eucarose nang mm
Mentholatum thuc m
Orafar du nc xoa
Patitussin du nc xoa
Solclean du nc xoa
Thuc ho ngi ln dung dch thuc ung
Thuc ho tr em dung dch thuc ung
Traguton nang mm
Vin xng Hng Trm
CH KHI CH NH THUC
Chng ch nh: mc 4
Tr em: tr em di 20 thng tui, c nguy c xut hin co git.
295
FENOVERIN
Phenothiazin c tc dng lm gim co cng nhu ng
trn h c trn ng tiu ho, ng dn mt v c t cung
CC THUC TRONG NHM
FENOVERIN nang 100 mg
Spasmopriv nang 100 mg
MEBEVERIN vin nn bao ng 135 mg
Duspatalin vin nn bao ng 135 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Qu mn vi thuc: Theo di lm sng ngi bnh ln dng u tin
Thi k cho con b: V thiu d liu, trnh k n trong thi k cho con b.
Thn trng: mc 2
Thi k mang thai: Do thn trng, v thiu d liu.
FIBRAT
Thuc chng ri lon lipid mu
CC THUC TRONG NHM

BENZAFIBRAT vin nn 200 mg, 400 mg
Befizal vin nn 200 mg, 400 mg
CIPROFIBRAT nang 100 mg
Lipanor nang 100 mg
CLOFIBRAT nang 500 mg
Lipavlon nang 500 mg, 250mg
GEMFIBROZIL vin 450 mg
Lipur vin 450 mg
FENOFIBRAT nang 100 mg, 300 mg
296
Fenofibrat Bayer nang 100 mg, 300 mg

Fenofibrate MSD nang 100 mg, 300 mg
Lipanthyl nang 100 mg, 200mg
Lipanthyl Sapra vin nn bao 160mg
Secalip nang 100 mg, 300 mg
CH KHI CH NH THUC
Thi k mang thai: Nn trnh dng thuc ny, mc du khng thy gy qui thai
sau khi iu tr trong nhng thng u ca thai k.
Suy gan: Cc ri lon gan (tng transaminase, gan hi to) thi k u iu tr
c thng bo, nhng dung np ca gan ni chung tt, tr trng hp suy gan
nng.
Suy thn: Clofibrat hon ton o thi qua thn sau khi glucuronic lin hp t i
ch. Trng hp suy thn, na i ca thuc ko di nhiu, c tnh, c bit c
tng (au c) v nguy c si mt cng tng.
Thn trng: mc 2
Tr em: An ton s dng khng c chng minh.
TNG TC THUC
Tng tc cn trnh: mc 3
cholesterol. Nn lp li cn bng cc thnh phn trong mt, v nh vy thuc c th
gp phn lm thoi trin si mt cholesterol. Phc hp acid ursodesoxycholic
(cholestyramin v cc khng acid), hoc lm tng bo ho ca mt (estrogen,
progestogen, fibrat, neomycin ung) c s gim hot tnh ca acid ursodesoxycholic.
X l: iu tr vi acid ursodesoxycholic phi lu di (t 6 thng n 1 nm). Nn
trnh tht bi iu tr v khng phi hp vi cc thuc lm gim hiu lc ca thuc acid
chenodesoxycholic, tr khi vic phi hp ch tin hnh trong mt thi gian rt ngn.
Phn tch: Tng nguy c vim c, c bit vi gemfibrozil. Theo di nng
creatin phosphokinase huyt thanh.
X l: Trnh phi hp cc thuc c th c cng nhng tnh cht iu tr v sinh
hc. Cc tc dng khng mong mun s hip ng vi nhau v v nguy c tiu c vn,
thy thuc k n cn hng theo cch iu tr khc.
297
Phn tch: Cnh tranh cc v tr gn trn protein huyt tng km vi kh nng

tng tc dng li niu v tng mt kali. Tng tc ny c nu trong y vn vi
furosemid cn c xc nhn.
X l: Theo di phi hp ny v thng bo cho Trung tm cnh gic thuc ca
vng mi bt thng sinh hc hoc lm sng. Tng cng theo di ngi suy thn.
Phn tch: Nguy c tng tc dng h glucose mu do y thuc ra khi cc lin
kt protein. Na i ca thuc chng tiu ng c th tng (c nu vi
clorpropamid) v khng insulin c th gim.
X l: Khi dng phi hp ny, cn nh lng u n glucose mu khi bt u
iu tr bng thuc chng tiu ng hoc fibrat, trong v sau khi ngng iu tr fibrat.
Thc hin ng gi gic ung thuc l quan trng nm c nhng thay i
glucose mu v iu chnh liu ca thuc chng tiu ng. Thng tin cho ngi bnh
tng cng t theo di.
Phn tch: Cnh tranh cc v tr gn trn protein huyt tng km vi kh nng
tng tc dng li tiu v mt kali. Tng tc ny c nu trong y vn ch ring v i
furosemid (li tiu thi kali), cn c xc nhn vi cc thiazid li tiu.
X l: Theo di phi hp ny v tu trng hp thng bo cho Trung tm cnh
gic thuc mi bt thng sinh hc hoc lm sng. Tng cng theo di ngi bnh
suy thn.
298

Phn tch: Nguy c gim prothrombin mu do thuc khng vitamin K b y ra khi
cc v tr gn vi protein huyt tng. Phn t do ca thuc khng vitamin K tng, chy
mu v t vong tng xy ra. Tng tc dc ng hc.
X l: Nu cn phi hp, theo di t l prothrombin v / hoc INR (t l chun
quc t) khi bt u, khi ang v sau khi iu tr bng fibrat. iu chnh liu lng hay
khng tu theo kt qu sinh hc. Thng bo cho ngi bnh lu n s i u chnh
liu lng ny.
Desmopressin
Phn tch: Tng tc dng chng li tiu.
sinh hc v lm sng.
FINASTERID
Thuc chng ph i lnh tnh tuyn tin lit,
do c ch 5 - alpha reductase
CC THUC TRONG NHM

FINASTERIX vin nn 5 mg
Finast vin nn 5 mg
Proscar vin nn 5 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Tr em: K n khng hp l.
Thi k mang thai: Thuc ny khng c ch nh no cho ph n, nu v dng
c th gy d tt thai.
Suy gan: Cn theo di, do thiu thng tin v nghin cu chnh xc ng i suy
gan.
Trng hp khc: Qu mn vi mt trong nhng thnh phn ca sn phm
(hot cht hoc t dc)
299
FLAVOXAT
Thuc chng au co tht ngtit niu
CC THUC TRONG NHM

FLAVOXAT vin nn 100 mg; 200 mg
Urim vin nn 200 mg
Flavoxat vin nn 100 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: V thn trng, do thiu d liu.
Trng hp khc: Tc mn v v t trng, thng tn tc rut, chy mu d dy
t trng.
FLECAINID HOC THUC TNG T

Thuc chng lon nhp thuc nhm 1C ca Vaughan - Williams.
Nh tt c cc thuc chng lon nhp nhm 1, nhng thuc ny tc dng
bng cch n nh mng; ngoi ra chng lm gim dn truyn mi khu
(nh, b ni v tht) m khng bin i thi gian in th hot ng
CC THUC TRONG NHM

CIBENZOLIN vin nn 130 mg
Cipralan vin nn130 mg
APRINDIN nang 50 mg
Fiboran nang 50 mg
FLECAINID vin nn 100 mg
Flecaine vin nn 100 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Suy tim: V c tc dng gim lc co c, theo di cht ch chc nng tim.
Cc trng hp: Bloc nh-tht, bloc nhnh tri, nhi mu c tim.
300
Thi k mang thai: Do thn trng, c bit trong ba thng u

TNG TC THUC
Benzamid
Phn tch: Duy nht sultoprid (Barnetil) trong nhm benzamid, c th gy nguy c.
Tt c cc thuc gim lc co c tim (gy chm nhp tim) c th dn n tng nguy c
ri lon nhp tht, nht l xon nh, do thm cc tnh cht in sinh l ca sultoprid.
X l: Chng ch nh v cm dng phi hp ny.
Cisaprid
Phn tch: C th tng nguy c ri lon nhp tim e do tnh mng, bao gm xon
nh. C ch do ko di thm khong QT.
X l: Chng ch nh dng cisaprid cho bnh nhn ang dng cc thuc chng
lon nhp nhm Ia v nhm III.
Phn tch: Phi hp hai thuc chng lon nhp, mt thuc nhm Ib ca Vaughan Williams, mt thuc nhm Ic (c ch dn truyn trong tht). Phi hp cn c s di
in tm u n, v c nguy c tng cc tc dng khng mong mun v tim.
X l: S phi hp hai thuc chng lon nhp ny thuc thm quyn ca thy
thuc chuyn khoa v ch c th thc hin km vi theo di in tm .
Quinidin hoc dn cht
Phn tch: Phi hp hai thuc chng lon nhp, mt thuc nhm Ia ca VaughanWilliams, mt thuc nhm Ic (c ch dn truyn trong tht). Nng flecainid trong
huyt tng c th tng, lm tng tc dng dc l v c tnh ca flecainid. C ch
cha r, c th do chuyn ho ca flecainid b c ch. Phi hp cn c s theo di
in tm u n, v c nguy c tng cc tc dng khng mong mun v tim.
X l: S phi hp hai thuc lon nhp ny thuc thm quyn ca thy thuc
chuyn khoa v ch c th thc hin km vi s theo di in tm . iu chnh liu
ca flecainid cho ph hp.
Ritonavir
Phn tch: Nng flecainid trong huyt thanh c th tng cao, lm tng nguy c
c tnh ca flecainid. C ch do ritonavir c ch chuyn ho ca flecainid (cytochrom
P450 2D6).
X l: Chng ch nh ritonavir cho bnh nhn ang dng flecainid.
Amiodaron
Phn tch: Hm lng flecainid trong huyt tng c th tng. C ch do
amiodaron c th lm gim chuyn ho ca flecainid.
X l: Theo di cht ch ngi bnh khi dng phi hp ny. C th cn phi iu
chnh liu ca flecainid, gim 33% n 50%.
301
Dihydropyridin
Phn tch: Dng cc dihydropyridin c tnh cht gim lc co c (lm chm nhp
tim) phi hp vi mt s thuc chng lon nhp c th dn n nhp tim chm qu
mc.
X l: Khuyn khng dng nhng thuc ny trong vng 48 gi trc hoc trong
vng 24 gi sau khi dng cc thuc i khng calci c tnh cht gim lc co c . Nu
phi phi hp, cn theo di in tm . Cn bit rng mt s dihydropyridin gim l c
co c t hay nhiu.
Propafenon; sotalol
Phn tch: Phi hp cc thuc chng lon nhp thuc nhm khc nhau c th dn
n tng nguy c tc dng khng mong mun v tim ( cc khu: t ng, dn truyn,
nhp, hng lc co c)
X l: Theo di lm sng v in tm cht ch
Cimetidin
Phn tch: Cimetidin c th lm tng din tch di ng cong (AUC) v s o
thi ton phn thn ca flecainid. C ch do cimetidin c th lm tng sinh kh dng
hoc c ch chuyn ho ca flecainid.
X l: Khi dng ng thi cimetidin v flecainid nn thn trng. Bnh nhn suy
thn c th c nguy c cao v cn iu chnh liu.
Digoxin
Phn tch: Tc dng dc l ca digoxin c th tng. Tng tc xy ra chm. C
ch cha r.
X l: Nu c du hiu nhim c digoxin v nghi c tng tc, cn gi m li u
digoxin. Theo di nng huyt thanh ca digoxin.
Disopyramid
Phn tch: Khi phi hp cc thuc chng lon nhp thuc cc nhm khc nhau
trong phn loi Vaughan - Williams, cn phi tng cng theo di (in tm ) nht l
vi disopyramid.
X l: Phi hp cc thuc chng lon nhp vi nhau cn c chuyn khoa, ngay c
trong khoa tim v c phng tin theo di (khoa hi sc tim).
Thuc chn beta
Phn tch: Tc dng dc l ca propranolol (v c th ca cc thuc chn beta
khc) v ca flecainid c th tng. C ch cha r, c th c s c ch chuyn ho
ca c hai thuc v c hip ng tc dng dc l.
X l: Theo di lm sng v in tm phi c tng cng.
302
FLOCTAFENIN
Thuc gim au ngoi vi, dn cht ca acid anthranilic
CC THUC TRONG NHM

FLOCTAFENIN vin nn 200 mg
Idarac vin nn 200 mg
CH KHI CH NH THUC
Ru: Trnh ung ru ng thi.
Thi k cho con b: V thuc qua c sa m
Suy tim: Suy tim nng, bnh tim thiu mu cc b
Suy gan: Do c tnh vi gan (nguy c vim gan nng)
Trng hp khc: Nguy c sc phn v.
Cn theo di: mc 1
Thi k mang thai: Thn trng, v thiu d liu
Si thn: Nguy c tinh th niu. Ung nhiu nc trong khi iu tr.
TNG TC THUC
Sotalol
Phn tch: Nu gp phn ng d ng, cc thuc chn beta lm gim b chnh tim
mch, c bit trong trng hp h huyt p hoc sc.
X l: Hi ngi bnh v tin s. H c dng floctafenin ln u khng? Nu b
sc, s gim cc c ch b chnh c th nguy him v chng ch nh dng phi hp
ny. Khng k n cho ngi c tin s d ng.
Thuc chn beta
Phn tch: Floctafenin c th gy phn ng qu mn, dn n sc phn
v nng. Khi , cc thuc chn beta (k c di dng thuc nh mt), lm nng thm
bnh cnh lm sng v lm gim b chnh tim mch (do adrenalin v noradrenalin), c
bit trong trng hp h huyt p hoc sc.
X l: Hi ngi bnh v tin s dng thuc. H c dng floctafenin ln u
khng? Nu b sc, s gim c ch b chnh c th nguy him v chng ch nh dng
phi hp ny. Khng k n thuc gim au ny cho ngi bnh c tin s d ng. D
thay i thuc gim au hn l thuc chn beta
303
FLUCYTOSIN
Thuc chng nm ph hp [Candida, Cryptococcus, cc tc nhn gy bnh
nm mu (chromomycose) v Aspergillus mc thp hn]
CC THUC TRONG NHM

FLUCYTOSIN vin nn 500 mg; l thuc tim 2,5 g/250 mL
Ancotil vin nn 500 mg
Ancotil l thuc tim 2,5 g/250 mL
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai: Trnh dng. Thuc gy qui thai chut.
Thi k cho con b: Trnh dng.
Suy thn
Bnh v mu
TNG TC THUC
Zidovudin
Phn tch: Tng c tnh vi ty xng
X l: Cho lm huyt thng xuyn hn
304
FLUMAZENIL
Imidazobenzodiazepin l cht i khng benzodiazepin,
do c ch cnh tranh th th
CC THUC TRONG NHM

IMIDAZOBENZODIAZEPIN ng tim 0,5 mg; 1 mg
Anexat ng tim 0,5 mg; 1 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Cc trng hp qu mn vi thuc hoc vi cc benzodiazepin khc.
Thn trng: mc 2
Tr em: Do thn trng, v thiu d liu chnh xc.
Cn theo di: mc 1
ng kinh: Mc du flumazenil c tnh cht chng co git yu, s dng thuc
ny ngi bnh iu tr bng benzodiazepin c th dn n co git.
TNG TC THUC
Benzodiazepin
Phn tch: l s i khng dc l tc dng trn cng th th v c dng
trong iu tr.
X l: Ch yu c cc chuyn gia gy m dng v trong nhng n v chm
sc tng cng iu tr qu liu hoc ngng an thn hoc gy m. Vic s dng
phi do thy thuc c kinh nghim.
FLUOR (Dn cht)

Nguyn t kch thch to xng v to thun li
cho gi calci trong xng
CC THUC TRONG NHM

CALCI FLUORID vin nn
Fluorure calcium vin nn 153 mg
305
MONOFLUOROPHOSPHAT DISODIC vin si bt

Fluocalcic vin si bt
NATRI FLUORID vin nn bc 20 mg; 25 mg; 40 mg
Naf vin nn
Osteofluor vin nn
Zymafluor vin nn
FLUORESCEIN natri ng tim 0,5 g/5 mL; thuc nh mt 2 %
Fluoresceinat natri thuc tim 10 %
Fluorescein thuc tim 20 %
CH KHI CH NH THUC
Thi k cho con b/ thi k mang thai: Thiu d liu
Tr em: tr em di 15 tui trong thi k pht trin xng khi liu lng cao
hn liu d phng su rng.
Suy thn: Nguy c qu liu fluor v tnh trng suy thn nng ln
Thn trng: mc 2
Nhuyn xng, thi k pht trin xng: Chng ch nh cung cp fluor khi c
nguy c qu liu, nht l khi nc sch tiu dng c fluor.
Cn theo di: mc 1
Ngi cao tui: Kim tra chc nng thn, v dng fluor c th lm h hi chc
nng thn.
FLUORO-5-URACIL
Thuc km t bo, khng pyrimidin
CC THUC TRONG NHM

FLUORO-5-URACIL thuc tim 250 mg; 500 mg; 1000 mg.
Fluorouracil thuc tim 250 mg; 500 mg; 1000 mg.
CH KHI CH NH THUC
Thuc ny phi do thy thuc chuyn khoa k n. V vy, cc chng ch nh
phi c cn nhc tu theo tnh trng ngi bnh v phi c nh chuyn khoa
nh gi.
TNG TC THUC
306

Phn tch: Dng ng thi vi cc thuc c ch min dch lm tng nguy c xut
X l: Mc du cc trng hp thng bo ch lin quan n lovastatin, c nguy c
tim n vi simvastatin v pravastatin. Cn trnh phi hp.
Vaccin sng gim c lc
Phn tch: Nguy c mc nhim khun tng ng vi vaccin, do tc dng c ch
X l: Cn tn trng khong cch gia hai thuc l t 3 thng n 1 nm v tu
thuc vo mc c ch min dch.
Amphotericin B
Phn tch: Phi hp amphotericin B bng ng tim vi cc cht c vi tu
xng khc bt buc phi thn trng. Nguy c thiu mu hoc ri lon huyt hc khc.
cyclophosphamid hoc thuc tng t; dactinomycin; doxorubicin hoc dn cht;
ganciclovir; levamisol; melphalan; mercaptopurin; methotrexat; penicilamin hoc
thuc tng t; procarbazin; thiothepa; thuc chng ung th cc loi; vincristin
hoc thuc tng t
Phn tch: Nguy c tng c tnh v mu do tc dng hip ng c ch tu
xng, c th dn n mt bch cu ht.
hin v cc s iu tr thng c nh r.
Ciclosporin
Phn tch: Phi hp hai thuc c tnh cht c ch min dch. Do c ch min dch
ny qu mnh, c th c nguy c pht trin u lympho gi.
X l: S phi hp ca hai cht c ch min dch ny phi c suy xt cn
nhc tng quan nguy c / li ch tu theo mc tiu iu tr. S phi hp ch c tin
hnh ti c s chuyn khoa c s theo di cht ch ngi bnh.
Clozapin
xng, c th dn n mt bch cu ht. Ch dng n c clozapin cng c th mt
X l: Trnh phi hp. Nu cn phi hp, dng cc liu thp cho mi thuc.
Khng g cho php tin on s xut hin mt bch cu ht vi clozapin. S theo di
cn thn huyt thng c thc hin khi dng mt thuc km t bo, vn c gi tr.
307
Tuy nhin ngi bnh phi c thng bo l nu c st nh, vim hng v lot ming
phi ngng iu tr.
hm lng acid uric. Ngoi ra, c s tng nguy c gim bch cu v gim tiu cu do
cng hp cc tc dng khng mong mun ca hai thuc.
X l: Tt nht, nn trnh dng hai thuc trong cng thi gian, nu khng, s thy
tht bi iu tr chng gt. Nn dng alopurinol (c ch tng hp acid uric) hn l dng
cc thuc o thi acid uric, trnh cc bnh thn.
Glycosid tr tim
Phn tch: Phi hp vi mt cht km t bo dn n km hp thu cc thuc
digitalis khong 50%, do thng tn nim mc rut c hi phc.
X l: Theo di cht ch hm lng cc thuc digitalis trong huyt thanh trong
sut qu trnh iu tr.
X l: Interleukin l mt thuc ch c dng trong c s chuyn khoa do mc
nng ca bnh. Cc tng tc phi c cn nhc v tt c cc
chc nng ca c th phi c theo di thng xuyn. Theo di huyt l bt buc.
Pentostatin
huyt hc nng tu theo thi gian iu tr.
X l: Phi hp cn theo di v mt huyt hc.
Phenicol
Phn tch: Nguy c tng c tnh v mu do tc dng hip ng c ch ty
xng, c th dn n mt bch cu ht. Ch dng n c phenicol cng c th mt
X l: Nu cn phi hp, dng liu thp cho mi thuc. Khng g cho php tin
on s xut hin mt bch cu ht vi cc phenicol. Vic theo di cn thn huyt
thng thc hin khi dng thuc km t bo, vn c gi tr. Tuy nhin ngi bnh phi
c thng bo l nu c st nh, vim hng v lot ming phi ng ng iu tr v i
phenicol.
Phn tch: Phi hp hai thuc c tim nng c vi gan (cng hp cc tc dng
khng mong mun).
(ASAT, ALAT, phosphatase kim, bilirubin), hoc hon mt trong hai liu trnh, nu c
th. Xc minh l ngi bnh khng ung ru thng xuyn v khng c tin s vim
Nu c phi hp ban da, nga v hch to, th c kh nng bnh cn do thuc. Phn
308
bit r, tu theo kt qu xt nghim sinh hc, nguy c xut hin vim gan tiu t bo
Phn tch: Tc dng chng ng ca warfarin c th tng. C ch c th do
chuyn dch protein, c ch chuyn ho ca warfarin hoc c ch tng hp yu t
ng mu.
X l: Theo di cn thn cc thng s ng mu trong v sau ho tr liu. i u
chnh liu ca warfarin nu cn thit.
Vng
Phn tch: H hi cc dng t bo mu c nguy c nng thm (bt sn tu).
X l: Phi hp cn c theo di sinh hc ngi bnh c nguy c (huyt )
Zidovudin
Phn tch: Phi hp zidovudin cng cc cht c tu xng khc bt buc phi
ht sc thn trng. Nguy c thiu mu hoc ri lon huyt hc khc.
Phn tch: Dng ng thi vi acid folinic di dng calci folinat c th lm tng
tc dng iu tr v c tnh ca fluoro 5 uracil.
X l: C th dng hai thuc cng thi gian, nhng c th cn phi iu chnh
liu. Vic k n ch c th tin hnh ti c s chuyn khoa vi s theo di huyt
u n.
Cimetidin
Phn tch: Sinh kh dng ca fluoro-5-uracil c th tng do cimetidin. C ch
cha r.
X l: Nu phi hp ny c s dng, theo di bnh nhn v cc triu chng
c ca fluoro-5-uracil. Ngng cimetidin nu cn thit.
Interferon alpha ti t hp
xng, c th dn n mt bch cu ht. Ngoi ra c s tng c tnh ca fluoro-5
uracil ng tiu ho.
X l: Nu cn phi hp, dng liu thp cho mi thuc, v theo di cn thn
huyt . S phi hp cc thuc km t bo do cc thy thuc chuyn khoa thc hi n
v cc s iu tr thng c nh r.
Nitroimidazol
Phn tch: Tng c tnh ca fluoro-5-uracil, do gim thanh lc.
X l: Phi hp c k n c s bnh vin; nu cn phi hp, tng cng
theo di lm sng v huyt hc v nguy c c tnh ca fluoro-5-uracil.
309
Thuc li tiu thiazid

Phn tch: Cc thiazid c th ko di s gim bch cu do thuc chng ung th
gy ra. C ch cha r.
X l: Nn xem xt thay th thuc chng tng huyt p khc bnh nhn ang
dng thuc chng ung th.
FLUOXETIN
Thuc chng trm cm, thuc nhm cc cht c ch
ti nhp serotonin
CC THUC TRONG NHM
FLUOXETIN nang 20 mg
Prozac nang 20 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Tr em: V thiu d liu chnh xc
Trng hp khc: Qu mn vi thuc. Thng tin cho ngi bnh v nu c th,
theo di lm sng ngi bnh ln dng thuc u tin.
Thi k cho con b: Do thuc qua sa.
Thi k mang thai: Cha xc nh c tnh v hi
Cn theo di: mc 1
Suy gan: Nguy c gim chuyn ho gan. iu chnh liu.
Suy thn: Gim o thi. iu chnh liu.
TNG TC THUC
Phenylpropanolamin
Phn tch: Tng nhy cm vi tc dng ca phenylpropanolamin v tng nguy c
b hi chng tng tit serotonin. C ch cha r.
X l: Nu phi dng phi hp cc thuc ny vi nhau, cn theo di ngi bnh
v tng cc triu chng h thn kinh trung ng. iu chnh liu
nu cn.
Procarbazin
310
Phn tch: Procarbazin c tnh cht c ch MAO. Nh vy nguy c ging nh

ni mc trn: Tng ti nhp serotonin, nn c th ci thin p ng vi iu tr,
nhng thi gian sau cng lm tng tc dng c nng (h nhit, co git)
X l: Tn trng thi gian t nht 2 tun t khi ngng thuc c ch MAO n khi
bt u iu tr bng thuc chng trm cm serotoninergic. Khi ngng iu tr bng
thuc chng trm cm serotoninergic, ch 5 tun ri mi dng thuc c ch MAO.
Sumatriptan
Phn tch: Tng tc dc l do hip ng cc tc dng serotoninergic, c th
dn n tng huyt p ng mch v co tht ng mch vnh. C ch c l do c s
tch lu nhanh chng serotonin h thn kinh trung ng.
K n: Trnh phi hp. Nu cn phi hp, tn trng thi hn 5 tun t khi
ngng thuc chng trm cm n khi a sumatriptan vo s dng.
Phn tch: Tng ti nhp serotonin, nn c th ci thin p ng vi iu tr,
nhng thi gian sau cng lm tng mnh c tnh (h nhit, co git).
X l: Tn trng thi gian t nht 2 tun t khi ngng thuc c ch MAO n khi
bt u iu tr bng thuc chng trm cm serotoninergic. Khi ngng iu tr bng
thuc chng trm cm serotoninergic (fluoxetin), ch 5 tun ri mi dng thuc c ch
MAO.
Thuc c ch MAO typ B
Phn tch: Gp hi chng tng tit serotonin, khi phi hp mt hot cht gy tit
serotonin v mt thuc c ch MAO. Do phi hp mt thuc chng trm cm gy tit
serotonin thun tu vi mt thuc c ch MAO, ngay c vi thuc c ch MAO c
hiu, c nguy c dn n l ln, kch ng, st cao, co git, co mch ngoi vi v tng
huyt p nng. C ch c l do c s tch t serotonin nhanh v qu mc h thn
kinh trung ng.
X l: Khng dng cng lc. Ngng dng thuc c ch MAO typ B hai tun ri
mi bt u dng thuc chng trm cm serotoninergic v ngc li, ngng thuc
chng trm cm t nht mt tun ri mi bt u iu tr bng thuc c ch MAO typ
B. Do na i ca fluoxetin di, nn cn tn trng khong thi gian 5 tu n gi a lc
ngng dng fluoxetin v lc bt u dng thuc c ch MAO typ B (tng ng 5 ln
na i ca fluoxetin).
Dextropropoxyphen
an thn bun ng. Tng tc dc lc hc.
tnh to ngi li xe v ngi s dng my mc. Khuyn khng nn ung ru v
Thuc c ch MAO typ A
311
Phn tch: Qu liu serotoninergic, do cng hp cc tc dng dc l ca cc

thuc. C th xut hin hi chng serotonin, mc nng nh thay i nhng c th
dn n t vong.
X l: Hi chng serotonin c nhiu sc thi khc nhau, km vi nhng triu
chng kiu tm thn (l ln, kch ng, thm ch hn m), kiu vn ng (git rung c,
run, tng hot ng, cng ), kiu thc vt (tng hoc h huyt p, nhp tim nhanh,
cn rt run, ra m hi), kiu tiu ho (tiu chy). Cn trnh phi hp ny.
Ru
an thn bun ng. Mt s tc dng tm thn vn ng c th c ghi nhn vi mt s
sn phm, nht l trong tun u iu tr. Tng tc dc l.
X l: Tt nht, khng nn phi hp fluoxetin vi ru, v ngi k n khng th
khng ch vic ung ru ca bnh nhn. Nguy c an thn bun ng c bit nguy
him ngi li xe v ngi s dng my mc. Khuyn ngi bnh khng ung ru,
v
khng
t
dng
thuc
hoc
ch
phm
c ru.
Amineptin
Phn tch: Tng tc dng c ch h thn kinh trung ng, c ch h hp, h
huyt p. Ch , phi hp hai thuc c th lm tng nguy c nghin.
Ngh n gim tnh to ngi li xe v ngi s dng my mc. Khuyn khng nn
Buspiron
an thn bun ng. Tng tc dc lc
to ngi li xe v ngi s dng my. Khuyn khng ung ru v khng t dng
Butyrophenon
Phn tch: Nguy c tng hi chng ngoi thp, do thuc an thn kinh gy nn, v
tng tc dng an thn bun ng.
X l: Lu nguy c ny iu chnh liu ca hai thuc, nu phi hp ny cn
thit. Ngh n s gim tnh to ngi li xe v ngi s dng my mc. Khuyn
khng ung ru v khng t dng thuc hoc cc ch phm c ru.
Carbamazepin
c.
Phn tch: Nguy c tng hm lng carbamazepin trong huyt thanh c th gy
X l: Theo di lm sng v sinh hc. Kim tra nng carbamazepin trong huyt
tng khi bt u, khi ang v khi ngng iu tr fluoxetin. iu chnh liu ca
carbamazepin cho ph hp.
312
Glycosid tr tim
Phn tch: Nguy c chuyn dch glycosid tr tim ra khi v tr gn vi protein, dn
n tng cc phn thuc t do v lm tng tc dng khng mong mun ca digitalis.
X l: Theo di lm sng ngi bnh v nhng triu chng ng c nu c (bun
nn, nn, nhp tim chm, ri lon nhn mu sc) Yu cu xc nh hm lng digoxin
nu phi hp t ra cn thit. Tng cng s theo di ny, nht l ngi cao tui.
Lithi
Phn tch: Cng hp tc dng khng mong mun: Tng c tnh thn kinh ca
cc mui lithi, km vi nguy c xut hin hi chng serotonin (kch ng, run, cng ,
gim hoc tng huyt p, nhp tim nhanh, ra m hi, rng mnh.
X l: Theo di lm sng u n nu phi hp cn thit tu trng hp, iu
chnh liu trong v sau iu tr bng thuc chng trm cm v kim sot nng lithi
trong huyt thanh.
Phn tch: Nng valproat trong huyt thanh c th tng, lm tng tc d ng
ph. C ch do fluoxetin c th c ch chuyn ho ca valproat gan.
X l: Theo di nng ca valproat v nhn xt p ng lm sng ca ng i
bnh khi bt u, khi ngng hoc thay i liu ca fluoxetin.
Phn tch: Tc dng dc l v c tnh ca cc thuc chng trm cm ba vng
c th tng. C ch do fluoxetin c ch chuyn ho ca cc thuc chng trm cm ba
vng gan.
X l: Theo di bnh nhn v cc du hiu c tnh ca thuc chng trm cm
ba vng. iu chnh liu nu cn thit. Khi thm fluoxetin, c th cn phi gim nhiu
n 75% liu ca thuc chng trm cm ba vng. Khi dng hai thuc cng vi nhau
hoc ngay c khi ngng fluoxetin vi tun, nn bt u dng thuc chng trm cm ba
vng vi liu thp hn thng l.

Phn tch: Do lin kt mnh vi protein, thuc phi hp c th y cc khng
vitamin K, c bit l acenocoumarol (Sintrom) ra khi lin kt vi protein huyt t ng.
Nguy c chy mu.
X l: Theo di thi gian prothrombin hoc INR (t l chun quc t) v
iu chnh liu khi bt u, khi ang iu tr v trong 8 ngy sau khi ngng iu tr.
Viloxazin
an thn bun ng. Tng tc dc lc.
313
X l: Lu nguy c ny iu chnh liu ca hai thuc, nu phi hp ny t ra

cn thit. Ngh n s gim tnh to ngi li xe v ngi s dng my mc. Khuyn
khng ung ru v khng t dng thuc hoc ch phm c ru.
Phn tch: i khng tc dng. C th tng tnh hung hng ngi nghin
amphetamin.
ngi bnh gp li thy thuc nu thy kt qu iu tr khng n nh.
Baclofen; barbituric; benzamid; benzodiazepin; carbamat hoc thuc tng
t; mianserin; phenothiazin; thuc an thn kinh cc loi; thuc chng ng kinh
khng barbituric; thuc khng histamin khng H1 an thn; thuc c ch h thn
kinh trung ng cc loi
to ngi li xe v ngi s dng my. Khuyn khng ung ru v t dng thuc
hoc ch phm c ru.
an thn bun ng. Tng tc dc lc. Nn nh rng rilmenidin, liu thng dng
khng lm tng tc dng c ch h thn kinh trung ng ca fluoxetin.
X l: Lu nguy c ny iu chnh liu ca hai thuc, nu phi hp l cn
thit. Ngh n s gim tnh to ngi li xe v ngi s dng my. Khuyn khng
ung ru v khng t dng thuc v cc ch phm c ru.
Methadon
Phn tch: Tng tc dng c ch h thn kinh trung ng, km an thn bun ng
mnh, c hi c bit cho ngi li xe v s dng my.
X l: Ngi k n phi lu s tng tc dng an thn bun ng ny cho li
khuyn thch hp (trnh li xe hoc vn hnh my mc, thng bo cho ng i xung
quanh bit mi nguy him)
Phenytoin
an thn bun ng. Cng tng c hm lng phenytoin km vi du hiu qu liu (do c
ch chuyn ho)
X l: Lu nguy c ny iu chnh liu ca hai thuc trong v sau khi iu tr
bng fluoxetin, nu cn phi hp ny. Ngh n s gim tnh to ngi li xe v
ngi s dng my. Khuyn khng ung ru v khng t dng thuc hoc cc ch
phm c ru.
314
Primidon hoc dn cht; thuc ch vn morphin

Ngh n s gim tnh to ngi li xe v ngi s dng my mc. Khuyn khng
ung ru v khng t dng thuc hoc cc ch phm c ru.
liu.
X l: Nu cn phi hp hai sn phm, lu nguy c ny khi gy m v chn
FLUVOXAMIN
Thuc chng trm cm, thuc nhm
cc cht c ch ti thu nhp serotonin
CC THUC TRONG NHM

FLUVOXAMIN vin nn 50 mg; 100 mg
Floxyfral vin nn 50 mg; 100 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Ru: Nht thit phi trnh ung ru.
Thi k cho con b / thi k mang thai: Thiu d liu chnh xc
Tr em / tr ang b: Thiu d liu chnh xc.
Cn theo di: mc 1
Suy gan: Nguy c tng cc enzym gan.
TNG TC THUC
Procarbazin
Phn tch: Procarbazin c tnh cht c ch IMAO. Nguy c l tng ti nhp
serotonin, c th ci thin p ng vi iu tr, nhng thi gian sau cng c th lm
tng tc dng c nng (h nhit, co git).
315
X l: Ngng dng thuc c ch MAO t nht hai tun ri mi bt u iu tr

bng cht chng trm cm serotoninergic. Ngc li, ngng iu tr bng thuc
chng trm cm serotoninergic mt tun trc khi dng thuc c ch MAO.
Sumatriptan
Phn tch: Tng tc dc lc do hip ng cc tc dng tng tit serotonin, c
th dn n tng huyt p ng mch v co tht ng mch vnh. C ch c th do
c s tch lu nhanh chng serotonin h thn kinh trung ng.
X l: Trnh phi hp. Nu xt thy cn thit, bt u vi liu thp v theo di
cht ch ngi bnh. Tn trng thi hn mt tun t khi ngng thuc chng trm cm
n khi bt u dng sumatriptan.
Thuc khng histamin khng an thn, khng gy bun ng
Phn tch: Tng nng huyt thanh ca thuc khng histamin khng an thn,
khng gy bun ng (nh astemisol v terfenadin) km theo c tnh vi tim. C ch:
Fluvoxamin c th c ch chuyn ho ca astemisol vi terfenadin gan. Terfenadin
th hin tc dng vi tim tng t nh ca quinidin.
X l: Chng ch nh astemisol v terfenadin cho bnh nhn ang dng
fluvoxamin. Cetirizin (Zyrtec) hoc loratadin (Claritin) c th l thuc thay th an ton.
Phn tch: Tng ti nhp serotonin, c th ci thin p ng vi iu tr, nhng thi
gian sau, cng lm tng mnh cc tc dng c (h nhit, co git).
X l: Ngng dng thuc c ch MAO t nht 2 tun ri mi bt u iu tr bng
cht chng trm cm serotoninergic v ngc li, ngng thuc chng trm cm t nht
1 tun ri mi bt u iu tr bng thuc c ch MAO.
Thuc c ch MAO typ B
Phn tch: Hi chng tng tit serotonin khi phi hp mt hot cht tng tit
serotonin v mt thuc c ch MAO. Nu phi hp mt thuc chng trm cm
serotoninergic thun tu vi mt thuc c ch MAO, ngay c vi thuc c ch MAO
c hiu, c nguy c dn n l ln, kch ng, st cao, co git, co tht mch ngoi vi
v tng huyt p nng. C ch c l c s tch t serotonin nhanh v qu mc h
thn kinh trung ng.
X l: Khng dng cng lc. Ngng dng thuc c ch MAO hai tun ri mi bt
u iu tr bng cht chng trm cm tng tit serotonin v ngc li ngng thuc
chng trm cm t nht 1 tun ri mi bt u iu tr bng thuc c ch MAO.
Ru
an thn bun ng. Mt s tc dng tm thn vn ng c th c ghi nhn vi mt s
sn phm, nht l trong tun u iu tr. Tng tc dc lc hc.
th
X l: Tt nht, khng nn dng fluvoxamin cng vi ru, v ngi k n khng

khng ch c vic ung ru ca ngi bnh. Nguy c an
316
thn bun ng c bit nguy him ngi li xe v ngi s dng my. Khuyn ngi
bnh khng ung ru v khng t dng thuc hoc ch phm c ru.
Thuc c ch MAO typ A
Phn tch: Qu liu serotonin, do hip ng cc tc dng dc l ca cc thuc.
C th xut hin hi chng serotonin, mc nng nh thay i, nhng c th d n
n t vong.
X l: Hi chng serotonin c nhiu sc thi khc nhau, vi nhng triu chng
kiu tm thn (l ln, kch ng, thm ch hn m), kiu vn ng (git rung c, run,
tng hot ng, cng ), kiu thc vt (tng hoc h huyt p, nhp tim nhanh, rt
run, ra m hi), kiu tiu ho (tiu chy). Nn trnh phi hp.
Phn tch: i khng tc dng, c th tng tnh hung hn ngi nghin
amphetamin.
ngi bnh gp li thy thuc nu thy kt qu iu tr khng
n nh.
317
Baclofen; barbituric; benzamid; benzodiazepin; butyrophenon; carbamat

hoc thuc tng t; dextropropoxyphen; phenothiazin; phenytoin; thuc an
thn kinh cc loi; thuc chng ng kinh khng barbituric; thuc khng
histamin khng H1 an thn; thuc c ch h thn kinh trung ng cc loi
X l: Lu nguy c ny iu chnh liu lng ca hai thuc. Ngh n s
gim tnh to ngi li xe v ngi s dng my. Khuyn khng nn ung ru v
Buspiron; mianserin; viloxazin
X l: Lu nguy c ny iu chnh liu lng ca hai thuc. Ch n s
gim tnh to ngi li xe v ngi s dng my. Khuyn khng ung ru v khng
t dng thuc hoc ch phm c ru.
Carbamazepin
Phn tch: Nng carbamazepin trong huyt thanh c th tng, dn n tng
tc dng dc lc v tc dng c. C ch cha r.
X l: Khi bt u iu tr vi carbamazepin bnh nhn ang dng fluvoxamin,
nn dng carbamazepin vi liu d dt ri iu chnh dn. nhng ngi bnh n nh
vi carbamazepin th c th cn phi thay i liu khi bt u dng, hoc khi ng ng
fluvoxamin. Theo di nng carbamazepin trong huyt thanh v quan st ng i bnh
v cc du hiu c tnh.
Carmustin hoc dn cht; dantrolen; estrogen hoc thuc nga thai;
estroprogestogen; griseofulvin; isoniazid hoc thuc tng t; macrolid;
methotrexat; natri valpoat hoc dn cht; progabid; rifampicin; thuc chng nm;
dn cht imidazol
khng mong mun).
(ASAT, ALAT, phosphatase kim, bilirubin), hoc hon mt trong hai li u trnh nu c
th. Xc minh l ngi bnh khng ung ru thng xuyn v khng c tin s vim
gan virus. Cc triu chng lm sng chnh khng c hiu: bun nn, st, vng da. Nu
c phi hp ban da, nga v hch to, th c kh nng bnh cn do thuc. Phn bit r,
tu theo kt qu xt nghim sinh hc, nguy c xut hin vim gan tiu t bo khng hi
phc vi vim gan mt hi phc c khi ngng thuc.
Clonidin hoc cc thuc tng t
an thn bun ng. Tng tc dc lc. Nn nh rng rilmenidin, liu thng dng,
khng lm tng tc dng c ch h thn kinh trung ng ca fluvoxamin.
318

Ch n s gim tnh to ngi li xe v ngi s dng my. Nn trnh ung ru
Lithi
Phn tch: S dng ng thi lithi vi fluvoxamin c th gy ng g trm trng.
C ch c l do tng nng serotonin trong no.
X l: Nhc nh bnh nhn v tc dng an thn bun ng c th gp v nhn
xt cht ch cho ngi bnh trong qu trnh iu tr ban u. Nu tng tc xy ra, c
th phi ngng mt trong hai thuc.
319
Methadon
Phn tch: Tng nng methadon trong huyt thanh v tng c tnh; tc dng
c ch h thn kinh trung ng km an thn bun ng mnh, c hi c bit cho
ngi li xe v s dng my. C ch do fluvoxamin c th c ch chuyn ho c a
methadon gan.
X l: Bt u v ngng iu tr fluvoxamin mt cch thn trng bnh nhn
ang iu tr duy tr bng methadon. Ngi k n phi lu s tng tc dng an thn
cho li khuyn thch hp (trnh li xe hoc vn hnh my, thng bo cho ngi xung
quanh bit mi nguy him).
Theophylin
Phn tch: Tng nng ca theophylin trong huyt thanh. C ch: do fluvoxamin
c ch chuyn ho theophylin gan, c th dn n nguy c qu liu. Tng tc dc
X l: Theo di lm sng, nu cn, kim tra nng theophylin trong mu v iu
chnh liu trong v sau khi iu tr bng fluvoxamin. C khuyn co gim 33% liu ca
theophylin khi bt u dng thuc ny cho mt bnh nhn ang dng fluvoxamin.
Primidon hoc dn cht; thuc ch vn morphin
Ch n s gim tnh to ngi li xe v ngi s dng my. Nn trnh ung ru
Phn tch: Cc tc dng dc l v c tnh ca thuc chng trm cm ba vng
c th tng. C ch: do fluvoxamin c th c ch chuyn ho oxy ho ca thuc chng
trm cm ba vng (cytochrom P450 2D6).
X l: Nu khng trnh c phi hp ny, phi gim liu ca thuc chng trm
cm ba vng trong khi dng cng vi fluvoxamin. Theo di cn thn s p ng lm
sng ca ngi bnh v nng ca thuc chng trm cm ba vng trong huyt thanh
khi bt u hoc khi ngng fluvoxamin. Dng mt thuc chng trm cm ba vng m
khng b oxy ho, th d desipramin c th trnh c tng tc ny.
Thuc gy m cc loi
X l: Khuyn ngi bnh phi can thip ngoi khoa thng tin cho bc s gy m
nhng thuc h dng.
Phn tch: Do lin kt mnh vi protein, thuc phi hp c th y cc khng
vitamin K, c bit l acenocoumarol (Sintrom) ra khi lin kt vi protein huyt t ng.
Nguy c chy mu.
320
X l: Theo di t l prothrombin hoc t l chun quc t (INR) v iu chnh

liu khi bt u, khi ang iu tr v trong vng 8 ngy sau khi ngng thuc.
321
FOSCARNET
Thuc km virus ph rng, c tc dng chn lc chng cc virus nhm herpes
(virus Herpes typ I v II, virus varicella zona, Epstein Barr v cytomegalovirus)
CC THUC TROG NHM

FOSCARNET dung dch tim truyn 24 mg/mL (l 500 mL)
Foscavir dung dch tim truyn 24 mg/mL (l 500 mL)
CH KHI CH NH THUC
Thi k cho con b: Do thiu d liu, khng nn cho con b trong khi iu tr vi
foscanet.
Thi k mang thai: Do thn trng, nn trnh dng cho ngi mang thai.
Trng hp khc: Qu mn vi thuc.
Cn theo di: mc 1
Suy thn: Duy tr tip nc ng v iu chnh liu tu theo thanh lc
creatinin. Theo di c calci mu v ion .
Trng hp khc: Trng hp calci mu thp, nn theo di.
TNG TC THUC
Aminosid dng ngoi ng tiu ho hoc ti ch; ciclosporin; penicilamin
hoc thuc tng t; lincosanid; methotrexat; vng
thn. Cng hp cc tc dng khng mong mun.
X l: Nhng phi hp ny c th hay gp, nht l bnh vin. Khi cn phi hp,
nn iu chnh liu tu theo thanh lc creatinin (cng thc Cockroft). Nu c tnh
xy ra, cn phi ngng foscarnet. Theo di c bit ngi cao tui.
Cephalosporin hoc thuc tng t
thn.
Phn tch: y l ni v cefalotin v cefaloridin trong phi hp cc thuc c vi
X l: Theo di cn thn v u n chc nng thn, nu cn phi hp, nht l

ngi suy thn v ngi bnh cao tui. iu chnh liu theo thanh lc creatinin.
Phn tch: Phi hp cc thuc c vi thn.
322
X l: Cisplatin c bit c vi thn. Theo di cn thn v u n chc nng

thn, nu cn phi hp, nht l ngi suy thn v ngi bnh cao tui. iu chnh
liu theo thanh lc creatinin.
Amphotericin B
Phn tch: Nguy c tng tc dng c vi thn.
X l: Nu khng hon c mt trong hai liu trnh, phi theo di cn thn ion
v thanh lc creatinin.
Phn tch: Phi hp hai thuc c vi thn, dn n nguy c xut hin suy thn
khng hi phc.
X l: Thng c iu tr bnh vin. Theo di u n ion v thanh
lc creatinin v t iu chnh liu.
Phn tch: Interleukin ch c th dng c s chuyn khoa. Nguy c tng tc
dng c vi thn ca hai thuc.
X l: iu tr bng interleukin ch c th thc hin c s chuyn khoa, do mc
nghim trng ca ch nh. Do , cc tng tc cn phi c cn nhc tu theo
tnh trng chung ca ngi bnh. Nu khng th hon c mt trong hai li u trnh,
theo di cn thn ion v thanh lc creatinin.
Khng sinh polypeptid
Phn tch: Phi hp hai thuc c tim nng c vi thn, do tng nguy c xut
hin suy thn.
X l: l hai thuc dng trong bnh vin v c s theo di cn thit. Theo
di cht ch ion v thanh lc creatinin v t iu chnh liu.
Pentamidin
Phn tch: Nguy c h calci mu nng. Theo di cn thn ion v thanh lc
creatinin. Khng dng foscarnet vi pentamidin tim tnh mch.
X l: Theo di calci mu v b sung calci theo nhu cu.
Quinolon
Phn tch: C th tng nguy c co git. C ch c th do hip ng tc dng gy
ng kinh.
X l: Theo di ngi bnh c tin s gia nh v co git khi dng hai thuc cng
vi nhau.
Zalcitabin
Phn tch: Tng nng zalcitabin trong huyt tng, km tng nguy c gy c.
X l: Theo di cc tc dng khng mong mun lin quan n zalcitabin v gim
liu, nu cn.
323
FOSFOMYCIN
Khng sinh dit khun tc dng ch yu vi Staphylococcus,
Pneumococcus, Meningococcus, v vi khun ng rut
CC THUC TRONG NHM

FOSFOMYCIN bt pha tim 1g; cm pha hn dch ung 2g/6g v 3g/8g
Fosfocina bt pha tim 1g
Monurol cm pha hn dch ung 2g/6g v 3g/8g
CH KHI CH NH THUC
Khng dng n tr liu: Ch dng thuc ny phi hp vi mt khng sinh khc
c tc dng hip ng. Chng ch nh ngi mn cm vi thuc.
Cn thn trng: mc 2
Thi k cho con b: Qua c sa m vi lng nh.
Thi k mang thai: Do thn trng, trong ba thng u ca thai k.
FUROSEMID HOC THUC TNG T

Sulfamid li niu thi kali, tc dng quai Henl
CC THUC TRONG NHM

BUMETANID vin nn 1 mg; 2 mg; 5 mg; ng tim 0,5 mg/mL
Burinex vin nn 1 mg;2 mg; 5 mg
Burinex ng tim 0,5 mg/1mL
FUROSEMID vin nn 20 mg; 40 mg; ng tim 20 mg/2 mL
Furosemid Dakota vin nn 20 mg
Furosemid thuc tim 20 mg
324
Lasix vin nn 20 mg
Lasilix thuc tim 20 mg
CH KHI CH NH THUC
Thi k cho con b: Cn trnh cho b, v furosemid qua c sa m v lm
gim tit sa.
Bnh gt: Nguy c tng acid uric mu, buc phi theo di cht ch ngi bnh
gt, nu cn phi hp.
Suy gan: Cc thuc li niu thi kali c th khi pht hn m gan. Chng lm
tng nguy c nhim kim chuyn ho, trng thi ny lm tng amoniac bi thn v lm
cht ny d dng chuyn vo no.
Cn theo di: mc 1
Tiu ng: Cc thiazid li tiu hoc thuc tng t v c acid etacrynic c th
c tc dng gy tiu ng: Dung np glucose gim v glucose mu lc i thng
tng. Vic s dng chng c th lm glucose mu mt cn bng v d xut hin hn
m h glucose mu.
Thi k mang thai: Nguy c thiu mu cc b thai - nhau thai, km theo suy dinh
dng thai khng chng minh cho vic s dng cc thuc li tiu trong ph v tng
huyt p ngi mang thai, nhng l yu t cn thit ca iu tr ph tim, thn v
gan ngi mang thai.
Suy thn: Bt k thuc li tiu no u gy suy thn chc nng, lin quan n
mt mui km gim lc cu thn v tng ur mu. S thng tn chc nng ny c th
lm nng thm suy thn c trc.
TNG TC THUC
Cisaprid
Phn tch: Tng nguy c lon nhp tim e da tnh mng bao gm xon nh. C
ch c th ko di thm khong QT do mt cht in gii.
X l: Chng ch nh dng cisaprid cho bnh nhn b gim nhanh kali, th d
ngi ang dng cc thuc li tiu quai.
Benzamid
Phn tch: Nguy c xut hin xon nh khi dng phi hp ny. Ch , tng tc
ch m t vi ring sultoprid (Barnetil) trong nhm benzamid. H kali mu, nhp tim
chm v khong QT di c t trc (ch nhn c trn in tm ) l nhng yu t
thun li cho s xut hin xon nh. Xon nh l mt kiu nhp tht c bit, c th
xut hin tng cn rt ngn (vi giy, mt thu: cm gic ngt m khng mt thc).
Cc thuc dn n h kali mu to thun li cho xut hin xon nh vi cc sn phm
khng chng lon nhp.
325
X l: Nn trnh phi hp. Dng cc thuc khng dn n xon nh. Nu cn

phi hp, nn theo di thng xuyn khong QT v kim tra u n kali mu. Ch
cc du hiu lm sng c th bo hiu h kali mu nh mt nhc, yu c, co cng c.
Bepridil; halofantrin
Phn tch: Nguy c xut hin xon nh, khi dng phi hp ny. H kali mu, nhp
tim chm v khong QT di c t trc (ch thy c trn in tm ) l nhng yu t
thun li cho s xut hin xon nh. Xon nh l mt kiu nhp tht c bit, c th
xut hin tng cn rt ngn (vi giy, mt thu: cm gic ngt m khng mt thc) i
khi tin trin thnh rung tht.
X l: Nn trnh phi hp. Dng cc thuc khng dn n xon nh. Nu cn
phi hp, nn theo di thng xuyn khong QT v kim tra u n kali mu.
Lithi
Phn tch: Tng nng lithi trong huyt tng v c th tng nguy c gy c.
C ch cha r.
X l: Theo di bnh nhn v c tnh lithi, theo di hm lng lithi v iu chnh
liu nu cn thit.
Macrolid
Phn tch: Tng nguy c xon nh do tc dng hip ng c m t duy nht
vi erythromycin tim tnh mch. H kali mu, nhp tim chm v khong QT di c t
trc (ch nhn c trn in tm ) l nhng yu t thun li cho s xut hin xon
nh. Xon nh l mt kiu nhp tht c bit c th xut hin tng cn rt ngn (vi
giy, mt thu: cm gic ngt v khng mt thc). Trong nhm macrolid, ring
erythromycin, c bit dng tim tnh mch, c th dn n ri lon nhp tim (ko di
khong QT, ngoi tm thu tht, xon nh, bloc nh - tht)
ny. Ngay c khi dng mt mnh, erythromycin tim tnh mch c th dn n ri lon
nhp tim. Khuyn khng tim nhanh c liu m phi truyn tnh mch lin tc hoc chia
nh, thi gian truyn mi ln phi t nht 60 pht.
Methenamin
Phn tch: Trong nc tiu acid, methenamin phn gii thnh formol, c nguy c
gy ta vi sulfamid km ho tan (furosemid c cu trc sulfamid), c th dn n tinh
th niu v si thn.
X l: Tt nht, nn thay thuc.
Pentamidin
Phn tch: Nguy c xut hin xon nh, khi dng phi hp ny. H kali mu, nhp
tim chm v khong QT di c t trc (ch nhn c trn in tm ) l nhng yu
t thun li cho s xut hin xon nh. Xon nh l mt kiu nhp tht c bit c th
xut hin tng cn rt ngn (vi giy, mt thu: cm gic ngt v khng mt thc) i
khi dn n rung tht.
X l: Cn trnh phi hp ny. Dng cc thuc khng dn n xon nh. Nu
cn phi hp, nn theo di thng xuyn khong QT v kim tra u n kali mu. Ch
326
cc du hiu lm sng c th bo trc h kali mu nh mt nhc, yu c, co cng

c.
Sparfloxacin
Phn tch: Tng tc ny ch c gi tr vi sparfloxacin (Zagam). C s gia tng
nguy c xon nh do cng hp cc tc dng in sinh l. H kali mu, nhp tim chm
v khong QT di c t trc (ch nhn thy trn in tm ) l nhng yu t thun li
cho s xut hin xon nh. Xon nh l mt kiu nhp tht c bit c th xut hin
tng cn rt ngn (vi giy, mt thu: cm gic ngt v khng mt thc).
c.
Tacrin
Phn tch: Nguy c tng c tnh gan
X l: Nu cn thit, tng cng theo di chc nng gan. Trnh cc phi hp c
nguy c ngi bnh cao tui.
Phn tch: Tng tc ch c ghi nhn duy nht vi thuc khng histamin khng
an thn: astemizol (Hismanal). H kali mu (c tiu chy ko di cng c th gy mt
nc - in gii) l mt yu t thun li cho xon nh. Nguy c tng khi cc thuc h
kali mu c phi hp vi cc cht khc c th gy xon nh. Xon nh l mt kiu
nhp tht c bit, c th xut hin tng cn rt ngn (vi giy, mt thu: cm gic ngt
m khng mt thc).
X l: Nn trnh phi hp. Thay i chin lc iu tr v la chn nhng thuc
khng gy xon nh. Nu cn duy tr phi hp, theo di kali mu v b sung kali n u
cn.
Phn tch: Phi hp khng hp l cc thuc cng mt nhm dc l. n thuc
trng lp v ch.
X l: K n tha v ch.
Vincamin
Phn tch: Nguy c xut hin xon nh, khi dng phi hp hai thuc ny. H kali
mu, nhp tim chm v khong QT di c t trc (trn in tm ) l nhng yu t
thun li cho s xut hin xon nh. Xon nh l mt kiu nhp tht c bit c th
khi tin trin n rung tht cht ngi.
c.
327
Aminosid dng ngoi ng tiu ho hoc ti ch

Phn tch: c tnh vi tai ca cc aminosid v cc thuc li niu quai c th tng
khi hai h thuc ny c dng phi hp. C th xut hin mt thnh l c mc
khc nhau v i khi khng hi phc. C ch khng r, c l hip ng khu c vi
tai. Tim tnh mch v suy thn l cc yu t tng nguy c tai bin.
X l: Nu cn phi hp, phi theo di u n chc nng thnh gic. Gim liu
ca mt trong hai thuc hoc c hai thuc ngi suy thn l cn thit.
Amiodaron
Phn tch: Nguy c xon nh c to thun li bi h kali mu. H kali mu,
nhp tim chm v khong QT di c t trc (trn in tm ) l nhng yu t thun
li cho s xut hin xon nh. Xon nh l mt kiu nhp tht c bi t c th xut
hin tng cn rt ngn (vi giy, mt thu: cm gic ngt v khng mt thc).
X l: Nu s phi hp cc thuc h kali mu vi amiodaron l cn thit, ngn
nga h kali mu bng tng cng gim st v theo di in tm . Trng hp xut
hin xon nh, khng dng thuc chng lon nhp. Khuyn ngi bnh theo di kali
mu. Cn nhc nh bnh nhn l h kali mu c biu hin bng tnh trng mt
nhc, yu c, thm ch co cng c. Nu nhng triu chng ny xut hin, khuyn
ngi bnh gp li thy thuc iu tr.
Phn tch: Furosemid v cc thuc tng t lm tng acid uric mu v gim tc
dng iu tr gt.
bi.
X l: Nn trnh dng hai thuc ny cng lc, nu khng s thy iu tr gt tht

Amphotericin B
Phn tch: Tc dng h kali mu tng ln vi dng tim. Amphotericin B rt t

c hp thu khi dng theo ng ung hoc ti ch trong cc hon cnh bnh thng.
X l: Theo di kali mu. nh gi cc nguy c ca tng tc, tu theo con ng
dng thuc amphotericin B.
Baclofen; butyrophenon
Phn tch: Tng tc dng h huyt p ca nhng thuc ny.
X l: Nu cn phi hp, tng cng theo di huyt p, trong v khi ngng iu
tr bng mt trong hai thuc. iu chnh liu tu trng hp. Nhn mnh v k hoch
dng thuc v s tun th. c bit cnh gic ngi bnh cao tui.
Biguanid
Phn tch: Trng hp suy thn chc nng, sinh l v / hoc lin quan n thuc
li tiu, tng nguy c nhim acid lactic do metformin (Stagid, Glucophage, Glucinan).
X l: Lu tng tc ny v trnh k n metformin nu ngi bnh b suy
thn c creatinin mu ln hn 15 mg/ lt (135micromol / lt) nam, v 12 mg / lt (110
micromol / lt) n. c bit ch n s k n ng th i metformin v thu c l i
tiu ngi bnh cao tui. Nn nh nhng du hiu bo trc chng nhim acid
lactic l bun nn, nn, co cng c, tng thng kh, cm gic kh , au bng.
328
Ciclosporin
Phn tch: Nguy c tng creatinin mu, nht l vi cc thuc li tiu thiazid.
Tng tc ny cn c thm t liu. Cc cng b cn him.
X l: Theo di chc nng thn trong trng hp phi hp cc thuc ny. Nu
nhn thy c bt thng, c th trao i cc nhn xt cho Trung tm cnh gic thuc,
v tng tc ny cn c tha nhn.
Phn tch: Tng tc ny c m t duy nht vi furosemid v cefaloridin (l
cephalosporin hin nay t dng.) Cefaloridin ring l cng c vi thn, nhng c tnh
vi thn ny nng thm do furosemid th cha hiu r. Nhiu cephalosporin khc c v
khng tng tc vi furosemid.
X l: Cn c s nghi ng v c tnh vi thn ca s phi hp mt vi
cephalosporin vi furosemid. Nn cnh gic v theo di st chc nng thn nu cn
phi hp hai thuc ny.
Cholestyramin
Phn tch: Gim hp thu furosemid ng tiu ho.
X l: Nu hai thuc c k n, khuyn dng furosemid trc 2 gi hoc 4 gi
sau khi dng cholestyramin.
Clonidin hoc thuc tng t; levodopa; methyldopa; phenothiazin;
spironolacton; thuc chng tng huyt p gin mch
Phn tch: Tng tc dng h huyt p.
X l: Cn thit phi iu chnh liu, xc nh k hoch dng thuc v nhn
mnh cho ngi bnh tun th. Lc u iu tr, khuyn ngi bnh o u n huyt
p ng mch cho ti khi t cn bng iu tr.
Clozapin
Phn tch: Nguy c tng tc dng lm h huyt p
huyt p c k n ban u, trong v sau khi ngng iu tr clozapin. Thn trng
ngi bnh cao tui.
Corticoid-khong; tetracosactid; thuc nhun trng lm trn
Phn tch: Phi hp hai thuc gy h kali mu dn n tng nguy c h kali mu,
X l: Theo di kali mu v hiu chnh bng mui kali nu cn. H kali mu th
hin lm sng bng mt nhc, thm ch co cng c v i khi ri lon nhp tim. Ch
n s mt nc qu mc (khi hot ng th lc hoc nng nhiu hoc tiu chy kh
cha) lm tng mt kali hn na. Khi cn, c th khuyn b sung kali (chu i, mn,
hoc mui kali).
Cura cc loi
Phn tch: Nguy c tng chn thn kinh - c do h kali mu, nht l vi cc loi
cura khng kh cc.
329
X l: C th cn nh lng kali mu, trc khi dng loi cura khng kh cc.
Diazoxyd
Phn tch: Tng tc ba khu:
Tng tc dng gy tng glucose mu.
Tng tc dng gy tng acid uric mu.
Tng tc dng h huyt p.
X l: Phi hp ch c th thc hin ti c s bnh vin. Tu theo mc tiu iu
tr v sinh l bnh ca ngi bnh, lu ba tc dng ny theo di lm sng v sinh
hc cho thch hp.
Didanosin
thuc
Phn tch: Hip ng cc tc dng khng mong mun: Tng nguy c vim tu do
X l: Theo di lm sng v nu cn thit, khi b au bng phi theo di sinh hc

chc nng tu (amylase mu v amylase nc tiu).
Disopyramid; sotalol
Phn tch: Nguy c xon nh, khi phi hp mt trong hai thuc ny vi furosemid.
H kali mu, nhp tim chm v khong QT di c t trc (in tm ) l nhng yu t
thun li cho xut hin xon nh. Xon nh l mt kiu nhp tht dc bit, c th xut
hin tng c rt ngn (vi giy, mt thu: cm gic ngt m khng mt thc).
X l: Nu cn phi hp, ngn nga h kali mu bng cch tng cng theo di
ngi bnh v in tm . Trng hp xut hin xon nh, khng dng thuc chng
lon nhp. Nh rng h kali mu th hin bng mt nhc, yu c, thm ch co cng c.
Nu nhng triu chng ny xut hin, khuyn khch ngi bnh gp li thy thuc.
Fibrat
Phn tch: Cnh tranh cc v tr gn vi protein huyt tng km vi kh nng
tng li tiu v tng mt kali. Tng tc ny c nu trong y vn vi furosemid, cn
c xc nhn.
X l: Theo di phi hp ny v thng bo cho Trung tm cnh gic thuc mi bt
thng sinh hc hoc lm sng, nu c. Tng cng theo di ngi suy thn.
Glycosid tr tim
Phn tch: Ri lon in gii do thuc li tiu d dn n lon nhp tim do
digitalis. C ch: Tng bi xut kali v magnesi ra nc tiu nh hng n hot ng
ca c tim. Mt s yu t khc cng c th tham gia.
X l: o hm lng ca kali v magnesi trong huyt tng khi phi hp digitalis
vi furosemid. B sung thm kali v magnesi cho ngi bnh. Phng mt thm bng
ch n hn ch natri hoc dng thm thuc li niu gi kali.
330

Phn tch: Tng tc dng h huyt p, thng s dng trong iu tr v cn liu
lng thch hp.
X l: Tng cng theo di huyt p. Nhn mnh v s tun th dng thuc
ng gi, khi phi hp hai thuc. Cnh gic ngi bnh cao tui.
Insulin
Phn tch: Trong nhm thuc li tiu quai, m t cc tnh cht gy tng
glucose mu ca furosemid, c th dn n gim tc dng ca cc thuc chng tiu
ng. C ch cha sng t.
X l: C th k n cc thuc li tiu quai cho ngi tiu ng, nhng phi
ch n nhng bin ng v glucose mu v iu chnh liu tu theo kt qu sinh
hc.
Lidocain hoc thuc tng t; thuc ch vn morphin
X l: Theo di huyt p trong khi phi hp. Tu theo thuc dng, h huyt p c
th nng t hay nhiu. iu chnh liu ca mt hay hai thuc, tu theo trng hp. Xy
dng k hoch dng thuc u n. Khuyn ngi bnh, nu b chng mt lc u
iu tr, nn gp li thy thuc iu chnh liu ca mt hoc hai thuc, tu trng
hp. Tng cng theo di ngi bnh cao tui (nguy c ng) v khuyn h khi t
th nm hoc ngi m chuyn sang t th ng phi t t.
Nitrat chng au tht ngc; nicorandil
Phn tch: Phi hp vi bt k thuc no c tnh cht chng tng huyt p c th
lm tng nguy c h huyt p i khi dn n sc.
X l: Theo di huyt p ng mch trong khi iu tr v sau khi ngng mt trong
hai liu trnh. Thn trng c bit ngi bnh cao tui.
Phenytoin
Phn tch: Phenytoin c th lm gim tc dng li tiu ca furosemid c th ti
50% do c ch cha sng t hon ton. C th do gim hp thu furosemid dng ng
ung.
X l: Tng liu furosemid nu cn thit, ngi bnh dng phenytoin, trong v
sau khi ngng iu tr bng phenytoin. Theo di s bi tit.
Probenecid
Phn tch: Tc dng ca furosemid c th gim. C ch do probenecid c th lm
gim s phn b ca furosemid n cc v tr tc dng trong lng ng thn.
X l: C l khng cn phi c can thip lm sng no.
Quinidin hoc dn cht
Phn tch: Nguy c xut hin xon nh khi phi hp mt thuc li tiu thi kali
vi mt thuc chng lon nhp nhm mt Vaughan - Williams. H kali mu, nhp tim
331
chm v khong QT di c t trc (in tm ) l nhng yu t thun li cho s xut

hin xon nh. Xon nh l mt kiu nhp tht c bit c th xut hin tng cn rt
ngn (vi giy, mt thu: cm gic ngt v khng mt thc). C th tin trin n rung
tht cht ngi.
X l: Nu cn phi phi hp furosemid vi thuc ny, ngn nga h kali mu
bng b sung kali c tnh ton v theo di in tm . Trong trng hp xon nh,
khng dng thuc chng lon nhp. Nn nh rng, h kali mu biu hin bng trng thi
mt nhc, yu c, thm ch co cng c. Nu cc triu chng ny xut hin, khuyn
Reserpin
tr.
Phn tch: Nguy c tng tc dng h huyt p, c th c s dng trong iu

huyt p c la chn ban u, trong v sau khi ngng iu tr bng reserpin.
Reserpin hin nay rt him c k n lm thuc iu tr chng tng huyt p, tr
mt s nc.
Sn phm cn quang c iod
Phn tch: Tng nguy c suy thn cp, nu b mt nc do thuc li tiu (c bit
vi cc sn phm c ba iod ion ho v cc sn phm c 6 iod).
X l: Nn tip nc cho ngi bnh trc khi dng sn phm cn quang c iod.
Khuyn ngi bnh thng tin cho thy thuc X quang l ang iu tr thuc li tiu
c nhng bin php cn thit.
Phn tch: Cc thuc li tiu quai c th trong mt s him trng hp lm tng
glucose mu hoc nh hng n tc dng h glucose mu ca cc thuc chng tiu
ng.
X l: Trng hp kh cn bng trong iu tr chng tiu ng, lu n kh
nng tng tc ny. Thng tin cho ngi bnh tng cng t theo di v iu chnh
liu khi ang v khi ngng iu tr bng thuc li tiu quai.
Tetracyclin
Phn tch: Nguy c tng ur mu ngi suy thn do c ch cha r: mt mnh
tetracyclin c th gy tng ur. ngha lm sng ca tng tc ny hnh nh khng
r.
X l: Nu ur tng ngi bnh, bt u chng t ri lon chc nng, th nn
xem xt ngng mt hoc c th c hai thuc.
Phn tch: Tc dng chng tng huyt p ca furosemid c th gim khi dng
ng thi vi cc thuc cng giao cm.
X l: Theo di huyt p phi thng xuyn. Tt c u ph thuc vo bi cnh
iu tr v dng bo ch s dng. Nu c th, phi trnh phi hp ngn cc nguy
c quan trng v bin ng huyt p.
332

Phn tch: Nguy c h huyt p do gim th tch mu.
X l: Theo di huyt ng hc v hiu chnh cc ri lon chuyn ho. Khuyn
ngi bnh phi can thip ngoi khoa thng tin cho ngi gy m v nhng thuc ang
dng.
Phn tch: Thuc khng acid lm gim hp thu qua ng tiu ho v gy gim
X l: Phi dng hai thuc cch nhau t nht 1 n 2 gi. Nn nh rng cc thuc
khng acid thng dng 1 gi 30 pht sau ba n, v thc n lm tng tit dch v.
Phn tch: Phi hp hai thuc gy h kali mu dn n tng nguy c h kali mu,
nht l khi dng thuc nhun trng di ngy.
X l: Theo di kali mu v hi u chnh b ng mu i kali n u c n. H kali mu
th hin lm sng bng mt nhc, thm ch co cng c v i khi r i lo n nh p tim.
Ch n s mt nc qu mc (khi hot ng th l c ho c nng nhi u ho c tiu
chy kh cha) lm tng mt kali h n n a. Tr ng h p c n thi t, c th khuyn b
sung tm thi kali (chui, mn, ho c mu i kali).
Phn tch: Nguy c h huyt p ng mch nng v/ hoc suy thn cp, trong
trng hp h natri mu. Mt mui - nc nhiu hoc hp ng mch thn dn n
tng kch thch h thng renin - angiotensin; do chn h thng ny, cht c ch enzym
chuyn c th gy gim t ngt huyt p, ngay ln ung thuc u tin, v i khi
him gp hn, suy thn cp.
X l: Nu iu tr li niu t trc, ngng thuc li niu trong khong 2 n 3
ngy trc khi bt u iu tr bng cht c ch enzym chuyn, ri tip dng l i
thuc li niu, nu cn thit. Lun lun bt u iu tr bng thuc c ch enzym
chuyn vi liu thp, ri tng dn liu, nu cn thit. Nhng iu thn trng ny c gi
tr c trong iu tr tng huyt p ng mch v trong iu tr suy tim. Theo di chc
nng thn ngay trong nhng tun u iu tr bng thuc c ch enzym chuyn. Thn
trng c bit khi dng ngi bnh cao tui. Cui cng, phi nh rng trong mt s
bit dc, c phi hp thuc li niu thi kali v thuc c ch enzym chuyn, vi liu
ti u.
Thuc c ch MAO khng chn lc; procarbazin
Phn tch: Dng ng thi hai thuc c th dn n nhng bin ng huyt p
quan trng.
X l: Cc thuc c ch MAO him khi c dng, tng tc th nhiu, k n th
him nn c t cc nhn xt v cnh gic thuc. Tuy nhin nn thn trng gi thi hn
2 n 3 tun sau khi ngng thuc, trc khi k n li thuc c ch MAO.
Thuc c ch MAO typ B
333
Phn tch: S c ch c hiu monoamin oxydase typ B dn n ko di tc

dng ca levodopa, iu gii thch s cng k n vi cht ny. Nh vy cc tng
tc l cng ging nh ca levodopa v xem nhm thuc ny. Khi phi hp furosemid
vi levodopa, s tng tc dng h huyt p.
X l: Cn thit phi iu chnh liu, xy dng chng trnh dng thuc v nhn
mnh vi ngi bnh v s tun th. Lc u iu tr, theo di u n huyt p cho
ti khi t huyt p bnh thng.
Dn cht salicylic; indometacin hoc dn cht; pyrazol; thuc chng vim
khng steroid
Phn tch: Gim tc dng chng tng huyt p. Cc thuc chng vim khng
steroid c ch tng hp prostaglandin thn l cht gy gin mch v/hoc dn n
gi mui - nc. Nguy c suy thn cp ngi bnh mt nc.
X l: Xc minh c s tip nc tt cho ngi bnh, theo di chc nng thn (
thanh lc creatinin), xc minh c s n nh huyt p, c bit thi k u i u tr .
Khuyn ngi bnh theo di u n huyt p ng mch.
Glucocorticoid
Phn tch: Phi hp hai thuc gy h kali mu, dn n tng nguy c h kali mu
X l: Theo di kali mu v hiu chnh bng mui kali theo nhu cu. H kali mu
th hin trn lm sng l mt nhc, thm ch co cng c v i khi ri lon nhp tim.
Ch n s mt nc qu mc (khi gng sc, hoc nng nhiu hoc tiu chy kh
cha) lm nng thm s mt kali. Trng hp cn thit, c th khuyn nn b sung
tm thi kali (chui, mn, hoc mui kali).
X l: Nu cn phi hp, phi tng cng theo di huyt p ng mch trong v
khi ngng iu tr bng mt trong hai thuc. Tin hnh iu chnh liu. Nhn mnh v
k hoch dng thuc v tun th. c bit cnh gic ngi bnh cao tui.
Phn tch: S dng ng thi cc thuc chng tng huyt p hoc thuc c th
dn n h huyt p cng vi cc thuc gy m barbituric c th gy tt huyt p
nng.
X l: Khuyn ngi bnh bo cho thy thuc gy m bit cc thuc ang dng.
FUSAFUNGIN
Thuc khng khun c tnh cht chng vim
334
CC THUC TRONG NHM

FUSAFUNGIN dung dch phun m 1%
Locabiotal dung dch phun m 1%
CH KHI CH NH THUC
Tr em: Tr em di 30 thng tui, do nguy c co tht thanh qun.
GANCICLOVIR
Thuc km virus, tc dng trn Cytomegalovirus. Dnh cho nhim virus nng
nh hng n s sng hoc th gic ca ngi bnh suy gim min dch
CC THUC TRONG NHM
GANCICLOVIR nang 250 mg
Cymevan nang 250 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: Do tnh cht gy t bin v gy ung th ca thuc.
Thi k mang thai: Thuc gy qui thai, ch dng km vi bin php nga thai
(nam v n) c hiu lc
Tr em: Ch dng trong trng hp cn thit tuyt i, v tc dng gy ung th
khi dng lu di.
Bnh v mu: Do c vi tu xng, dng rt thn trng ngi bnh ang
hoc b chng gim t bo.
Suy thn: iu chnh liu tu theo thanh lc creatinin, do thuc o thi qua
nc tiu.
Trng hp khc: Tin s tm thn.
Cn theo di: mc 1
Ngi cao tui: V nguy c tn hi n chc nng thn ngi cao tui.
TNG TC THUC
335
Didanosin
Phn tch: Tng c tnh ca didanosin (bnh vim dy thn kinh ngoi bin, tiu
chy, vim tu) do tng nng ca thuc trong huyt tng. Ngoi ra, thy mt
vi ngi bnh hin tng c ch ty xng.
X l: Nu khng trnh c phi hp ny, bo m c s theo di huyt hc
(m cng thc mu), theo di lm sng (tiu chy, bnh vim dy th n kinh ngo i
bin) v theo di tu (lipase huyt thanh).
Zalcitabin
Phn tch: Tng nguy c xut hin bnh vim dy thn kinh ngoi vi, do hip
ng cc tc dng khng mong mun. Tng tc dc lc hc.
X l: Bo m theo di lm sng u n.
Actinomycin
Phn tch: Nguy c tng c tnh v mu do hip ng tc dng c ch tu
xng c th dn n mt bch cu ht.
X l: Nu cn phi hp, nn dng liu thp cho mi thuc. Theo di cn thn
huyt .
Amphotericin B
Phn tch: Phi hp amphotericin B bng ng tim vi cc cht c vi tu
xng khc buc phi rt thn trng. Nguy c thiu mu hoc ri lon huyt hc khc.
X l: Khi cn phi hp, phi theo di cn thn huyt v tin hnh gim li u,
nu cn.
Azathioprin; carmustin hoc dn cht; cisplatin hoc dn cht; colchicin
hoc dn cht; cyclophosphamid hoc thuc tng t; doxorubicin hoc dn
cht; fluoro-5-uracil; interferon alpha ti t hp; levamisol; mercaptopurin;
melphalan; methotrexat; procarbazin; thiotepa; thuc chng ung th cc loi;
trimethoprim; vincristin hoc thuc tng t.
hin v cc phc iu tr thng c nh r.
336
Clozapin
xng c th dn n mt bch cu ht. Ch dng n c clozapin hoc
noramidopyrin cng c th mt bch cu ht nng, thm ch t vong (c tnh mi n
dch).
X l: Trnh phi hp. Nu cn phi hp, dng cc liu thp cho t ng thuc.
Khng g cho php bit trc s xut hin mt bch cu ht vi clozapin. Vic theo di
cn thn huyt , thng thc hin khi dng mt thuc km t bo, vn c gi tr. Tuy
nhin ngi bnh phi c thng bo l nu c st nh, vim hng v lot ming phi
ngng iu tr.
Phenicol
xng, c th dn n mt bch cu ht. Ch dng n c phenicol cng c th mt
bch cu ht nng thm ch gy t vong (c tnh min dch).
X l: Nu cn phi hp, dng cc liu thp cho tng thuc. Khng g cho php
bit trc s xut hin mt bch cu ht vi phenicol. S theo di cn thn huyt
thc hin bnh thng khi dng mt thuc km t bo, vn c gi tr. Tuy nhin ngi
bnh phi c thng bo l nu c st nh, vim hng v lot ming, ph i ng ng
dng cc phenicol.
Probenecid
Phn tch: Probenecid c ch s bi xut thn v c th dn n tch t
ganciclovir, do gim thanh lc ca thuc chng virus thn.
X l: Ngi k n c th dng tng tc ny gim liu ca ganciclovir. Nu
hai thuc c dng phi hp, nn iu chnh liu ca thuc chng virus.
Zidovudin
Phn tch: Phi hp zidovudin vi cc cht c vi tu xng khc buc phi rt
thn trng. Nguy c thiu mu hoc ri lon huyt hc khc.
X l: Khi cn phi hp, phi theo di cn thn huyt v tin hnh gim liu,
nu cn. Foscarnet c th l thuc thay th ganciclovir ph hp trong iu tr nhi m
Cytomegalovirus bnh nhn suy gim min dch ang dng zidovudin.
GLUCAGON
Hormon ty gy tng glucose mu
CC THUC TRONG NHM
Glucagon l bt ng kh tim 1 mg
Glucagon l bt ng kh pha tim 1 mg
337
CH KHI CH NH THUC
Chng ch nh: mc 4
H glucose mu do cc sulfamid: U glucagon, u t bo a crm v u insulin l
nhng chng ch nh s dng glucagon.
n ung; ru: H glucose mu do ung ru khng phi l mt ch nh ca
glucagon nu khng phi l ngoi l v nu iu tr c tip theo bng truyn
glucose.
i tho ng: Glucagon khng c dng cho ngi tiu ng, tr khi h
glucose mu do insulin.
TNG TC THUC
Phn tch: Tng tc dc lc. Glucagon to thun li cho c s tn to glucose
v s thu phn glycogen, bng cch kch thch adenylcyclase sn xut AMP vng.
Hu qu l lm tng nng glucose trong huyt tng.
X l: Phi hp glucagon vi cc thuc gy h glucose mu l bt hp l, tr khi
tm kim mt i khng dc l.
Biguanid; insulin
Phn tch: Tng tc dc lc. Glucagon to thun li cho tn to glucose v
ng thi c cho thy phn glycogen, bng cch kch thch adenylcyclase to AMP
vng. Hu qu l lm tng nng glucose trong huyt tng.
X l: Phi hp glucagon vi cc thuc gy h glucose mu l bt hp l, tr khi
tm kim mt s i khng dc l.
Octreotid
Phn tch: S dng glucagon trong khi iu tr bng octreotid c th to thun li
cho gim hoc tng glucose mu.
X l: Do tnh cht ca cch s dng octreotid v ca cc ch nh, vic iu tr
thng c thc hin ti c s bnh vin. ngi tiu ng c iu tr, nn theo
di cn thn glucose mu v qua iu chnh liu.
Phn tch: Tc dng tng glucose mu ca glucagon c th b gim bt ngi
bnh ang iu tr thuc chn beta. C ch cha r.
X l: Da trn cc d liu lm sng hin c, khng cn phi c nhng thn trng
c bit. Tuy nhin, nn xem xt dng glucose thay cho glucagon trong giai o n h
glucose mu ngi bnh tiu ng ang dng thuc chn beta.
338

Phn tch: Tng tc dng ca cc khng vitamin K do c ch cha xc nh.
X l: S tng ny c m t vi cc liu glucagon trn 25 mg mi ngy cho
hai hoc nhiu ngy. Liu him c s dng. Nu cn thit, tng cng theo di u
n thi gian Quick v / hoc t l chun ha quc t - INR c bit lc u, trong v
khi ngng phi hp ny. iu chnh liu tu theo kt qu sinh hc.
GLUCOCORTICOID
Thuc chng vim steroid, dn cht ca cc hormon v thng thn
CC THUC TRONG NHM

HYDROCORTISON
Hydrocortison - Richter l bt pha tim 125mg/5mL
Lycortin-S l bt pha tim 100mg (dng Na Succinat)
PREDNISOLON
Prednisolon 5mg Jenapharm vin nn 5mg
Prednisolon - Rotex Medica ng tim 25mg/mL
FLUDROCORTISON
Cortineff vin nn 0.1mg
MAZIPREDON
Depersolon ng tim 30mg/mL
PREDNISON
Apo-Prednison v Prednison Domesco vin nn 5mg
METHYL PREDNISOLON
Depo-Medrol l hn dch tim 40mg/mL
Medrol vin nn 4 mg; 16mg
Solu-Medrol l dung dch tim 40mg/mL; l bt pha tim 500mg/l
TRIAMCINOLON
Polcortolone vin nn 4mg
Kenacort retard ng cha bt pha tim 40mg/2mL; 8mg/2mL
BECLOMETHASON
Becotide bnh xt nh liu 50 mcg v 100mcg/ln ht
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Candid-B kem bi da 0,0025% v clotrimazol 1% + gentamicin 0,1%

BETAMETHASON
Betnovate kem bi da 0,1% (dng valerat)
Betnovate -GM kem bi da 0.12% + gentamicin v miconazol
Betnovate-S kem bi da 0,12% v acid salicylic 3%
Celestamine vin nn 0.25mg + dexchlorpheniramin 2mg
Celestone vin nn 0.5mg
BUDESONID
Inflamide bm xt nh liu 200mcg/liu
DEXAMETHASON
Dexone vin nn 0.5mg
Asmacort vin nn 0.25mg + theophylin v phenobarbital
Cortibion kem bi da 50mg + chloramphenicol 2g/100g
Cortebios kem bi da 50mg + chloramphenicol 2g/100g
Dexacol v dexaclor thuc nh mt 5mg c 5mg + 20mg chloramphenicol
Neodexa thuc nh mt, nh mi 5mg c 5,5mg (dng phosphat) + neomycin v
polymyxin B
FLUTICASON
Flixonase thuc xt mi 0.05% (dng propionat)
Flixotide thuc ht 125mcg/ln v 250mcg/ln
Fluticare kem bi da 0.5mg/1g
Seretide bt ht que ng ming 100-250-500mcg/liu + salmeterol
Dung dch ht qua ng ming 50-125-250mcg/liu + salmeterol
CH KHI CH NH THUC
Thi k cho con b: Do thn trng, trnh dng cho ph n cho con b, v nhng
tnh cht v nc - in gii ca nhng thuc ny tr s sinh.
Gt: Nguy c tng acid uric mu.
Thi k mang thai: Cc glucocorticoid khng c tc dng gy qui thai i vi
thai ngi (tri vi th, chut cng v chut nht), nhng gy nguy c xut hin tng
huyt p, tiu ng, tng cn nhiu ngi m v suy thng thn tr em (theo di
s sinh).
Lot d dy-t trng; vim d dy: Cc corticoid c tc dng gy lot (tng tit
acid chlohydric d dy, gim sc khng ca nim mc c
th pht hin lot tim n hoc lm tng lot sn c). Khi dng li u php corticoid di
340
ngy phi
chng lot.
kim
tra
dy,
khi
km
mt
thuc
Trng hp khc: Vi vim lot kt trng, mi ni rut v long xng, cn phi

thn trng trong s dng glucocorticoid. Cng nn thn trng trong cc trng thi nhim
khun hoc nhim nm (do c ch min dch). Cui cng, trnh k n ngi bnh
qa mn vi nhm thuc ny.
Thn trng: mc 2
Suy gan: D ho corticoid b chm li ngi suy gan do bnh nhn d b tc
dng khng mong mun ca liu php corticoid (cc ri lon tiu ho, chuyn ho, tm
thn, ni tit).
Cn theo di: mc 1
Trm cm / ng kinh: Cc tc ng tm thn ca cc corticoid c mc rt
khng ng u: nh sng khoi, mt ng, d b kch thch v xu nht l trng thi
trm cm, l ln tm thn v nh t vn. Mi khuynh hng trm cm hoc ng
kinh v cn bit bt buc phi tng cng theo di v i khi tng cng iu tr.
Tiu ng: Cc glucocorticoid lm tng tn to glucose gan (v vy mi gi l
glucocorticoid). iu ny th hin bng tng glucose mu, gim nhy cm vi insulin v
th hin tin tiu ng ngi bnh thng. Vy, phi tng cng theo di v tng
liu ca thuc gy h glucose mu ngi tiu ng.
Tr em: S chm hoc ngng ln t l vi liu dng v th hin c bit l vi
prednison v dexamethason. iu tr cch nht c th gi c s pht trin bnh
thng.
Tng huyt p: Gi mui v nc do tc dng corticoid-khong ca
glucocorticoid lm nng thm tng huyt p ng mch c trc. ngi tng huyt
p, phi hp thuc li niu vi ch king mui c th c ch.
Suy thn: Cc glucocorticoid c tc dng corticoid-khong km vi gi nc v
mui v mt kali. Ngoi ra, chng lm tng d ho protein, km vi nguy c c nh ng
t tng nit mu ngi suy thn tim n.
Nhc c: Cc corticoid, nht l loi c fluo (triamcinolon, dexamethason) c th
gy teo c v cc bnh c, nht l chi di, i khi c th cn tr vic i li. Sau thi
k , c s ci thin nhc c v prednison dung np tt hn, c a dng.
TNG TC THUC
Benzamid
Phn tch: Nguy c xut hin xon nh, khi c phi hp ny. Ch l tng tc
c m t duy nht vi sultoprid, trong nhm benzamid. H kali mu, nhp tim chm v
khong QT di c t trc (trn in tm ) l nhng yu t thun li cho s xut
hin xon nh. Xon nh l mt kiu nhp tht c bit c th xut hin tng cn rt
ngn (vi giy, mt thu: cm gic ngt v khng mt thc). Cc thuc d n n h
kali mu to thun li cho s xut hin xon nh vi cc thuc khng chng lon nhp.
X l: Nn trnh phi hp ny. Dng cc thuc khng dn n xon nh. Nu
341
cc du hiu lm sng c th bo hiu h kali mu nh mt nhc, yu c, co c ng

c.
Bepridil; halofantrin; pentamidin; vincamin
Phn tch: Nguy c xut hin xon nh, khi c phi hp ny. H kali mu, nhp
tim chm v khong QT di c t trc (ch nhn c trn in tm ) l nhng yu
t thun li cho s xut hin xon nh. Xon nh l mt kiu nhp tht c bit c th
khi tin trin n rung tht.
c.
Phn tch: Gim tc dng ca nhng thuc ny v tnh cht tng glucose mu
gin tip ca cc corticoid. Gim dung np vi glucid bi cc corticoid v nguy c xut
hin tch lu ceton.
X l: Lu n cc tc dng ca cc corticoid khi iu tr bng thuc chng tiu
ng. Cn bng glucose mu cn c thit lp khi bt u, khi ang v sau khi iu
tr bng corticoid. Thng tin cho ngi bnh v cc nguy c bin ng glucose mu v
xy dng k hoch dng thuc.
Heparin
Phn tch: Phi hp mt corticoid c tnh cht gy lot vi mt thuc chng ng
hoc mt thuc chng kt tp tiu cu lm tng nguy c chy mu d dy.
X l: Hi ngi bnh v tin s lot ca h, nu c, trnh phi hp. Nu phi
hp ny vn cn c th thc hin, buc phi theo di bng cc test ng mu thch hp
(thi gian Howell v thi gian cephalin kaolin). Tt nht l tm mt gi i php i u tr
khc.
Phn tch: Tng tc c ghi nhn duy nht vi thuc khng histamin khng an
thn l astemisol (Hismanal). H kali mu (nhng cng c tiu chy dai dng c th gy
mt mui-nc) l mt yu t thun li cho xon nh. Nguy c c tng cng khi
cc thuc gy h kali mu c phi hp vi nhng thuc khc c th gy xon nh.
Xon nh l mt kiu nhp tht c bit c th xut hin tng cn rt ngn (vi giy,
mt thu: cm gic ngt v khng mt thc).
X l: Cn trnh phi hp. Thay i chin lc iu tr v chn cc thuc khng
c bt li gy xon nh. Nu phi phi hp, theo di kali mu v, nu cn, b sung
kali.
Macrolid
Phn tch: Tng tc c ghi nhn duy nht vi erythromycin tim tnh mch,
trong h macrolid. Nguy c xut hin xon nh khi dng phi hp hai thuc ny. H
kali mu, nhp tim chm v khong QT di c t trc (ch nhn c trn in tm )
l nhng yu t thun li cho xut hin xon nh. Xon nh l mt kiu nhp tht c
342
bit c th xut hin tng cn rt ngn (vi giy, mt thu: cm gic ngt m khng mt
thc). Cc thuc dn n h kali mu to thun li cho xut hin xon nh vi
nhng sn phm khng chng lon nhip.
c.
Ritonavir
Phn tch: Ritonavir c i lc cao vi isoenzym 3A4 ca cytochrom P450. C nguy
c quan trng cnh tranh gia ritonavir v cc thuc khc c chuyn ho hoc nghi
c chuyn ho bi isoenzym ny. S cnh tranh ny s gy gim chuyn ho v
nguy c tng ng k nng ca glucocorticoid trong huyt tng. Nguy c ph v
tng huyt p km tng tnh d kch ng (c m t vi prednison v prednisolon).
Tng tc dc ng hc v chuyn ho thuc.
X l: Theo di cht ch ngi bnh v s xut hin tc dng c v gim liu
corticoid tu trng hp.
Sparfloxacin
Phn tch: Tng tc ny ch c gi tr vi sparfloxacin (Zagam). Tng nguy c
xon nh do hip ng cc tc dng in sinh l. H kali mu, nhp tim chm v
khong QT di c t trc (ch nhn c trn in tm ) l nhng yu t thun li
cho xut hin xon nh. Xon nh l mt kiu nhp tht c bit c th xut hin tng
cn rt ngn (vi giy, mt thu: cm gic ngt m khng mt thc).
c.
Phn tch: Dng cc thuc nhun trng lm trn di hn (cng nh tiu chy
nng) c th gy h kali mu.
X l: Nu phi hp cc thuc nhun trng lm trn vi glucocorticoid xt ra c
ch, nn phng nga h kali mu bng cch cung cp kali v nu cn, tu theo lm
sng m theo di in tm . Nguy c h kali mu t hn l vi thuc nhun trng kch
thch. Khuyn ngi bnh t b sung kali (n nhiu chui, mn...) v cho theo di kali
mu. Nn nh, h kali mu biu hin bng tnh trng mt nhc, yu c, thm ch co
cng c. Nu nhng triu chng ny xut hin, khuyn ngi bnh gp li thy thuc
iu tr.
Vaccin sng gim c lc
Phn tch: Nguy c mc nhim khun tng ng vi vaccin do tc dng c ch
X l: Khong cch phi tn trng gia hai thuc l t 3 thng n 1 nm v ph
thuc vo mc c ch min dch.
343
Amiodaron
Phn tch: Nguy c xon nh c to thun li bi h kali mu. H kali mu,
nhp tim chm v khong QT di c t trc (ch nhn c trn in tm ) l nhng
yu t thun li cho xut hin xon nh. Xon nh l mt kiu nhp tht c bit c
thc).
X l: Nu phi hp cc sn phm gy h kali mu vi amiodaron l cn thi t,
ngn nga h kali mu bng cch tng cng gim st v theo di in tm . Trng
hp xut hin xon nh, khng dng thuc chng lon nhp. Nn nh, h kali mu
biu hin bng trng thi mt nhoc, yu c, thm ch co cng c. Nu nh ng tri u
chng ny xut hin, khuyn ngi bnh gp li thy thuc iu tr.
Amphotericin B
Phn tch: Tc dng gy h kali mu tng vi amphotericin dng tim.
Amphotericin B rt t c hp thu khi dng ng ung hoc ti ch, trong cc iu
kin bnh thng.
X l: Theo di kali mu. nh gi cc nguy c tng tc tu theo ng s dng
amphotericin.
Asparaginase
Phn tch: Tng tc dng gy tng glucose mu v tng nguy c bnh vim dy
thn kinh ngoi bin v ri lon to hng cu.
X l: Phi hp c cc thy thuc chuyn khoa theo di ti bnh vin. c tnh
s yu hn khi asparaginase c dng sau corticoid, ch khng phi l trc hoc
trong khi dng corticoid.
Phn tch: Tng d ho ca corticosteroid bi cc thuc cm ng enzym. S cm
ng enzym ch th hin 10 - 12 ngy sau khi bt u iu tr.
thuc cm ng enzym trung v di hn phi tnh n nguy c gim tc dng iu tr.
iu chnh liu ca corticosteroid trong v sau khi ngng cht cm ng.
Cc dn cht salicylic; indometacin hoc dn cht; pyrazol; thuc chng
vim khng steroid
Phn tch: Tng tc dng khng mong mun do hip ng tc dng gy lot trn
nim mc d dy.
X l: Cn nhc li ch / nguy c trc khi k n mt phi hp nh vy. Do tng
nguy c gy lot, phi xem xt li cch iu tr cho ngi bnh cao tui v ng i c
tin s lot. Nu cn thit, phi hp cc thuc bo v nim mc d dy.
Ciclosporin
Phn tch: Tuy s phi hp ny c li v iu tr ghp c quan, nhng c tnh c
th tng. C ch do c s gim d ho ca mt hoc c hai thuc gan.
X l: iu chnh liu ca mt hoc c hai thuc nu c du hiu thi ghp hoc
c tnh xy ra.
344

Phn tch: Hiu lc ca thuc chng tng huyt p gim, c l do tc dng ca
corticosteroid gi natri.
X l: Nu cn phi hp, tng cng theo di huyt p, trong v khi ng ng iu
tr bng mt trong hai thuc. Tin hnh iu chnh liu. Nhn mnh v k hoch dng
thuc v s tun th. c bit cnh gic khi dng ngi bnh cao tui.
Corticoid-khong; tetracosactid
Phn tch: Phi hp hai thuc h kali mu, dn n tng nguy c h kali mu v
nguy c xut hin xon nh.
X l: Theo di kali mu v hiu chnh nu cn, bng mui kali. H kali mu biu
hin lm sng bng mt nhc, thm ch co cng c v i khi ri lon nhp tim. Ch ,
s mt nc qu mc (khi hot ng th lc hoc nng nhiu hoc tiu chy dai dng)
cn lm tng hn na s mt kali. Khuyn ngi bnh t b sung nht thi kali (chui,
mn).
Cura cc loi
Phn tch: Nguy c tng chn thn kinh - c do h kali mu, nht l vi cc loi
cura khng kh cc.
cc.
X l: C th cn phi nh lng kali mu trc khi dng loi cura khng kh

Dihydropyridin
Phn tch: Gim tc dng chng tng huyt p; cc thuc chng vim c ch
tng hp prostaglandin thn gy gin mch, v/hoc dn n gi mui v nc.
Nguy c suy thn cp ngi bnh mt nc.
X l: Xc minh c s tip nc tt cho ngi bnh. Theo di chc nng thn (
thanh lc creatinin) kim sot s n nh ca huyt p, c bit lc u iu tr.
Khuyn ngi bnh theo di u n huyt p ng mch.
Disopyramid
Phn tch: Nguy c xon nh khi phi hp cc thuc ny. H kali mu, nhp tim
chm v khong QT di c t trc (trn in tm ) l nhng yu t thun li cho
xut hin xon nh. Xon nh l mt kiu nhp tht c bit c th xut hin tng cn
rt ngn (vi giy, mt thu: cm gic ngt m khng mt thc).
X l: Nu cn phi hp, phi phng nga h kali mu bng cch tng cng
gim st v theo di in tm . Khi xut hin xon nh, khng dng thuc chng
lon nhp. Nn nh, h kali mu biu hin bng trng thi mt nhc, yu c, thm ch
co cng c. Nu nhng triu chng ny xut hin, khuyn ng i bnh g p l i th y
thuc iu tr.
Phn tch: Tng tc dng v c tnh ca mt s glucocorticoid (prednison v
prednisolon), do b chm chuyn ho, khi c dng cng vi cc thuc nga thai
ung.
345
X l: C th cn phi gim liu ca corticosteroid nu thm thuc nga thai

ung vo phc .
Furosemid hoc thuc tng t; thuc li tiu gy h kali mu
Phn tch: Phi hp hai thuc gy h kali mu, dn n tng nguy c h kali mu
X l: Theo di kali mu v hiu chnh nu cn bng mui kali. H kali mu th
s mt nc qu mc (n lc hot ng th lc, nng nhiu hoc tiu chy dai dng)
lm nng thm s mt kali. Khuyn ngi bnh t b sung nht thi kali (chui, mn).
Glycosid tr tim
Phn tch: Cc glucocorticoid dng di ngy gy h kali mu, dn n yu c, c
kh nng lm tng c tnh ca cc dn cht digitalis. Cc glycosid tr tim c ch
ATPase Na+/ K+ lin quan n chuyn vn cc ion natri v kali qua mng t bo c tim.
H kali mu nng (< 3mEq/ lt) c th dn n ngoi tm thu tht hoc nh v nhp tim
nhanh tht hoc nh v c ri lon ln v dn truyn nh tht. ngi bnh i u tr
digitalis, cc ri lon tng t xut hin khi kali mu h t hn.
X l: Trc khi dng phi hp hai thuc ny, cn tin hnh nh lng kali
huyt thanh, v hiu chnh tnh trng h kali mu nu c, v theo di u n kali
mu. Tng tc ny da vo nhng chng c dc l. Nn nh rng, v lm sng, h
kali mu c th bt u bng yu c, co cng c ri n nhng triu chng nng hn
nh: ri lon nhp v lit h hp. Cn d chng h kali mu c th do ra m hi qu
mc hoc tiu chy dai dng.
Phn tch: Aminogluthetimid l mt cht cm ng enzym, lm tng chuyn ho
cc corticoid-khong, do c th lm gim tc dng ca cc corticoid-khong. Cn
phi nh gi ngha lm sng ca tng tc ny.
X l: Lu n thi gian iu tr vi cc corticoid-khong. S cm ng enzym
ch th hin dn dn, sau nhiu ngy iu tr. Cn phi xc nh ngha lm sng ca
tng tc ny.
Phn tch: Nguy c c ch tc dng sinh hc ca interferon, c m t vi
prednison, nhng cng c gi tr vi cc corticoid khc. C ch cha r.
X l: Phi lu s gim tc dng ny trc khi phi hp nhng thuc ny.
Nghin cu tng quan nguy c/ li ch v gi c/ hiu qu.
Phn tch: Cc glucocorticoid c m t l lm gim tc dng chng u ca
aldesleukin.
X l: Mc du c tnh cht lm gim tc dng chng u, dexamethason hay c
dng gim nhiu tc dng khng mong mun ca interleukin (st, suy thn, tng
bilirubin mu, kh th, l ln...). Ngi k n phi thng xuyn cn nhc nguy c / li
ch.
346

Phn tch: Khng m t cho c h thuc, m ch vi prednisolon. Nguy c tng
chuyn ho ca isoniazid gan, km theo gim tc dng cng gim c tc dng ca
corticoid.
X l: Nguy c tht bi iu tr vi isoniazid, nu iu tr vi prednison phi ko
di. Trng hp ny, lu n nhng hu qu ca tng tc trong iu tr duy tr
phi hp hay khng. Vi cc corticoid khc, phi cnh gic.
Methyldopa; guanethidin hoc thuc tng t; reserpin; thuc gin mch
chng tng huyt p; thuc c ch enzym chuyn dng angiotensin
Phn tch: Cc tc dng chng tng huyt p c th gim do gi mui v nc
m glucocorticoid gy ra.
X l: iu chnh liu trong v sau iu tr bng corticoid. Thng tin cho ngi bnh
nn tng cng t theo di trong khi iu tr bng corticoid. Khuyn t k hoch dng
thuc u n trong qu trnh iu tr. Nu c nhng bin ng huyt p quan trng,
khuyn ngi bnh gp li bc s
Praziquantel
Phn tch: Tng tc dc ng hc, c xc nh r vi dexamethason. Gim
50% hm lng praziquantel khi phi hp vi dexamethason.
X l: iu tr ph thuc liu, phi lu tng tc ny iu chnh liu. Tu
trng hp, thay i corticoid v cnh gic.
Quinidin hoc dn cht
Phn tch: Nguy c xut hin xon nh khi phi mt thuc h kali mu vi mt
thuc chng lon nhp nhm mt Vaughan - Williams. H kali mu, nhp tim chm v
khong QT di c t trc (ch nhn thy trn in tm ) l nhng yu t thun li
cho s xut hin xon nh. Xon nh l mt kiu nhp tht c bit c th xut hin
tng cn rt ngn (vi giy, mt thu: cm gic ngt v khng mt thc).
X l: Nu cn phi hp glucocorticoid vi quinidin, ngn nga h kali mu bng
cch cung cp kali c tnh ton v nu cn th cho lm in tm . Trng hp xon
nh, khng dng thuc chng lon nhp. Nn nh, h kali mu biu hin bng trng
thi mt nhoc, yu c, thm ch co cng c. Nu nhng tri u chng ny xu t hi n,
khuyn ngi bnh gp li thy thuc iu tr.
Sotalol
Phn tch: Nguy c xon nh khi phi hp nhng thuc ny. H kali mu, nhp
tim chm v khong QT di c t trc (trn in tm ) l nhng yu t thun li cho
xut hin xon nh. Xon nh l mt kiu nhp tht c bit, c th xut hin tng c
rt ngn (vi giy, mt thu: cm gic ngt m khng mt thc)
X l: Nu cn phi hp cc corticoid vi sotalol, ngn nga h kali mu bng
cch tng cng theo di, v theo di in tm . Trng hp xut hin xon nh,
khng dng thuc chng lon nhp. Nn nh, h kali mu biu hin bng trng thi mt
nhoc, yu c, thm ch co cng c. Nu nhng triu chng ny xut hin, khuyn
347
Phn tch: Dng ng thi hai thuc c th lm tng nguy c xut hin ph.
Tng tc dc lc.
X l: Cn nhc s cn thit phi k n hai thuc v, nu cn, iu chnh liu
v theo di ion . Ch n vic s dng "ln lt" steroid ng ho (vn ng vin
th thao).
Phn tch: Tc dng ca corticosteroid c th tng, c th dn n tng c tnh.
C ch c l do cc thuc chng nm imidazol c ch chuyn ho ca corticosteroid
(CYP3A4) v lm gim o thi cht ny.
X l: Theo di cht ch ngi bnh v cc tc dng ph. iu chnh liu nu
cn thit.
Phn tch: Thuc khng acid lm gim hp thu qua ng tiu ho v do lm
gim tc dng ca thuc c phi hp.
X l: Cn ung hai thuc cch nhau t nht 1-2 gi. Nn nh rng cc thu c
khng acid thng c dng 1 gi 30 pht sau ba n, v n ung lm tng tit dch
v.
Thuc li tiu gi kali
Phn tch: Phi hp mt thuc li tiu c tc dng h huyt p vi cc corticoid
c tc dng gi mui v nc. Tc dng sau c th lm gim tc d ng chng tng
huyt p
X l: Lu nhng tc dng dc l ny iu chnh liu. Thng tin cho ngi
bnh h tng cng t theo di huyt p. Xy dng k hoch dng thuc theo gi
gic u n.
Phn tch: Phi hp hai thuc gy gim kali mu dn n tng nguy c h kali
mu nht l khi dng thuc nhun trng di ngy.
X l: Theo di kali mu v hiu chnh nu cn, bng mui kali. H kali mu biu
s mt nc qu mc (khi hot ng th lc hoc nng nhiu hoc tiu chy dai dng)
cn lm tng hn na s mt kali. Khuyn ngi bnh t b sung nht thi kali (chui,
mn).
Phn tch: Tc dng gy lot ca corticoid lm tng nguy c lot chy mu, nht
l ngi bnh cao tui.
X l: Hi ngi bnh v tin s lot, tng cng theo di lm sng v sinh hc,
nu cn phi hp ny.
348
GLUTETHIMID HOC THUC TNG T

Thuc ng dng trong mt s hnh thi ung th (v) v trong chng tng nng
v thng thn nh tnh cht c ch tng hp steroid ca thuc
CC THUC TRONG NHM

GLUTETHIMID vin nn 250 mg
Rigenox vin nn 250 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai: Nguy c tnh trng lng tnh gi. Hy dng bin php nga
thai khng c hormon.
Ri lon chuyn ho porphyrin: Do thn trng, v thiu d liu.
Cc trng thi khc: Qu mn vi thuc.
n ung; ru: Ru lm tng tc dng c ch h thn kinh trung ng ca
cc thuc ny. Gluthetimid nh hng n chuyn ho ca ru v lm tng nng
ru trong mu.
TNG TC THUC
Benzodiazepin; dextropropoxyphen
to ngi li tu xe v ngi vn hnh my mc. Khuyn khng ung ru v khng
t dng thuc hoc ch phm cha ru.
xut
Phn tch: Aminogluthetimid gy cm ng enzym. Tng chuyn ho cc

estroprogestogen v cc progestogen gan do cm ng enzym, do dn n nguy
c th thai.
X l: Trnh dng cc thuc nga thai liu thp v tt hn nn dng thuc ng a
thai liu cao hoc khuyn p dng mt bin php nga thai khc, nu i u tr b ng
gluthetimid ko di. Cn nh cm ng enzym khng bao gi l mt hin tng tc thi.
Ru
349
an thn bun ng. Mt s thuc c th c tc dng tm thn vn ng, nht l trong
tun iu tr u tin. Tng tc dc lc.
X l: Tt nht, khng nn dng thuc ny, v ngi k n khng kim sot
c vic ung ru ca ngi bnh. Nguy c an thn bun ng nguy him cho ngi
li tu xe v ngi vn hnh my mc. Khuyn ngi bnh khng ung ru v khng
t dng thuc hoc ch phm cha ru.
Amineptin
Phn tch: Tng tc dng c ch h thn kinh trung ng, c ch h hp v h
huyt p. Hn na, phi hp hai thuc ny c th lm tng nguy c l thuc thuc.
n gim tnh to ngi li tu xe v ngi vn hnh my mc. Khuyn khng ung
ru v khng t dng thuc hoc ch phm c ru.
Phn tch: i khng tc dng; c th lm tng tnh hung hn ng i nghi n
amphetamin.
ngi bnh gp li bc s iu tr, nu thy iu tr khng n nh.
Baclofen
Phn tch: Tng tc dng c ch h thn kinh trung ng dn n tng tc dng
an thn bun ng. Tng tc dng h huyt p. Tng tc dc lc.
n gim tnh to ngi li tu xe v ngi vn hnh my mc. Theo di huyt p.
Khuyn khng ung ru v khng t dng thuc hoc ch phm c ru.
Carbamat hoc thuc tng t; barbituric; dantrolen; primidon hoc dn
cht; thuc chng ng kinh khng barbituric; thuc gy c ch h thn kinh
trung ng khc.
X l: Lu nguy c ny iu chnh liu lng ca hai thuc. Ch n gim
tnh to ngi li tu xe v ngi vn hnh my mc. Khuyn khng ung r u v
Corticoid-khong
Phn tch: Aminogluthetimid gy cm ng enzym, kch thch chuyn ho ca
dexamethazon, nhng vi hydrocorticoid th khng, do vy c th lm gim cc tc
dng cc thuc ny.
X l: Lu tng tc dc ng hc ny tu theo mc ch iu tr. Tnh n
thi gian iu tr corticoid: cm ng enzym ch th hin sau nhiu ngy iu tr. Tng
tc ch c m t vi dexamethazon.
350
Disopyramid
Phn tch: Tng cc tnh cht khng cholinergic nh b tiu tin, kh ming v to
bn.
X l: Lu nhng tc dng ph ca phi hp thuc ny. Nu cn phi hp, hy
cnh bo cho ngi bnh nhng tc dng ph. Trnh dng cho ngi b bnh tuyn
tin lit v ngi b tng nhn p.
Glycosid tr tim
Phn tch: Tng chuyn ho gan, do cm ng enzym, dn n gim hot tnh
ca thuc digitalis chuyn ho (l digitalin tri vi digoxin).
X l: Lu nguy c ny iu chnh liu ca digitalin (digoxin c thi qua
thn), nu cn phi hp. iu chnh liu trong v sau khi iu tr.
Glucocorticoid
Phn tch: Aminogluthetimid gy cm ng enzym, kch thch chuyn ho ca cc
corticoid-khong, do vy lm gim cc tc dng ca cc cht thuc nhm ny. Cn
phi c tnh ngha lm sng.
X l: Lu tng tc dc ng hc ny tu theo mc ch iu tr. Tnh n
thi gian iu tr bng cc corticoid-khong: cm ng enzym ch th hin sau nhiu
ngy iu tr. Cn phi xc nh ngha lm sng.
Khng cholinergic; medifoxamin
Phn tch: Gluthetimid c tnh khng cholinergic v an thn. S phi hp dn n
tng tc dng khng cholinergic v an thn, biu hin bng tc dng c ch h thn
kinh trung ng, v tng nguy c b tiu tin, kh ming v to bn.
X l: Lu nhng iu bt li ca phi hp thuc ny. Nu cn phi hp ny,
hy cnh bo cho ngi bnh nhng tc dng ph. Trnh dng cho ngi b bnh
tuyn tin lit v ngi b tng nhn p. Ch ngi vn hnh my mc v tu xe
(tng tc dng an thn bun ng). Xt nguy c tu theo dng bo ch c dng (dng
ti ch); ch dng nh mt; cng phi theo di vic t dng thuc.
Methadon
Phn tch: Tng tc dng c ch h thn kinh trung ng, vi tc dng an thn
bun ng mnh, c bit c hi ngi iu khin tu xe v my mc.
X l: Lu s gia tng tc dng an thn ny a ra nhng li khuyn thch
hp (trnh li tu xe hoc vn hnh my mc; bo cho ngi xung quanh bit mi nguy
him).
Methyldopa
Phn tch: Phi hp glutethimid vi cc thuc chng tng huyt p, gia tng nguy
c h huyt p t th ng trm trng.
X l: Thng tin cho ngi bnh v phn b vic dng thuc trong ngy.
Phn tch: Dng ng thi hai thuc ny c th dn n bin ng huyt p
nghim trng. Hn na, thm vo l cc tc dng c ch h thn kinh trung ng.
351
X l: Cc thuc c ch MAO him khi c s dng; c rt nhiu tng tc v

v him khi k n nn c t cc nhn xt v cnh gic thuc. Hy tun th mt cch
thn trng khong cch hai n ba tun sau khi ngng iu tr, trc khi k n l i
thuc c ch MAO.
Khng histamin khng H1 an thn; thuc chng trm cm ba vng hoc cc
thuc tng t.
Phn tch: Gluthetimid c tnh khng cholinergic v an thn. Do vy, phi hp dn
n tng tc dng khng cholinergic v an thn, th hin bng tc dng c ch h thn
kinh trung ng v tng nguy c b tiu tin, kh ming v to bn.
X l: Lu nhng tc dng ph ca phi hp thuc ny. Nu cn phi hp, hy
cnh bo cho ngi bnh bit nhng tc dng ph . Trnh dng cho ngi b bnh
tuyn tin lit v ngi b tng nhn p. Ch ngi vn hnh my mc v tu xe do
tng tc dng an thn bun ng. Xt nguy c tu theo dng bo ch c dng (dng
ti ch); ch dng nh mt; cng phi theo di vic t dng thuc.
Oxaflozan
to ngi li tu xe v ngi vn hnh my mc. Khuyn khng ung ru v khng
t dng thuc hoc ch phm c ru.
Sulfamid lm h glucose mu
Phn tch: Aminogluthetimid tc dng nh mt cht cm ng enzym. Thuc ny
c th lm tng chuyn ho ca cc sulfamid h glucose mu v lm mt cn bng ca
iu tr i tho ng.
X l: iu chnh liu trong v sau khi iu tr vi aminogluthetimid. Thng tin cho
ngi bnh tng cng t theo di khi phi hp hai thuc ny. K n mt k hoch
dng thuc r rng.
Tetracyclin
Phn tch: Tng d ho doxycyclin gan do cm ng enzym. Tuy iu ny khng
xy ra vi cc tetracyclin khc khng thi qua thn, nhng vn cn phi thn trng.
X l: Tng tc ny i hi phi iu tr nhiu ngy mi xy ra. Nguy c tht bi
iu tr xy ra nu nng ti thiu c ch (MIC) ca khng sinh khng i vi mt
mm bnh. Lu nguy c ny v tu trng hp, la chn chin lc iu tr khng
sinh khc.
Thuc ch vn morphin
X l: Theo di huyt p trong khi phi hp. Ty theo thuc dng, h huyt p c
th nh hoc nng. Tu trng hp, iu chnh liu ca mt hoc hai thuc. Thit lp
mt k hoch dng thuc u n. Khuyn ngi bnh, nu thy chng mt ngay t
u iu tr, gp li bc s iu tr iu chnh liu ca mt hoc hai thuc. Tng
cng theo di ngi bnh cao tui (nguy c ng) v khuyn h khng nn thay i
t th t ngt t nm hoc ngi sang ng.
352
Thuc gy m loi barbituric

X l: Nu cn phi hp, lu nguy c ny khi gy m v la chn liu dng.
Phn tch: Tng tc dng lm h huyt p.
X l: iu chnh liu. Thit lp mt k hoch dng thuc v nhn mnh vic
tun th. Ngay t u iu tr, khuyn ngi bnh o u n huyt p cho n khi t
c s cn bng trong iu tr.
Thuc ung chng ng mu, khng vitamin K
Phn tch: Aminogluthetimid l cht cm ng enzym, gy tng nhanh tc d
ho gan ca thuc chng ng mu. Cm ng enzym khng phi l hin tng tc
thi, pht huy tc dng, cn mt t iu tr vi cht cm ng enzym t tr c t
nht 10 ngy.
K n: Phi tnh n nh hng ny iu chnh liu thuc ung chng ng
mu v phi theo di sinh hc t l chun ha quc t -INR v t l prothrombin
thng xuyn hn nu thm gluthetimid vo liu php chng ng hoc lc ngng
gluthetimid.
GLYCOSID TR TIM
Thuc tr tim dng trong suy tim c lu lng thp v trong lon nhp trn tht.
Thuc c tnh: tng lc co c tim, lm chm tn s tim, dn truyn c (tnh dn)
v lm tng tnh kch thch cc t bo c tim
CC THUC TRONG NHM

Digoxin vin nn 0,25 mg
Digoxine Nativelle vin nn 0,25 mg
CH KHI CH NH THUC
Blc nh tht, nhp tim chm, ngoi tm thu tht, nhp tim nhanh, nhp nhanh
tht, rung tht l nhng chng ch nh s dng cc dn cht digitalis, nng nh nhiu
hay t tu theo mc .
Cn theo di: mc 1
Thi k cho con b: Do thn trng, v tnh cht dc l ca thuc.
353
Thi k mang thai: Do thn trng, theo di nng trong huyt thanh ba thng
cui thai k.
Suy thn: Digoxin: nguy c cao ng c digitalis do tng nng trong huyt
thanh v tng na i. Ouabain: tng hm lng trong huyt thanh m khng tng na
i (hin tng khng c gii thch r). Digitoxin khng tng hm lng trong huyt
thanh v gim na i, do khng c nguy c.
Ngi cao tui: Ng c digitalis thng hay gp ngi cao tui. Tng c
tnh do gim khi lng c, to thun li lm tng nng trong huyt tng, h kali
mu (n ung khng , thuc nhun trng, thuc li niu) v gi m o thi thn.
Cn gim liu.
TNG TC THUC
Benzamid
Phn tch: Ch ring sultoprid (Barnetil) trong nhm benzamid l c th c nguy c.
Mi sn phm gim lc co c (gy chm nhp tim) c th dn n tng nguy c r i
lon nhp tht, nht l xon nh, do thm cc tnh cht in sinh l ca sultoprid.
Bretylium
Phn tch: S gii phng ban u noradrenalin do bretylium, c nguy c lm tng
c tnh ca cc dn cht digitalis (ri lon nhp nng thm).
X l: Cn trnh phi hp v thay i cch iu tr, nu khng c phng tin
theo di thng xuyn ti c s chuyn khoa.
Calci; magnesi
Phn tch: Tim tnh mch calci v magnesi cng lc vi cc dn cht digitalis c
th gy t vong. Dng magnesi hoc calci ng ung, phi hp vi vitamin D c th
lm xut hin ri lon nhp tht (ngoi tm thu, nhp tim nhanh, rung tht).
X l: Chng ch nh dng phi hp calci tim tnh mch vi dn cht digitalis.
Thay i chin lc iu tr. Khi phi hp calci hoc magnesi bng ng ung vi
vitamin D, phi theo di lm sng v nu cn, phi theo di c in tm .
Cyclosporin
Phn tch: Tc dng dc l ca digoxin c th tng. Hm lng digoxin tng v
c tnh c th xy ra. C ch khng r, c l l c ch dc ng hc.
X l: Khi cyclosporin c dng cng, theo di bnh nhn v tng nng
digoxin v du hiu c tnh. Nu c bng chng v c tnh digoxin, cho ngng
digoxin v gim liu khi li tip tc iu tr. iu chnh li liu ca digoxin sau khi ghp
tim.
Tetracyclin
Phn tch: Dng tetracyclin cng vi digoxin c th dn n tng hm lng
digoxin huyt thanh khong 10% s bnh nhn. c tnh ca digoxin c th xy ra.
354
Cc tc dng ny c th tn ti hng thng sau khi ngng tetracyclin. C ch: C

khong 10% s bnh nhn, mt lng ln digoxin b chuyn ho bi vi khun ng
tiu ho thnh nhng sn phm kh, khng cn hot tnh. Tetracyclin c th c ch
qu trnh ny do lm thay i h vi khun ng rut, do c thm nhi u digoxin
c hp thu v hm lng digoxin huyt thanh tng.
X l: Theo di ngi bnh v tng hm lng digoxin v du hiu qu tha
digoxin. C th cn phi gim liu digoxin. S dng dng nang c th gim thiu s
to thnh sn phm kh v lm tng sinh kh dng.
Thuc cng giao cm
Phn tch: Dng ng thi hai thuc c th dn n tng nguy c lon nhp tim.
hp.
X l: Nu cn phi hp, b tr theo di in tm . Tuy nhin nn trnh phi

Phn tch: Nguy c xut hin ri lon tnh t ng v dn truyn nh -tht v/

hoc trong tht.
X l: Nn trnh phi hp ny. Nu cn phi hp, tng cng theo di in tm
v thn trng khi dng.
Acarbose
Phn tch: Nng digoxin trong huyt thanh c th gim, lm gim tc dng
iu tr. C ch nghi do hp thu ca digoxin b nh hng.
X l: Theo di ngi bnh v gim p ng iu tr vi digoxin. Nu nghi c
tng tc, c th cn thit phi tng liu ca digoxin hoc ngng acarbose.
Actinomycin; azathioprin; carmustin hoc dn cht; cisplatin hoc dn
cht; cyclophosphamid hoc thuc tng t; doxorubicin hoc dn cht; fluoro5-uracil; mercaptopurin; methotrexat; procarbazin; thiotepa; thuc iu tr ung
th cc loi
Phn tch: Phi hp vi thuc km t bo dn n km hp thu cc dn cht
digitalis khong 50% do nim mc rut b tn thng nhng c kh nng hi phc
c.
X l: Theo di cn thn hm lng cc dn cht digitalis trong huyt thanh trong
sut qu trnh iu tr phi hp.
Aminosid ung
Phn tch: Nhn xt ch yu vi neomycin, cht ny lm gim v chm hp thu
digoxin, ngay c khi digoxin c ung 6 gi trc. Cng c th l neomycin, khi dit vi
khun ng rut s ko di tc dng ca cc dn cht digitalis bng cch c ch d
ho digoxin.
355
X l: Khi k n ng thi hai thuc, phi theo di cn thn hm lng digoxin

trong huyt thanh. Nn nh rng cc du hiu lm sng chnh ca ng c digitalis l
bun nn, nn v ri lon nhn mu.
Amiodaron
Phn tch: Tng nguy c nhp tim chm. Ngoi ra, amiodaron lm tng hm lng
digoxin trong huyt thanh dn n tng tc dng dc l v c tnh ca thuc ny.
X l: Khi bt u iu tr vi amiodaron, liu lng ca cc dn cht digitalis
phi gim 50%. Sau theo di cn thn hm lng ca chng trong v sau khi iu
tr.
Nn
nh
rng
amiodaron
c
na
i
l
28
ngy,
v tc dng ca tng tc c th cn th hin nhiu tun sau khi ngng
iu tr.
Amphotericin B
Phn tch: Dng amphotericin B bng ng tim gy h kali mu, dn n yu
c, nn c th lm tng thm tc dng ca cc loi cura khng kh cc (l nhng cht
chn tip ni thn kinh - c) v lm nng thm c tnh ca cc dn cht digitalis. Cc
glycosid tr tim c ch ATPase Na+ / K+ l enzym lin quan n s chuyn vn cc ion
natri v kali qua mng t bo c tim. H kali mu nng ( 3mEq/ lt) c th gy ngoi
tm thu tht hoc nh v lon nhp nhanh tht hoc nh v c ri lon ln v dn truyn
nh - tht. ngi bnh iu tr digitalis, cc ri lon tng t cng xut hin c khi
tnh trng kali mu h t hn.
X l: Trc khi dng ng thi hai thuc ny, cn tin hnh nh lng kali
mu v hiu chnh h kali mu nu c, v theo di u n kali mu. Nn nh v lm
sng, h kali mu c th bt u bng yu c, chut rt r i n nhng tri u ch ng
nng
hn
nh:
r i
lon
nhp
tim
v
lit
h
hp. Cn d chng h kali mu gy ra do ra m hi qu mc hoc tiu chy dai dng.
Barbituric; gluthetimid hoc thuc tng t; phenytoin; rifampicin
Phn tch: Tng chuyn ho gan, do cm ng enzym dn n gim tc dng
ca cc dn cht digitalis.
X l: Lu nguy c ny iu chnh liu ca cc dn cht digitalis, nu cn
phi hp ny. iu chnh liu digoxin trong khi iu tr v sau khi ngng cc thuc phi
hp (barbituric).
Bepridil
Phn tch: Ri lon tnh t ng tm tht khi phi hp hai thuc gy nhp tim
chm (nguy c nhp tim chm qu mc). Ri lon dn truyn nh - tht, c th dn n
suy tim.
X l: Phi hp phi c qun l c s chuyn khoa, cho php theo di u
n, nht l khi bt u iu tr.
Cc thuc gy m bay hi cha halogen
X l: Nu cn phi phi hp hai loi thuc ny, lu nguy c khi gy m v khi
la chn liu dng. Khuyn ngi bnh phi phu thut hy thng tin cho ngi gy
m cc thuc m bn thn ang dng.
356
Carbamazepin
ca digitalis chuyn ho (ngha l ca digitalin, tri vi digoxin).
X l: Lu nguy c ny iu chnh liu ca digitalin (digoxin thi qua ng
thn) nu cn phi hp. iu chnh liu, trong v sau khi iu tr vi cc barbituric.
Cholestyramin
Phn tch: Gim hp thu glycosid tr tim qua ng tiu ho.
X l: Trong trng hp phi hp, khuyn dng glycosid tr tim trc 2 gi hoc
4 gi sau cholestyramin.
Diltiazem
Phn tch: Tng tc ny cn ang tranh ci. Theo mt s tc gi, nng
digoxin trong huyt thanh ngi bnh c th tng ln ng k; theo mt s tc gi
khc, li khng bin i.
X l: Do cn tranh ci, nn cn cnh gic v theo di lm sng ngi bnh cng
vi theo di hm lng glycosid tr tim trong huyt thanh, nu cn, trong v sau khi
ngng iu tr bng diltiazem.
Fluoxetin
Phn tch: Nguy c chuyn dch cc glycosid tr tim ra khi v tr lin kt vi
protein huyt tng, dn n lm tng phn t do ca thuc digitalis v tng cc tc
dng khng mong mun ca cc thuc digitalis.
X l: Theo di lm sng ngi bnh v cc triu chng nhim c (bun nn,
nn, nhp tim chm, ri lon nhn mu sc). Yu cu xc nh nng digoxin nu cn
phi hp ny. Tng cng theo di, c bit khi s dng ngi bnh cao tui.
Phn tch: Furosemid v thuc li tiu thi kali gy h kali mu, dn n yu c
nn c kh nng tng c tnh ca cc digitalis.
Cc glycosid tr tim c ch ATPase Na+ / K+ l enzym lin quan n vn chuyn
cc ion Na+ v K+ qua mng t bo c tim. H kali mu trm trng
( 3mEq/lt) c th gy ngoi tm thu tht hoc nh v lon nhp nhanh tht hoc nh v
c ri lon ln v dn truyn nh - tht. ngi bnh iu tr digitalis, nhng ri lon
tng t cng xut hin c khi kali mu h t hn.
X l: Trc khi iu tr ng thi hai thuc ny, cn nh lng kali mu v hiu
chnh h kali mu tu trng hp c th ng thi theo di u n kali mu. Nh rng
trn lm sng, h kali mu c th bt u trc tin bng yu c, co cng c ri n
cc triu chng trm trng hn: ri lon nhp tim, lit h hp. D chng h kali mu gy
ra bi tng tit m hi qu mc v tiu chy ko di. Mt cch la ch n khc l s
dng thuc li tiu gi kali thay cho thuc li tiu thi kali.
Glucocorticoid; corticoid-khong
Phn tch: Dng glucocorticoid hoc corticoid-khong di ngy gy h kali mu,
dn n yu c v c kh nng tng c tnh ca thuc digitalis. Cc glycosid tr tim
c ch ATPase Na+ / K+, enzym ny lin quan n s vn chuyn cc ion Na + v K+ qua
357
mng t bo c tim. H kali mu trm trng ( 3mEq/lt) c th gy ngoi tm thu tht

hoc nh v lon nhp nhanh tht hoc nh v ri lon ln dn truyn nh tht. ngi
bnh iu tr digitalis, nhng ri lon tng t cng xut hin c khi kali mu h t hn.
chnh h kali mu tu trng hp c th v theo di u n kali mu. Nh rng, trn
lm sng, h kali mu c th bt u trc tin bng yu c, co cng c ri n cc
triu chng trm trng hn nh ri lon nhp tim, lit h hp. D chng h kali mu gy
ra do tit m hi qu mc v tiu chy ko di.
Kali
Phn tch: Khng khuyn co b sung kali ngi bnh ang iu tr digitalis (tr
trng hp h kali mu), do nguy c xut hin v/hoc lm nng thm bloc tim nhm
ngi bnh c nguy c.
X l: ngi bnh c nguy c (nh blc tim), phi theo di in tm v theo
di thn trng kali mu. Ch khng ngi bnh ang iu tr digitalis t dng
thm mui kali m khng theo di kali mu.
Khng acid ung hoc than hot
Phn tch: Thuc khng acid v than hot lm gim hp thu ca thuc phi hp
ng tiu ho, do lm gim tc dng ca thuc ny.
X l: Cn ung hai thuc cch nhau t nht t 1 n 2 gi. Nhc li rng cc
khng acid thng c ung 1 gi 30 pht sau ba n, v n ung gy tng tit d ch
v.
Macrolid
Phn tch: Dng khng sinh macrolid cng vi digoxin c th dn n tng hm
lng digoxin trong huyt thanh khong 10% s bnh nhn v c tnh c th xy ra.
Tc dng ca tng tc ny c th xy ra sau nhiu tun dng macrolid. C ch
khong 10% bnh nhn, digoxin c chuyn ho bi vi khun ng tiu ho thnh
cc sn phm kh. Cc khng sinh macrolid c ch h vi khun ny, nn c thm
nhiu digoxin hot ng c hp thu hn.
X l: Theo di nng digoxin v cc triu chng ng c, nu c. C khi cn
phi gim liu ca digoxin.
Primidon hoc dn cht
ca digitalis chuyn ho (tc l ca digitalin tri vi digoxin).
X l: Lu nguy c ny iu chnh liu ca digitalin (digoxin c o thi
qua thn), nu thy phi hp cn thit. iu chnh liu trong v sau khi i u tr bng
barbituric.
Quinin
Phn tch: Tng hm lng ca digoxin trong huyt thanh v c th tng c tnh.
C ch, hnh nh quinin lm gim thanh lc digoxin mt.
X l: Theo di bnh nhn v cc du hiu c tnh hoc tng hm lng ca
digoxin trong huyt thanh. C th cn phi gim liu digoxin.
358
Quinidin hoc dn cht

Phn tch: Tng tc dc ng hc v dc lc m t vi digoxin:
Nguy c tng nng digoxin trong huyt tng, do gim thanh lc thn.
Kh nng xut hin cc ri lon tnh t ng ca tim (nhp tim chm) v ri lon
dn truyn nh - tht.
X l: Theo di lm sng v nu cn lm in tm . iu chnh liu, tu theo
hm lng digoxin trong mu, trong v khi ngng iu tr bng quinidin hoc
hydroquinidin.
Sucralfat
Phn tch: Nng digoxin trong huyt thanh c th gim, lm gim tc d ng
iu tr. C ch do digoxin c th gn vo sucralfat nu s hp thu ng tiu ho
ca digoxin b gim.
X l: Theo di nng digoxin. Nu thy gim p ng lm sng, nn xem xt
ngng sucralfat. Khuyn ngi bnh ung hai thuc cch xa nhau 2 gi.
Phn tch: Tng tc dc ng hc ch lin quan n digoxin; sulfasalazin lm
gim hp thu digoxin, dn n gim nng digoxin trong huyt thanh, c th n
50%.
X l: Trong trng hp phi hp, iu chnh liu tu theo hm lng digoxin
trong mu, trong v khi ngng iu tr bng sulfasalazin.
359
Tetracosactid
Phn tch: Tetracosactid gy h kali mu, dn n yu c, iu c kh nng
lm tng c tnh ca cc digitalis.
Cc glycosid tr tim c ch ATPase Na+ / K+ l enzym lin quan n vn chuyn
cc ion Na+ v K+ qua mng t bo c tim. H kali mu trm trng ( 3mEq/lt) c th
gy ngoi tm thu tht hoc nh v lon nhp nhanh tht hoc nh cng vi ri lon l n
dn truyn nh - tht. ngi bnh dng digitalis, nhng ri lon tng t xut hin c
khi kali mu h t hn.
chnh h kali mu tu trng hp c th v theo di u n kali mu. Nh rng, trn
lm sng, h kali mu c th bt u trc tin bng yu c, chut rt ri n cc triu
chng trm trng hn nh: ri lon nhp tim, lit h hp. D chng h kali mu gy ra
bi tng tit m hi qu mc v tiu chy ko di.
Sotalol; thuc chn beta
Phn tch: C th phi hp hai thuc, nhng cn ang bn ci tu theo thuc
chn beta c s dng v sinh bnh l ca ngi bnh. Tng nguy c nhp tim chm.
Sotalol l thuc chn beta thng c s dng lm thuc chng lon nhp.
X l: Phi hp phi c dnh cho cc nh chuyn khoa trong mt s
ch nh c th vi iu kin phi theo di cc tc dng ca phi hp (in tm ).
Thuc gy m cc loi
X l: Khuyn ngi bnh, khi phi can thip ngoi khoa, cn thng bo cho
ngi gy m v nhng thuc h ang dng.
Thuc li tiu gi kali (spironolacton)
Phn tch: Spironolacton c th lm gim nh tc dng tng lc co c tim ca
digoxin. Nng digoxin huyt thanh cng c th tng. Ngoi ra, spironolacton c th
lm nh hng n nh lng min dch phng x digoxin, dn n tng gi to nng
digoxin. Tng tc xy ra nhanh. C ch v tc dng tng lc co c tim ca digoxin
c th b gim nh do tc dng gim lc co c tim ca spironolacton. Ngoi ra,
spironolacton cng c th chn bi xut digoxin qua ng thn, nn lm gim thanh
lc v lm tng nng digoxin trong huyt thanh.
X l: C th cn phi iu chnh liu digoxin trong khi phi hp vi
spironolacton, gim st ngi bnh cht ch. Cng cn phi cnh gic tng gi t o
nng digoxin c th xy ra do nh lng min dch phng x b ri lon.
Phn tch: H kali mu c th do cc thuc nhun trng kch thch gy ra, c th
lm tng tc dng c ca cc thuc digitalis.
X l: Theo di lm sng ngi bnh. Nu c th, nn ngng k n thuc nhun
trng kch ng ngi bnh cao tui ang iu tr digitalis. Kim tra kali mu u n
360
ngi bnh dng ko di cc thuc nhun trng. Nu cn theo di in tm . Cn

nh, mi mt, yu c, chut rt, ri lon tim l cc du hiu h kali mu.
Phn tch: Dng cc thuc nhun trng nhy v thm thu cng vi cc glycosid
tr tim lm gim hp thu v gim tc dng ca glycosid.
2 gi.
361
X l: Tng tc ny c th trnh c nu dng cc thuc ny cch nhau

Phn tch: Dng cc du v c cng vi cc glycosid tr tim lm gim hp thu v
gim tc dng ca glycosid.
X l: Hu qu ca tng tc ny c th trnh c bng cch khuyn ngi
bnh dng cc thuc ny cch nhau nhiu gi (trc 2 gi hoc sau 4 gi khi dng du
khong).
Verapamil
Phn tch: Nguy c tng nng digoxin trong huyt thanh. Tng nguy c ri lon
nh - tht v nhp tim chm, do tng cc tc dng ca digoxin trn tnh t ng v s
dn truyn v do gim o thi digoxin. Theo di c s chuyn khoa, nht l trong
tun u tin.
X l: Theo di lm sng, in tm , lng digoxin trong mu ti c s chuyn
khoa. Tu theo tnh hnh, iu chnh liu digoxin trong khi iu tr vi verapamil v khi
ngng.
Ch
vic
nhp
Na+
vo
bng
ng
n
ung hoc t mt s thuc, c th dn n nguy c ph phi cp ng i suy tim
nng.
Vitamin nhm D
Phn tch: Tng calci mu c th do hp thu calci v vitamin D ng thi v khng
kim sot c. S tng calci mu ny c th lm tng c tnh ca thuc digitalis cng
vi nguy c lon nhp tim.
X l: ngi cao tui v nht l ph n mn kinh, dng thm calci v vitamin
D tr nn kinh in (iu tr long xng). nhng ngi ny, iu quan trng l phi
c thc v nguy c khi k n ng thi digitalis, calci v vitamin D. N u c n, nn
theo di calci mu. Ch vic t dng thuc v l m dng h n h p polyvitamin v
cht in gii nhng ngi bnh ny.
GONADOTROPHIN NHAU THAI

Cc cht c ngun gc nhau thai c hot tnh LH. Cc cht ny cho php khi
ng
s rng trng ph n khi phi hp chng vi cc gonadotrophin hMG nam gii,
cc cht ny cho php bit ho cc t bo Leydig v gy sinh tinh trng
khi phi hp vi cc gonadotrophin hMG
CC THUC TRONG NHM

CHORIONIC GONADOTROPIN bt pha dung dch tim 1500 IU/ng; 5000 IU/ng
Pregnyl 1500 bt pha dung dch tim 1500 IU/ng
362
Pregnyl 5000 bt pha dung dch tim 5000 IU/ng

CH KHI CH NH THUC
Cc trng hp: U tuyn yn; u tuyn sinh dc; chng lon dng bung trng:
nng LH cao. Khng dng cho n trc 18 tui.
363
GONADOTROPHIN C HOT TNH FSH

Cc cht chit t nc tiu ca ph n mn kinh, c hot tnh FSH tri hn.
Cc cht ny gy pht trin v thun thc nang trng khi c dng trong
giai on u ca chu k v cho php khi ng s rng trng
hip ng vi HCG c hot tnh LH tri hn
CC THUC TRONG NHM
MENOTROPIN bt pha dung dch tim 75 IU/ng
Humegon 75 bt pha dung dch tim 75 IU/ng
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai: Chng ch nh. Phi khng nh l khng mang thai trc
khi iu tr.
Cc trng hp: a u nang bung trng (tr urofollitropin). U di i - tuyn
yn. C tin s huyt khi tc mch nam gii, v sinh bi xut, v sinh xut ti t do
tn thng tinh hon tin pht.
GRISEOFULVIN
Khng sinh chng nm
CC THUC TRONG NHM

Griseofulvin vin nn 500 mg
Griseofulvin kem bi da 5%
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai: Griseofulvin gy qui thai mo v th nn chng ch nh
ph n mang thai.
Ri lon chuyn ho porphyrin: L cht cm ng enzym, griseofulvin nh
hng n s chuyn ho porphyrin niu. ngi bnh thng, khng gy tc dng
lm sng; nhng c th gy cn ri lon chuyn ho porphyrin cp, cch qung, v i
cc chng nhp tim nhanh, au bng v vim dy thn kinh ngoi vi ngi c t bm
d mc.
364

Suy gan: Do nguy c tng tc dng c vi gan.
Cc trng hp khc: Lu ngi mn cm vi thuc. Thn trng khi dng
ln u tin. Lupus ban . Qu mn vi thuc.
TNG TC THUC
Ru
Phn tch: Tc dng antabuse (kiu disulfiram) cng thm vi nguy c c cho
gan: mt lng bt thng acetaldehyd tch t trong cc m (c ch enzym) dn n
cc du hiu lm sng nh: cc cn bng vn mch, gin mch nhiu, nhp tim nhanh,
st cao, bun nn, nn, pht ban da, i khi h huyt p v try mch. Cc triu chng
ny nng nhiu hay t tu theo lng ru ung.
X l: Trong khi iu tr vi thuc ny, khuyn khng ung ru, do tc dng
antabuse. Cn thn trnh dng tt c cc ch phm hay thuc c cha ru.
cht
Phn tch: Tng chuyn ho cc estroprogestogen gan, do cm ng enzym, do

dn n nguy c th thai.
X l: Trnh dng cc thuc nga thai liu thp v tt hn nn dng thuc ng a
thai liu cao hoc khuyn p dng mt bin php nga thai khc n u i u tr b ng
griseofulvin ko di. Cn nh, cm ng enzym khng bao gi l hin tng tc thi.
Tacrin
X l: Tng cng theo di gan nu cn. Trnh cc phi hp c nguy c ngi
bnh cao tui.
Amineptin; carmustin hoc dn cht; dantrolen; dn cht imidazol chng
nm; fluvoxamin; isoniazid hoc thuc tng t; macrolid; methotrexat; natri
valproat hoc dn cht; progabid; rifampicin
khng mong mun).
(ASAT, ALAT, phosphatase kim, bilirubin) hoc, nu c th, hon vic dng mt trong
hai thuc. Kim tra chc chn ngi bnh khng ung ru thng xuyn, v khng c
tin s vim gan do virus. Cc du hiu lm sng chnh khng c hiu nh bun nn,
st, vng da. Nu thy ng thi pht ban, nga, hch to th hng v nguyn nhn do
thuc. Phn bit tu theo kt qu xt nghim, nguy c xut hin vim gan tiu t bo
khng hi phc vi vim gan mt hi phc khi ngng iu tr.
Barbituric
365
Phn tch: Tng chuyn ho griseofulvin gan, do cm ng enzym c th dn

n gim hot tnh ca griseofulvin.
Cn phi xc nh tm quan trng ca tng tc ny.
Ciclosporin
Phn tch: Gim nng ciclosporin trong huyt thanh, do kch thch qu trnh d
ho bng enzym.
X l: Nu cn phi hp, theo di cn thn nng ciclosporin trong huyt thanh
v iu chnh liu khi bt u v kt thc iu tr bng griseofulvin. Lu r ng hm
lng ciclosporin trong mu c s bin ng ln tu theo c th v cn phi theo di
u n.
Hormon tuyn gip
Phn tch: Tng d ho hormon tuyn gip bi griseofulvin (thuc cm ng
enzym). Cm ng enzym ch biu hin t 10 n 12 ngy sau khi bt u iu tr.
X l: Cm ng enzym khng phi l hin tng tc thi. Khi iu tr bng mt
thuc cm ng enzym trung v di hn phi tnh n nguy c gim tc d ng i u tr
ca thuc phi hp. iu chnh liu hormon tuyn gip trong khi iu tr v sau khi
ngng dng cht gy cm ng (griseofulvin).
366
Phn tch: Mc tiu chnh l iu tr ung th biu m dng tuyn (adenocarcinom)
ca thn. Interleukin cng c vi gan. Do vy, y l phi hp hai thuc c tim nng
c vi gan.
X l: iu tr ch c tin hnh c s chuyn khoa. Khi dng interleukin, cn
c s theo di thng xuyn. Trong trng hp ny, nn cn nhc tu theo tnh trng
chung ca ngi bnh. Khi phi hp hai thuc c vi gan, hy theo di cht ch chc
nng gan (ASAT, ALAT, phosphatase kim, bilirubin) hoc, nu c th, hon mt trong
hai thuc.
Niridazol
Phn tch: Phi hp hai thuc c vi gan. Cn c c tnh thn kinh ca
niridazol. Nguy c xut hin co git, ri lon tm thn, v c vi gan, khi phi hp.
(ASAT, ALAT, phosphatase kim, bilirubin) hoc, nu c th, hon dng mt trong hai
thuc. Kim tra chc chn ngi bnh khng ung ru thng xuyn, v khng c
tin s vim gan do virus. Cc du hiu lm sng chnh khng c hiu nh bun nn,
st, vng da. Phi hp pht ban, nga v hch to minh chng cho nguyn nhn do
thuc. Phn bit tu theo kt qu xt nghim, nguy c xut hin vim gan tiu t bo
Primidon hoc dn cht; methadon
ca griseofulvin.
Tm quan trng ca tng tc ny cn cn c xc nh thm.
Tacrolimus
Phn tch: Gim nng tacrolimus trong huyt thanh, do kch thch d ho bng
enzym.
X l: Nu cn phi hp, phi theo di nng tacrolimus trong huyt thanh v
iu chnh liu khi bt u v kt thc iu tr bng griseofulvin.
Thuc ung chng ng mu, khng vitamin K
Phn tch: Griseofulvin gy cm ng enzym, lm tng nhanh tc d ho gan
ca cc thuc chng ng mu. Cm ng enzym khng phi l hin tng tc thi:
th hin tc dng, cn mt t iu tr vi cht cm ng t t nht 10 ngy.
X l: Phi tnh n tc dng ny iu chnh liu v phi theo di sinh hc t
l chun ha quc t (INR v t l prothrombin) thng xuyn hn khi bt u dng
thuc chng ng mu, trong v khi ngng dng cc thuc c tnh cht cm ng
enzym.
367
Phn tch: Do cm ng enzym, griseofulvin c th lm tng nhanh chuyn ho

ca bromocriptin v lm gim tc dng ca thuc ny. Tc dng ny ch c th biu
hin t 10 n 12 ngy sau khi bt u iu tr.
X l: iu chnh liu ca bromocriptin trong v sau khi iu tr bng griseofulvin.
368
GUANETHIDIN
Thuc chng tng huyt p do lm lit giao cm hu hch
CC THUC TRONG NHM

GUANETHIDIN vin nn 10 mg; thuc nh mt 5%
Sanotensin vin nn 10 mg
Ismelin thuc nh mt 5%
CH KHI CH NH THUC
Glocom: Glocom gc ng (mc du thuc ny c th dng trong iu tr bnh
glocom gc m).
Suy tim/ suy mch vnh: Guanethidin c hai tc ng ni tip nhau trn tim gy
nhp nhanh do gii phng noradrenalin, sau l nhp chm do lit thn kinh giao cm
vi s gim cng nng ca c tim v gim lc co bp c tim.
Cc trng hp khc: Chng ch nh dng guanethidin ngi bnh mi b tai
bin mch mu no v u t bo a crom.
Thn trng: mc 2
Thc n - ru: Ru lm tng tc dng an thn ca thuc chng tng huyt p
ny.
Thi k mang thai: Guanethidin khng gy qui thai nhng c th gy nguy him
trong trng hp gy m cp cu, vi nguy c tru tim mch v ngng tim.
Suy gan: Do chm b bt hot, suy gan lm tng c tnh ca guanethidin v tng
nguy c h huyt p th ng.
Suy thn: Guanethidin lm gim lu lng mu thn v gim tc lc ca
cu thn (hu qu ca tc ng chm nhp tim v gim lc co bp tim). S tng ti hp
thu nc v natri dn n gi mui v nc.
Suy h hp - hen: Thn trng ngi bnh hen.
Lot d dy- t trng; vim d dy: Thn trng trong trng hp lot d dy- t
trng.
Cn theo di: mc 1
Ngi cao tui: Liu dng phi tng dn v thn trng trnh h huyt p
nng v t ngt.
TNG TC THUC
Ru
369

X l: Thng tin cho ngi bnh, c bit ngi cao tui. Khng nn ung ru
Benzamid
Phn tch: Gim tc dng chng tng huyt p do c ch ti nhp guanethidin
nron bi cc benzamid an thn kinh.
X tr: Thay i chin lc iu tr bng cch chn mt thuc chng tng huyt
p khc. Nn trnh phi hp ny.
Butyrophenon
nron do cc butyrophenon m ng u nhm l haloperidol.
Phn tch: Kh nng bin ng huyt p nhiu.
X l: Tng cng theo di huyt p ng mch. Nhn mnh n thi gian dng
thuc u n khi phi hp hai thuc v vic tun th. Cnh gic ng i bnh cao
tui.
Oxaflozan
nron do oxaflozan, dn n kh cn bng huyt p.
Phenothiazin
nron do cc thuc an thn kinh phenothiazin (m t vi chlorpromazin).
Phn tch: Guanethidin l tc nhn c ch gii phng noradrenalin hu hch.
Tt c cc tc nhn c hot tnh chn alpha, chn beta, khi phi
hp vi guanethidin, c th dn n tng t l h huyt p th ng v nhp tim chm.
X l: Tng cng theo di huyt p ng mch. Nhn mnh n thi gian dng
thuc u n khi phi hp hai thuc v s tun th. Cnh gic ngi bnh cao tui.
nron bi cc thuc an thn kinh cc loi.
370
X l: Thay i chin lc iu tr bng cch chn mt thuc h huyt p khc.

Nn trnh phi hp ny.
Phn tch: Guanethidin c ch gii phng noradrenalin hu hch, do c s
i khng tc dng dc l.
X l: Cn trnh phi hp ny. Tt c ph thuc vo bi cnh iu tr, tnh hung
khn cp v cc trang thit b theo di thng xuyn. nh gi nguy c trong bi cnh
ny v tu theo dng bo ch ca thuc cng giao cm alpha 1 (dng dng t i ch,
ung hay tim). Khuyn ngi bnh thng bo cho bc s gy m nhng thu c ang
dng.
Phn tch: Cc thuc chng trm cm ba vng c th c ch tc dng lm h
huyt p ca guanethidin. C ch do c s c ch thu nhp guanethidin v tr tc
dng ca n l tn cng thn kinh.
X l: Theo di huyt p. Dng thuc chng tng huyt p khc kim sot
huyt p, nu cn.
371

Phn tch: Amphetamin l cht cng giao cm trc tip v c tnh cht tng
huyt p. Phi hp vi cc thuc lm h huyt p dn n s i khng tc d ng v
kh t c s cn bng v huyt p.
X l: Nn trnh k n cc thuc amphetamin ngi bnh tng huyt p.
Baclofen
huyt p la chn hng u, trong v sau khi ngng phi hp iu tr. Thn trng c
bit ngi bnh cao tui.
Barbituric; primidon hoc dn cht; thuc ch vn morphin
Phn tch: Tng nguy c lm h huyt p th ng.
X l: Thng tin cho ngi bnh. Theo di huyt p trong khi phi hp. Ty theo
thuc dng, mc nng, nh ca h huyt p c th khc nhau. Ty tr ng hp,
iu chnh liu ca mt hoc hai thuc. Thit lp mt k hoch dng thuc u n.
Khuyn ngi bnh nu thy chng mt ngay t u, gp bc s iu tr iu chnh
liu ca mt hoc hai thuc. Tng cng theo di ngi bnh cao tui (nguy c ng)
v khuyn h khng nn thay i t th t ngt t nm hoc ngi sang ng.
Corticoid-khong
Phn tch: Hiu qu ca thuc chng tng huyt p b gim, c th do tc dng
gi natri li ca cc steroid.
X l: Nu cn phi hp, hy tng cng theo di huyt p ng mch trong v
khi ngng iu tr bng mt trong hai thuc. Hy iu chnh liu. Nhn mnh mt k
hoch dng thuc v tun th. c bit thn trng khi dng ngi bnh cao tui.
Dn cht nitrat chng au tht ngc; nicorandil
Phn tch: Vic phi hp vi bt k thuc no c tnh cht chng tng huyt p c
th lm gia tng nguy c h huyt p, i khi dn n sc.
X l: Theo di huyt p ng mch trong v khi ngng mt trong hai thuc iu
tr. c bit thn trng khi dng ngi bnh cao tui.
Clozapin
huyt p la chn u tin, trong v sau khi ngng iu tr bng clozapin. Thn trng
c bit ngi bnh cao tui.
Phn tch: Tng huyt p gy ra bi cc thuc nga thai ung thng khng li
iu tr bng guanethidin. C ch ny cha c bit r.
372
X l: Rt kh kim sot huyt p trong trng hp ny, thm ch khng th. Hy

thay i chin lc iu tr. Trnh dng vi methyldopa v cng l do trn.
Furosemid hoc thuc tng t; methyldopa; reserpin; thuc li tiu gi
kali
Phn tch: Tng tc dng lm h huyt p, thng c s dng trong iu tr v
cn iu chnh liu thch hp.
X l: Tng cng theo di huyt p ng mch. Nhn mnh n thi im dng
thuc u n khi phi hp hai thuc v vic tun th. Cnh gic ng i bnh cao
tui.
Insulin
Phn tch: Tng tc dc ng hc. y insulin ra khi cc v tr gn trong
huyt tng.
X l: Nu cn phi hp, hy iu chnh liu trong v sau khi iu tr vi
guanethidin.
Phn tch: S dng ng thi hai thuc ny c th dn n bin ng huyt p
quan trng.
X l: Cc thuc c ch MAO kh him c s dng, cc tng tc th nhiu v
n thuc th him nn c t nhn xt v cnh gic thuc. Tuy nhin, hy th n tr ng
tun th khong cch hai n ba tun, sau khi ngng thuc, trc khi k n li thuc
c ch MAO.
Phn tch: Guanethidin c th lm tng tc dng ca cc thuc h glucose mu,
do y chng ra khi cc lin kt vi protein huyt tng.
X l: Thng tin cho ngi bnh tng cng t theo di v, nu cn iu
chnh liu ngay t u v khi ngng iu tr bng guanethidin, tu theo nng glucose
mu.
Phn tch: Tng tc i khng dc l. Cc thuc cng giao cm beta c tc
dng tng huyt p, nn tc dng chng tng huyt p c th gim khi s d ng ng
thi vi cc thuc ging thn kinh giao cm.
X l: Theo di huyt p u n. Thng tin cho ngi bnh nguy c bin ng
huyt p, thit lp mt k hoch dng thuc u n v lu dng thuc dng c
lng mc nghim trng ca bin ng huyt p (s dng cc thuc cng giao
cm beta trong hen hoc trong da non). Nu ngi bnh than phin, yu c u i
khm li.
Phn tch: Nguy c lm h huyt p do gim th tch mu.
X l: Khuyn ngi bnh, trc khi phu thut, thng bo cho ngi gy m
nhng thuc ang dng.
373
Thuc gy m cc loi
X l: Khuyn ngi bnh, trc khi phu thut, thng bo cho ngi gy m
nhng thuc ang dng.
Thuc gin mch chng tng huyt p; thuc li tiu thi kali
X tr: Cn phi iu chnh liu thch hp, thit lp k hoch dng thuc v nhn
mnh vic tun th vi ngi bnh. Ngay t lc khi u iu tr, khuyn ngi bnh
o hoc nh o huyt p ng mch u n, cho n khi t c s cn bng iu
tr.
Dn cht pyrazol; thuc chng vim khng steroid
steroid c ch tng hp prostaglandin thn gy gin mch hoc/v dn n gi mui
v nc. Nguy c suy thn cp ngi bnh mt nc.
X l: Kim tra c s tip nc tt cho ngi bnh, theo di chc nng thn (
thanh lc creatinin), bo m s n nh ca huyt p ng mch, c bit khi bt u
iu tr. Khuyn ngi bnh theo di u n huyt p ng mch.
374
Dn cht salicylat; indometacin hoc dn cht

Phn tch: Gim tc dng chng tng huyt p do cc thuc chng vim khng
steroid c ch tng hp prostaglandin thn gy gin mch v/hoc dn n gi mui
v nc. Nguy c suy thn cp ngi bnh mt nc.
X l: Kim tra c s tip nc y cho ngi bnh, theo di chc nng thn
( thanh lc creatinin), bo m s n nh ca huyt p ng mch, c bit khi bt
u iu tr. Nn thn trng ngi bnh cao tui (suy thn sinh l). Khuyn ngi
bnh theo di u n huyt p ng mch.
Phn tch: Cc tc dng chng tng huyt p c th b gim, do s gi mui v
nc gy bi cc glucocorticoid.
X l: iu chnh liu trong v sau khi iu tr bng cc glucocorticoid. Thng tin
cho ngi bnh tng cng t theo di trong khi iu tr bng corticoid. Khuyn c k
hoch dng thuc u n trong khi iu tr. Khuyn bnh nhn gp li bc s, trong
trng hp huyt p thay i nhiu.
Phn tch: S dng ng thi thuc chng tng huyt p hoc cc thuc c th
dn n h huyt p vi cc thuc gy m barbituric c th gy h huyt p trm
trng.
X l: Khuyn ngi bnh, trc khi phu thut, bo cho thy thuc gy m cc
thuc ang dng.
HALOFANTRIN
Thuc iu tr st rt, dit th phn lit, c bit trn cc th
Plasmodium falciparum khng chloroquin
CC THUC TRONG NHM

HALOFANTRIN vin nn 250 mg; dch treo ung 20%
Halfan vin nn 250 mg
Halfan dch treo ung 20%
CH KHI CH NH THUC
Chng ch nh: mc 4
Khong QT ko di hoc tin s gia nh c khong QT ko di.
375
Thi k cho con b: Chng ch nh halofantrin ph n cho con b. Cc

nghin cu trn ng vt cho thy thuc qua c sa m v lm chm s tng trng
tr em.
Thi k mang thai: Chng ch nh halofantrin ngi mang thai (c cho phi
ng vt).
Trng hp khc: Ngt cha r nguyn nhn.
376
TNG TC THUC
Benzamid
Phn tch: Ch mt thuc trong nhm benzamid l sultoprid (Barnetil) c th c
nguy c. Tt c cc thuc c tc dng gim lc co c (gy nhp tim chm) c th d n
n gia tng nguy c ri lon nhp tht, nht l xon nh, do thm cc tnh cht i n
sinh l ca sultoprid.
K n: Chng ch nh v khng c k n phi hp ny.
Macrolid
Phn tch: S gia tng nguy c xon nh do tc dng cng hp ch c m t
duy nht vi erythromycin tim tnh mch. H kali mu, nhip tim chm v khong QT
ko di t trc (in tm ) l cc yu t thun li cho s xut hin xon nh. Xon
nh l mt kiu nhp tht c bit c th xy ra tng cn rt ngn (vi giy; mt thu:
cm gic ngt m khng mt thc). Trong nhm macrolid, ch c erythromycin ( c
bit l dng tim tnh mch) c th dn n ri lon nhp tim (ko di khong QT, ngoi
tm thu tht, xon nh, bloc nh tht).
Ngay c khi s dng mt mnh erythromycin tim tnh mch cng
c th dn n ri lon nhp tim. Khng nn tim tnh mch vi tng liu ngay mt lc
m phi truyn tnh mch, lin tc hay ngt qung, thi gian truyn mi ln t nht phi
60 pht.
Mefloquin
Phn tch: Nguy c lon nhp tim e do tnh mng c th tng. C ch do hip
ng ko di khong QT.
X l: Khng dng halofantrin ng thi hoc tip sau mefloquin.
Phn tch: Tng tc ny ch m t vi mt khng histamin H 1 khng c tc dng
an thn l astemizol (Hismanal), tng nguy c xut hin xon nh. Xon nh l mt
kiu nhp tht c bit c th xy ra tng cn rt ngn (vi giy; mt thu: c m gic
ngt m khng mt thc), i khi tin trin thnh rung tht cht ngi.
X l: Chng ch nh phi hp. Chn mt thuc khng histamin khng an thn
khc khng gy xon nh (cetirizin, loratadin).
Sparfloxacin
Phn tch: Tng nguy c xon nh. Xon nh l mt kiu nhp tht c bit c
th xy ra tng cn rt ngn (vi giy; mt thu: cm gic ngt m khng mt thc),
i khi tin trin thnh rung tht cht ngi.
X l: Nn trnh phi hp. Nn chn mt fluoroquinolon khc hoc mt thuc
khc tu theo mc ch iu tr. Nu phi hp l tuyt i cn thit, bt buc phi theo
di lm sng v in tim.
377
Amiodaron; bretylium; disopyramid; glucocorticoid; corticoid-khong;

furosemid hoc cc thuc tng t; quinidin hoc dn cht; sotalol;
tetracosactid; thuc nhun trng kch thch; thuc li tiu thi h kali
Phn tch: Nguy c xut hin xon nh, khi c phi hp ny, c to thun li
bi h kali mu. H kali mu, nhp tim chm v khong QT ko di t trc (trn i n
tm ) l cc yu t thun li cho xut hin xon nh. Xon nh l mt kiu nhp
tht c bit c th xy ra tng cn rt ngn (vi giy; mt thu: c m gic ng t m
khng mt thc).
X l: Cn trnh phi hp ny. Dng cc thuc khng gy xon nh. Nu c n
phi hp ny, theo di thng xuyn khong QT v kim tra u n kali mu. Ch
cc du hiu lm sng c th bo trc h kali mu nh mt mi, yu c, co cng c...
Amphotericin B
Phn tch: Nguy c xon nh khi phi hp vi amphotericin B tim. H kali mu,
nhp tim chm v khong QT ko di t trc (ch nhn thy trn in tm ) l cc
yu t thun li cho xut hin xon nh. Xon nh l mt kiu nhp tht c bit, c
th xy ra tng cn rt ngn (vi giy; mt thu: cm gic ngt m khng mt thc).
Bepridil; Pentamidin
Phn tch: Nguy c xut hin xon nh khi c phi hp ny. H kali mu, nhp tim
chm v khong QT ko di t trc in tm ) l cc yu t thun li cho xut hin
xon nh. Xon nh l mt kiu nhp tht c bit c th xy ra tng cn r t ng n
(vi giy; mt thu: cm gic ngt m khng mt thc).
Vincamin
Phn tch: Nguy c xut hin xon nh khi phi hp hai thuc ny. H kali mu,
nhp tim chm v khong QT ko di t trc (in tm ) l cc yu t thun li cho
xut hin xon nh. Xon nh l mt kiu nhp tht c bit c th xy ra t ng c n
rt ngn (vi giy; mt thu: cm gic ngt m khng mt thc).
HEPARIN HOC CC DNG PHN T THP
378
Thuc chng ng mu sinh l. Thuc gii c l protamin sulfat.

Cc heparin phn t lng thp, mc du c tnh cht chng ng mu
thp hn nhiu, cng thuc nhm ny
CC THUC TRONG NHM
HEPARIN NATRI dung dch tim 2500 IU/0,1mL; gel bi ngoi da
Calciparine dung dch tim 2500 IU/0,1mL
Contratubex gel bi ngoi da
ENOXAPARIN dung dch tim 40 mg/0,4 mL; 60 mg/0,6 mL; 80 mg/0,8 mL; 100 mg/1mL; 20
mg/ 0,2 mL
Lovenox dung dch tim 20 mg/0,2 mL;40 mg/0,4 mL; 60 mg/0,6 mL; 80 mg/0,8mL; 100
mg/1mL
NADROPARIN dung dch tim 20000 IUAxa - IC/0,8 mL; 10000 IUAxa- IC/0,4 mL; 15000
IUAxa- IC/ 0,6 mL
Fraxiparine dung dch tim 20000 IUAxa - IC/0,8 mL; 10000 IUAxa- IC/0,4 mL;
15000 IUAxa- IC/ 0,6 mL
CALCI NADROPARIN dung dch tim 2850 IUAxa - IC/0,3 mL; 3800 IUAxa - IC/0,4 mL;
5700 IUAxa - IC/0,6 mL
Fraxiparine dung dch tim 2850 IUAxa - IC/0,3 mL; 3800 IUAxa - IC/0,4 mL; 5700
IUAxa - IC/0,6 mL
PARNAPARIN dung dch tim 4250 IU. Axa/0,4 mL; 3200 IU. Axa/0,3 mL; 6400 IU.
Axa/0,6 mL
Fluxum dung dch tim 4250 IU. Axa/0,4 mL; 3200 IU. Axa/0,3 mL; 6400 IU.
Axa/0,6 mL
CH KHI CH NH THUC
Chng ch nh: mc 4
Cc trng hp: Qu mn vi thuc, tin s gim tiu cu; tn thng thc th
c th chy mu; vim ni tm mc nhim khun; thi k sau phu thut thn kinh; tai
bin mch mu no chy mu.
Cn nhc li ch/nguy c: mc 3
Lot d dy - t trng; vim d dy: Cn phi lm mt iu tra nh gi bit
nhng tn thng c kh nng chy mu v c bit, lot d dy - t trng, phng
nga nguy c chy mu.
Cc trng hp khc: Tt c cc biu hin hoc xu hng chy mu do thiu
ht cc yu t ng mu hoc cc ri lon tnh thm mao mch u
l cc chng ch nh (tr trng hp lin quan n mt bnh l ng mu tiu th).
Cn theo di: mc 1
Thi k cho con b: Thuc khng qua c sa m.
379
Thi k mang thai: Heparin khng qua hng ro nhau - thai v c phn t lng
cao. y l thuc chng ng c la chn cho ph n mang thai, nhng cn theo
di cht ch trnh mi tai bin chy mu, nht l trong khi sinh.
Tng huyt p: Tng huyt p ng mch nng lm tng nguy c tai bin mch
mu no.
Suy gan: Suy gan lm tng nguy c chy mu, do qu liu iu tr.
Suy thn: Suy thn lm tng nguy c chy mu, do qu liu iu tr.
Lot d dy-t trng; vim d dy: Lot tin trin.
TNG TC THUC
Cephalosporin c nhn thiomethyltetrazol
Phn tch: Nguy c chy mu tng, ch yu i vi cc cephalosporin c nhn
thiomethyltetrazol (nh latamoxef, cefoperazon, cefamandol, cefmenoxim, cefotetan).
Nhn ny nh mt dn cht coumarin, c hot tnh chng ng (khng vitamin K), v
vy, cng thm cc tnh cht chng ng mu ca n vo, tnh cht khng vitamin K
hoc tnh cht chng kt tp tiu cu ca cc thuc phi hp.
X l: Cn trnh phi hp, ch yu c m t vi latamoxef, do lm tng nguy
c chy mu. Cn d chng c bit trng hp dng liu cao ca nhng khng sinh
ny.
Dn cht pyrazol; dn cht salicylat; indometacin hoc dn cht; thuc
chng vim khng steroid
Phn tch: Phi hp vi bt c thuc no c hot tnh chng kt tp tiu cu
hoc chng ng mu, lm tng nguy c chy mu. Nguy c ny gia tng bi tc dng
xm hi ca thuc chng vim khng steroid trn nim mc d dy (chy mu tiu
ha).
X l: S phi hp i hi phi theo di cc test ng mu thch hp (thi gian
Howell v thi gian cephalin-kaolin) trong v sau iu tr bng thuc chng vim khng
steroid. Nu c th, nn tm gii php iu tr khc cho nhng ngi bnh nhn c
tin s lot.
Dipyridamol; ticlopidin
Phn tch: Phi hp vi bt c thuc no c tnh cht chng kt tp tiu cu
hoc chng ng mu lm tng nguy c chy mu.
X l: C th phi hp c, nhng cn phi theo di cht ch bng cc test
ng mu thch hp (thi gian Howell, thi gian cephalin-kaolin). Nu c th, nn tm
gii php iu tr khc.
Dextran
Phn tch: Dextran l cht c ch tiu cu. Vi cc ch phm c hot tnh chng
ng mu v chng kt tp tiu cu, nguy c chy mu phi trnh hoc phi c
kim sot hon ho.
380
X l: Trnh phi hp cc ch phm ny v rt kh kim sot hon ho tnh trng

gim ng mu mong mun, v v nguy c chy mu.
Glucocorticoid
Phn tch: Phi hp mt corticoid c tnh cht gy lot vi mt cht chng ng
mu hoc cht c ch kt tp tiu cu lm gia tng nguy c chy mu ng tiu ha.
X l: Khi c tin s lot, nn trnh phi hp. Vn c th phi hp c, nhng
cn phi c gim st cht ch bng cc test ng mu thch hp (thi gian Howell,
thi gian cephalin-kaolin). Nu c th, nn tm gii php iu tr khc.
Thuc tiu huyt khi
Phn tch: Phi hp vi mi cht chng ng mu hoc cht c ch kt tp tiu
cu c th lm gia tng nguy c chy mu.
K n: K n cc thuc tiu huyt khi v s dng chng thng do cc
chuyn gia tim mch hoc thy thuc khoa cp cu thc hin v cc thuc ny c
phm vi iu tr hp v cn phi c mt phc iu tr tinh t. Nu phi ny l cn
thit th i hi phi theo di bng cc xt nghim ng mu thch hp (thi gian
Howell, thi gian cephalin-kaolin). Tt nht, hy tm mt gii php iu tr khc.
Phn tch: Natri valproat c th gy gim tiu cu, gim prothrombin - mu v
gim kt tp tiu cu. V vy c th gy chy mu ngi bnh ang dng thuc
chng ng mu ung, heparin hoc thuc tiu huyt khi.
X l: Khi phi hp v tu theo thuc chng ng mu s dng, tng cng theo
di m tiu cu, thi gian cephalin hot ho, thi gian Howell, thi gian chy mu.
Protamin
Phn tch: i khng l ho (pH) gia heparin v protamin sulfat, c dng rng
ri trong iu tr.
X l: Khi qu liu heparin hoc heparin phn t lng thp, c th dng protamin
sulfat tim tnh mch chm theo cc phc iu tr chnh xc vi liu lng cht ch.
Khi s dng ng thi hai thuc ging bnh, phi kim tra cc liu v nhp dng
trnh qu liu protamin.
Phn tch: Quinin c tnh cht gy gim prothrombin - mu. Thuc c th lm tng
tc dng chng ng ca heparin.
X l: C th b sung vitamin K cho ngi bnh, nu cn thit. Tng cng theo
di sinh hc v, nu cn, iu chnh liu ca heparin trong v sau khi i u tr b ng
quinin. Khi tim, cho y t bit nguy c.
Thuc khng gip trng tng hp
Phn tch: Gim hiu qu iu tr chng ng mu ngi bnh dng carbimazol
(Neomercazole) do c ch cha r.
381
X l: iu chnh liu heparin theo thi gian Howell hoc thi gian
cephalin - kaolin, khi bt u, ang v sau khi iu tr bng thuc khng gip trng.
Phn tch: Phi hp hai thuc c tnh cht chng ng mu dn n gia tng
nguy c chy mu.
X l: Ni chung nn chuyn tip heparin bng mt thuc ung chng ng mu.
Khi chuyn nh vy, tng cng theo di lm sng v sinh hc v khuyn l y mu
trc khi dng heparin lm cc xt nghim.
HEPARIN TNG HP
Cc dn cht bn tng hp, c cc tnh cht chng ng mu, tiu fibrin
CC NHM TRONG THUC

PENTOSAN POLYSULFAT thuc m 0,5%
Hemoclar thuc m 0,5%
Lasonil thuc m 0,5%
CH KHI CH NH THUC
Cn theo di: mc 1
Bnh d dy-t trng: Vim d dy, lot d dy - t trng tin trin.
Cc trng hp khc: Tai bin mch mu no. C tin s gim tiu cu vi
heparin c xu hng chy mu.
HEPTAMINOL
Thuc hi sc tim mch
CC THUC TRONG NHM
HEPTAMINOL vin nn 187,8 mg; dung dch ung git 30,5 g/100mL
Heptamyl vin nn 187,8 mg
Heptamyl dung dch ung git 30,5 g/100mL
CH KHI CH NH THUC
382

Tng huyt p: Thuc ny c dng chng tt huyt p.
Chng cng gip: Khng s dng trong trng hp cng gip.
Cc trng hp khc: Khng s dng trong trng hp ph no v qu mn vi
thuc.
Thn trng: mc 2
i tho ng/suy mch vnh: Do cc tnh cht cng thn kinh giao cm.
ng kinh: Khng s dng cho ngi bnh ng kinh.
Thi k mang thai: V thn trng, do cc tc dng cng thn kinh giao cm.
TNG TC THUC
Phn tch: Tng tc dng h huyt p.
X l: Xem xt cch iu tr h huyt p th ng khc.
Phn tch: Heptaminol c tnh cht cng thn kinh giao cm; do n c th gy
cc cn tng huyt p khi phi hp vi thuc c ch MAO hoc vi cc thuc c tnh
cht c ch MAO.
X l: Chng ch nh phi hp. Thay i chin lc iu tr. mt khong
cch t nht hai tun gia lc ngng thuc c ch MAO v lc a vo dng
heptaminol.
Thuc cholinergic
Phn tch: Tnh cht khng cholinergic ca heptaminol c th nh hng n tc
dng cholinergic mun c.
X l: Lu nguy c tht bi hoc gim tc dng iu tr, nu mc ch iu tr
chnh i hi phi k n cc cholinergic. Hi ngi bnh khi k li n thuc. Tc
dng khng nh cholinergic c th yu hoc va phi (dng dng ti ch: thuc nh
mt).
HISTAMIN HOC DN CHT

Cc thuc c tc dng tng t histamin
383
CC THUC TRONG NHM

BETAHISTIN vin nn 8 mg
Serc vin nn 8 mg
CH KHI CH NH THUC
Thi k cho con b: Khng dng histamin khi cho con b.
Thi k mang thai: Tt hn, khng nn dng cc thuc ny khi ang mang thai,
tuy rng trn ng vt cha pht hin c tc dng gy qui thai no.
Lot d dy, t trng; vim d dy : Cc thuc ny c tc dng tng t
histamin, nn trnh dng cho ngi b lot.
Cc trng hp khc: Khng dng thuc trong trng hp u t bo a crom.
Cn theo di: mc 1
Suy h hp; hen: Do cc tc dng tng t histamin, cc thuc ny phi dng
thn trng cho ngi bnh hen.
TNG TC THUC
Khng histamin khng H1 khng an thn; khng histamin khng H1 an thn
Phn tch: Phi hp ny khng hp l trong trng hp bnh thng, c th c
dng trong trng hp qu liu histamin.
X l: Nu mt trong hai thuc khng c dng lm thuc gii c th phi hp
ny khng hp l v c i khng dc l.
HORMON CHNG LI TIU HOC DN CHT

Hormon chng li tiu v cc dn cht tng hp
CC THUC TRONG NHM

LYPRESSIN thuc bm mi 50 IU/mL
Syntopressin thuc bm mi 50 IU/mL
TERLIPRESSIN bt ng kh tim 1 mg/mL
Glypressin bt ng kh tim 1 mg/mL
CH KHI CH NH THUC
Chng ch nh: mc 4
Suy mch vnh: Do cc tnh cht dc l v c th gi nc.
384
Cc trng hp khc: bit l qu mn vi thuc.

Thi k mang thai: V thn trng, do cc tc dng dc l.
Suy tim: Khng dng thuc cho ngi mc bnh mch mu.
Suy thn: Khng dng thuc cho ngi mc bnh thn.
Thn trng: mc 2
ng kinh: Gim ngng gy ng kinh.
Suy h hp; hen: Trnh dng cho ngi bnh d ng.
HORMON TNG TRNG HOC DN CHT

Hormon tng trng polypeptid thu c do ti t hp gen.
Cu trc ho hc ca n ging cu trc ca hormon tng trng t nhin.
CC THUC TRONG NHM

SOMATROPIN dung dch tim 10 IU/mL; 4 IU/mL
Saizen 10 dung dch tim 10 IU/mL
Saizen 4 dung dch tim 4 IU/mL
CH KHI CH NH THUC
Chng ch nh: mc 4
Cc trng hp: Chng ch nh hormon tng trng trong trng hp ung th
tin trin. Qu mn vi mt trong cc thnh phn ca thuc.
i tho ng: Do tc dng gy tiu ng ca hormon tng trng.
Thn trng: mc 2
Tr em: Chng ch nh dng thuc trong trng hp cc u xng dnh lin.
HORMON TUYN GIP

Cc hormon tit ra bi tuyn gip
CC THUC TRONG NHM

385
LEVOTHYROXIN vin nn 0,1 mg; 0,15 mg; 50 mg; 100 mg; 150 mg
Euthyrox 50 vin nn 50 mg
Thyrax 150 vin nn 0,15 mg
Levothyrox vin nn 0,1 mg; 50 mg; 100 mg
LIOTHYRONIN vin nn 20 mg; 50 mg
Triiodothyronine vin nn 20 mg; 50 mg
THYROXIN vin nn 100 mg
Thyrox vin nn 100 mg
TIRATRICOL vin nn 0,35 mg
Triacana vin nn 0,35 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Cng tuyn gip: Dng hormon tuyn gip lm nng thm cc du hiu cng
tuyn gip (gy i, thn kinh d b kch thch, nhc u, run ry, nhp tim nhanh, mt
ng...).
Suy tim: Cc hormon tuyn gip lm tng nhp tim, lu lng tm thu v tc
tun hon.
Suy mch vnh: Cc hormon tuyn gip gy nhp tim nhanh, km theo tng tiu
th oxy c tim rt nhiu, c th gy cn au tht ngc.
Cn theo di: mc 1
i tho ng: Cc hormon tuyn gip l cht gy tng glucose mu v vic
dng cc hormon ny ngi bnh tiu ng lm tng nhu cu insulin hoc thuc h
glucose mu ung.
Tng huyt p: Liu dng phi rt tun t v c tnh vi tim mch.
TNG TC THUC
Estrogen
Phn tch: Estrogen dng phi hp vi hormon tuyn gip lm gim nng
thyroxin t do trong huyt thanh, lm tng nng thyrotropin v do , lm tng nhu
cu v hormon tuyn gip. S thay i nng thyroxin v thyrotropin trong huyt
thanh do s dng estrogen c th l do nhng ph n c gim nng tuyn gip, c
hin tng tng nng thyroxin gn vi globulin trong huyt thanh.
386
X l: ph n gim nng tuyn gip, nh lng nng thyrotropin trong huyt

thanh vo khong 12 tun l sau khi bt u dng estrogen, v hiu chnh liu hormon
tuyn gip theo nh cn thit.
Mui st
Phn tch: nhng ngi gim nng tuyn gip, vic phi hp mui st vi
hormon tuyn gip lm cho hiu qu ca hormon gim. C ch cn cha r, nhng c
th l do s to phc hp gia st vi hormon tuyn gip (levothyroxin), lm gi m
hp thu ca thuc.
X l: Theo di chc nng tuyn gip khi phi hp hai thuc ny v nu cn, th
hiu chnh liu levothyroxin.
Sucralfat
Phn tch: Sucralfat lm gim hiu qu ca hormon tuyn gip (levothyroxin). C th
do sucralfat nh hng n s chuyn vn ca levothyroxin trong rut v qua rut.
X l: Vi nhng bnh nhn iu tr vi phi hp levothyroxin v sucralfat, phi
theo di xem c gim hp thu sucralfat khng. Nu nghi l c, tng liu levothyroxin hay
dng hai thuc cch nhau t nht 8 gi.
Theophylin
Phn tch: nhng bnh nhn gim nng tuyn gip, s thanh lc theophylin
gim v s thanh lc ny tr v mc bnh thng khi chc nng tuyn gip cng bnh
thng ho. C s tng quan dng tnh (ng bin) gia nng thyroxin trong
huyt tng v thanh lc theophylin. C trng hp tng nng tuyn gip hay gim
nng tuyn gip u nh hng n s thanh lc theophylin.
X l: a chc nng tuyn gip v mc bnh thng l ch yu kim sot s
thanh lc theophylin. Theo di nng theophylin trong huyt tng v hiu chnh liu
khi cn.
Thuc cng giao cm alpha, beta; thuc cng giao cm beta
Phn tch: Nguy c tng tc dng ca cc hormon tuyn gip. ngi bnh
mch vnh, cc hormon tuyn gip lm tng nguy c suy mch vnh.
K n: V nguy c ny, nu cn phi hp, phi iu chnh liu mt cch chnh
xc.
Barbituric; carbamazepin; griseofulvin; phenytoin; primidon hoc dn cht;
rifampicin
Phn tch: Tng d ho thuc ny bi cc thuc cm ng enzym (barbituric). Cm
ng enzym ch th hin sau khi bt u iu tr 10 n 12 ngy.
thuc cm ng enzym trung v di hn th phi tnh n nguy c gim tc dng iu tr.
iu chnh liu cho thch hp trong v sau khi ngng thuc cm ng enzym.
387
Phn tch: Dng hormon tuyn gip c th lm mt cn bng iu tr chng tiu

ng, do lm tng nhu cu insulin hoc thuc h glucose mu.
X l: Phi hp i hi iu chnh liu. Thng tin cho ngi bnh h tng
cng t theo di khi liu dng ca hormon tuyn gip thay i.
Cholestyramin
Phn tch: Gim hp thu cc hormon tuyn gip qua ng tiu ho.
X l: Nu k n c hai thuc, khuyn dng cc hormon tuyn gip trc 2 gi
hoc 4 gi sau khi dng cholestyramin.
St
Phn tch: Cc mui st c kh nng lm gim hp thu thyroxin qua ng tiu
ho.
X l: Khuyn ngi bnh dng cc mui st cch cc thuc kia t nht 2 gi.
Phn tch: Tc dng ca cc thuc chng ng c th b ri lon. Vic dng cc
hormon tuyn gip i hi gim liu ca thuc khng vitamin K (to thun li cho s d
ho cc yu t prothrombin).
X l: Vic thay i liu dng ca hormon tuyn gip nh hng n tc d ng
khng vitamin K. Phi hp i hi iu chnh liu tu theo t s chun ho quc t-INR
hoc t l prothrombin.
Phn tch: S dng ng thi hai thuc c th lm tng tc dng iu tr v c
tnh ca hai thuc.
X l: Theo di lm sng v, nu cn iu chnh liu lc bt u, trong khi iu tr
v khi kt thc iu tr bng cc hormon tuyn gip.
HUYT THANH KHC LOI C HIU

Cc huyt thanh khc loi ly t huyt thanh nga c tng cng min
dch,
cho php t c min dch th ng tc th, ko di trong 15 n 21 ngy
i vi cc nhim khun c hiu
CC THUC TRONG NHM
Huyt thanh chng bch hu ng tim 10 MIU
Huyt thanh chng di ng tim 10 MIU
Huyt thanh chng un vn ng tim 1,5 MUI v 25 MUI
388
Huyt thanh chng nc rn ng tim

CH KHI CH NH THUC
Thi k mang thai: Nu c th, dng gama globulin c hiu ca ngi.
Cc trng hp khc: Trnh dng cho nhng ngi trc y dng cng th
huyt thanh . D ng huyt thanh nga. C a d ng.
8 - HYDROXYQUINOLEIN (Dn cht)

Cc dn cht ca hydroxy- 8 - quinolein, t c hp thu, c hot tnh trn cc u
trng v nang sn l. Thuc c tc dng khng khun i vi nhiu vi khun ng
rut. Thuc cng c dng ti ch iu tr nhiu loi nhim khun khc (m o,
da...)
CC THUC TRONG NHM
CHLORQUINALDOL vin t m o 200 mg
Colposeptine vin t m o 200 mg
Intetrix nang 200 mg
Tilbroquinol v Tiliquinol nang 200 mg
CH KHI CH NH THUC
Suy gan, suy thn: Nguy c tng aminotransferase (transaminase) khi dng vi
tiliquinol. Vi liu cao v iu tr ko di, gy vim tu bn cp, vim dy th n kinh
ngoi bin, vim dy thn kinh th gic, gy teo.
Vim da u chi do bnh rut.
IDOXURIDIN HOC THUC TNG T

Cc thuc khng virus hot ng trn cc virus gy bnh herpes, bnh thu u
v bnh zona, ch c dng ti ch, do c tnh vi t bo tc ch
CC THUC TRONG NHM
IBACITABIN thuc nh mt 15 mg/10mL
389
Cuterpes thuc nh mt 15 mg/10mL

IDOXURIDIN thuc nh mt 0,1%
Iduviran thuc nh mt 0,1%
TRIFLURIDIN thuc nh mt 10 mg/mL
Triherpine thuc nh mt 10 mg/mL
CH KHI CH NH THUC
Chng ch nh: mc 4
Cc trng hp: Lot gic mc, vim gic mc hu herpes v hnh a.
Thn trng: mc 2
Ph n mang thai: V thn trng, do khng c thng tin.
IDROCILAMID
Thuc th gin c, dng xoa bp ti ch iu tr co c au
CC THUC TRONG NHM
IDROCILAMID thuc m 5%
Srilane thuc m 5%
CH KHI CH NH THUC
Lot d dy, t trng; vim d dy: Do cc tc dng khng mong mun ca
thuc.
TNG TC THUC
Cafein
Phn tch: Idrocilamid c ch chuyn ho ca cafein. Trng hp iu tr trong
nhiu ngy, nn gim thm ch ngng ung hoc thuc c cafein.
X l: Ch bn idrocilamid ngoi th trng di dng thuc m. Cn phi bi mt
lng ln ln c th mi gy c tc dng ton thn.
IMMUNOGLOBULIN KHNG T BO LYMPHO

390
Cc immunoglobulin ngun gc ng vt (th, nga) c tnh khng t bo lympho

CC THUC TRONG NHM
LYMPHOGLOBULIN dung dch tim tnh mch 100 mg/5mL
THYMOGLOBULIN dung dch tim tnh mch 25 mg/5 mL
CH KHI CH NH THUC
Chng ch nh: mc 4
Cc trng hp: Qu mn vi thuc, nhim virus tin trin hay nhim nng mt
chng k sinh ni t bo.
TNG TC THUC
Vaccin sng gim c lc
Phn tch: C nguy c nhim khun tng ng vi vaccin do hot tnh c ch
min dch ca cc immunoglobulin khng t bo lympho.
X l: Khong cch gia ln dng thuc v tim chng vaccin phi t ba thng
n mt nm tu theo mc gim min dch.
Ciclosporin
Phn tch: Phi hp hai thuc gim min dch c th ko theo pht trin cc u
lympho bo gi. Liu cao c nguy c gy c cho thn.
bnh.
X l: Phi lu n nguy c, c tnh n tnh trng sinh bnh l ca ngi

Tacrolimus
Phn tch: Phi hp hai thuc gim min dch, c th ko theo pht trin cc u
lympho bo gi. Liu cao c nguy c gy c cho thn.
bnh.
X l: Phi lu n nguy c, c tnh n tnh trng sinh bnh l ca ngi
IMMUNOGLOBULIN NGI
Cc immunoglobulin ngi c tnh c hiu khi c iu ch t mu ngi cho
c tng min nhim hoc c tch phn on t mu ngi cho chun;
c tnh a tr khi c ly t cc phn phn on ca huyt tng
hay nhau thai ca ngi cho chun
CC THUC TRONG NHM
SANDOGLOBULIN l bt ng kh IgG 1g; 3g; 6 g
391
CH KHI CH NH THUC
c min nhim; khng dung np mu hoc cc sn phm mu khi tim tnh
mch.
INDINAVIR
Thuc khng protease, dng trong iu tr bnh AIDS
CC THUC TRONG NHM
INDINAVIR vin nn 400 mg
Crixivan vin nn 400 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b/mang thai: Khng c d liu.
Qu mn vi thuc.
Suy gan: Trnh dng hoc gim liu trong trng hp suy gan nng.
TNG TC THUC
Benzodiazepin
Phn tch: Indinavir c i lc mnh vi isoenzym 3A4 cytochrom P450, dn n
gim chuyn ho benzodiazepin l nhng thuc c chuyn ho ch yu bi
isoenzym ny (i khng c cnh tranh), lm tng nng ca cc thuc ny trong
huyt tng v tng c tnh ca chng. Nguy c tc dng an thn ko di v c ch
h hp nng (vi midazolam, triazolam, alprazolam). Tng tc dc ng hc v
chuyn ho thuc.
X l: Khng k n phi hp thuc ny. Tm cch thay th thuc.
Cisaprid; khng histamin khng H1 khng an thn
Phn tch: Indinavir c i lc mnh vi isoenzym 3A4 cytochrom P450, dn n
gim chuyn ho ca thuc khng histamin khng H 1 khng an thn, cisaprid l nhng
thuc c chuyn ho ch yu bi isoenzym ny (i khng c cnh tranh), nn lm
tng nng cc thuc ny trong huyt tng v lm tng c tnh ca chng. Tng
c vi tim, th hin s ko di khong QT v c th xut hin xon nh. Tng tc
dc ng hc v chuyn ho thuc.
X l: Khng k n phi hp thuc ny. Tm cch thay th thuc.
Sildenafil
392
Phn tch: Nng trong huyt tng ca sildenafil c th tng, lm gim huyt
p nng c th gy t vong. Tng tc xy ra nhanh. C ch c ch chuyn ho
sildenafil (CYP3A4).
X l: Dng sildenafil rt thn trng v vi liu thp cho ngi ang dng cc
thuc c ch protease. i vi ngi ang dng ritonavir hoc amprenavir, th sildenafil
khng c vt qu liu ti a 25mg trong thi gian 48 gi. i vi ngi ang dng
saquinavir, liu khi u sildenafil c khuyn co l 25mg.
Alcaloid nm ca g (dihydroergotamin, ergotamin)
Phn tch: Tng nguy c nhim c nm ca g (co mch ngoi bin, thiu mu
cc b u cc chi). Tng tc xy ra chm. C ch do cc thuc c ch protease
(indinavir) c th gy cn tr chuyn ho (CYP3A4) ca alcaloid nm ca g.
X l: Chng ch nh phi hp indinavir vi alcaloid nm ca g.
Amiodaron
Phn tch: Nng trong huyt thanh ca amiodaron c th tng, lm tng nguy
c nhim c amiodaron. Tng tc xy ra mun. C ch do indinavir c th c ch
chuyn ho (CYP3A4) ca amiodaron.
X l: Indinavir chng ch nh dng cho ngi ang dng amiodaron v cc thuc
c ch protease khc c th c tng tc tng t, cn phi gim st cn thn nng
trong huyt tng ca amiodaron v cc du hiu nhim c amiodaron. iu chnh
liu amiodaron nu cn.
Rifampicin
Phn tch: Gy cm ng quan trng cc cytochrom P450, lm tng chuyn ho
indinavir, dn n gim nng dng c hot tnh ca indinavir v do lm gi m
hiu qu iu tr.
X l: Theo di nng indinavir trong huyt tng, c th phi tng liu
indinavir. m bo theo di nng indinavir trong huyt tng v c th phi i u
chnh liu.
Ritonavir
Phn tch: Ritonavir, do cnh tranh khu cytochrom P450 nn lm gim chuyn
ho indinavir l nhng thuc b isoenzym ca cytochrom P 450 chuyn ho mnh, nn
lm tng nng cc thuc trong huyt tng, v nh vy lm tng c tnh ca
chng. Nguy c si tit niu v tng bilirubin mu khng triu chng. Tng tc dc
X l: Theo di chc nng thn (nh lng u n nng creatinin trong
mu), c th phi gim liu indinavir.
Saquinavir
Phn tch: Indinavir, do cnh tranh cytochrom P450, lm gim chuyn ho
saquinavir l nhng thuc b isoenzym ca cytochrom P450 chuyn ho mnh. iu ny
dn n tng nng saquinavir trong huyt tng v nh vy, lm tng c tnh ca
393
chng. Nguy c c vi gan v mu (thiu mu tan huyt, bnh bch cu tu bo cp).

X l: Theo di huyt hc u n (lm huyt ); theo di chc nng gan ( nh
lng u n cc enzym gan); c th phi gim liu saquinavir.
Delavirdin
Phn tch: Nng trong huyt tng ca indinavir c th tng, lm tng tc
dng dc l v tc dng ph. C ch do c th chuyn ho v thanh lc sau hp
thu ca indinavir b gim.
X l: Gim st cht ngi bnh v iu chnh liu nu cn.
Didanosin
Phn tch: Lm gim sinh kh dng v hiu lc ca indinavir. Indinavir c hp
thu tt hn mi trng acid.
X l: K n hai th thuc, dng cch nhau 1 gi, vo lc i.
Neviparin
Phn tch: Nng trong huyt tng ca indinavir c th b gim, lm gim tc
dng. Tng tc xy ra chm. C ch do nghi c tng chuyn ho gan (CYP3A4) ca
indinavir.
X l: Gim st nng trong huyt tng ca indinavir v p ng lm sng
ca ngi bnh khi bt u cho hay ngng neviparin. iu chnh liu indinavir nu cn.
Rifabutin
Phn tch: Rifabutin l cht cm ng enzym, lm tng chuyn ha indinavir bi
isoenzym 3A4 ca cc cytochrom P450 nn lm gim nng dng hot tnh ca
indinavir trong huyt tng. ng thi cng thy din tch di ng cong (AUC) ca
rifabutin tng ln, c nng nh cng tng. Kt qu l gim hiu l c i u tr c a
indinavir v tng tc dng c ca rifabutin (au c, au khp, gi m bch c u trung
tnh).
X l: Gim na liu rifabutin.
Phn tch: Ketoconazol c ch chuyn ha indinavir gan, kt qu l lm tng
nng indinavir trong huyt tng, do cng lm tng c tnh ca n (si tit niu ,
tng bilirubin mu).
X l: Nn gim liu indinavir (khuyn dng 1,8g/ngy).
394
INDOMETACIN HOC DN CHT

CC THUC TRONG NHM
INDOMETHACIN nang 25 mg; bt ng kh pha dung dch nh mt 0,1%; dung
dch nh mt 1%; hn dch nh mt 0,5g/100 mL
Apo- methacin nang 25 mg
Indocid nang 25 mg
Indocollyre bt ng kh pha dung dch nh mt 0,1%; dung dch nh mt 1%
Indom Collyrium hn dch nh mt 0,5g/100 mL
Novo- methacin nang 25 mg
CH KHI CH NH THUC
Suy gan: Phi trnh dng thuc ny trong trng hp suy gan nng.
Suy thn: Trnh dng thuc ny trong trng hp suy thn nng.
Lot d dy t-trng; vim d dy: Cc thuc ny kch ng ng tiu ho, nn
khng c k dng khi b lot hoc c tin s lot. Indometacin lm gim v thay i
tit cht nhy bo v.
Thn trng: mc 2
Thi k cho con b: Cha xc nh c tnh v hi khi dng cc hp cht indol.
Tr em; tr cn b: Indometacin khng nn dng trong nhi khoa. Cc tc dng
khng mong mun thng gp l nhng ri lon ca h thn kinh trung ng (au u,
chng mt, trng thi l ln), v ca cc gic quan (ri lon th gic). Do h n ch
vic k n thuc ny cho tr em.
Thi k mang thai: Indometacin c th ko di thi k mang thai v dn n
nhng bt thng trong chuyn d; phi trnh dng thuc ny k t thng th su.
Trng hp khc: Vi bnh nhim khun, indometacin c th che lp cc triu
chng v lm chn on chm; trong trng hp hi chng nhim khun k c khi
c kim sot tt, s dng indometacin cng vn phi thn trng.
Cn theo di: mc 1
Trm cm; ng kinh; Parkinson: Cc thuc nhm indol thng dn n
nhng ri lon thn kinh cm gic, lm nng thm cc bnh trn.
Ngi cao tui: Tui tc c th lm tng nguy c xy ra cc tc dng khng
mong mun ca indometacin v cc dn cht, v vy phi thn trng khi dng cho
ngi cao tui.
TNG TC THUC
395

Methotrexat
Phn tch: Tng tc dng c vi mu ca methotrexat do methotrexat b y ra
khi lin kt protein huyt tng v/hoc b gim o thi qua th n. Tc d ng ny
ph thuc liu dng (tc dng vi ketoprofen quan trng hn).
X l: C th gp tng tc ny ti bnh vin. Nu phi k n methotrexat liu
cao, th trc 12 n 24 gi phi ngng dng thuc chng vim khng steroid cho
n khi nng methotrexat tr v mc khng c. Mc du tng tc ny cha c
m t cho tt c cc thuc chng vim khng steroid, nhng vn nn p dng cch x
l nguyn tc ny v nn trnh k n dng ng thi.
Probenecid
Phn tch: Probenecid c ch bi tit indometacin qua thn.
X l: V probenecid lm chm s o thi nhiu thuc, nn c th v c
dng gim liu mt s thuc. Nn rt cnh gic vi cc nguy c tim tng v vi s
tng c tnh ca thuc phi hp. Nghin cu bi cnh sinh bnh l.
Phn tch: Nguy c chy mu tng, ch yu i vi cc cephalosporin c nhn
thiomethyltetrazol (latamoxef, cefoperazon, cefamandol, cefmenoxim, cefotetan). Nhn
ny, nh mt dn cht coumarin, c tc dng chng ng (khng vitamin K), do
thm tnh cht chng ng ca n vo tnh cht hoc khng vitamin K, hoc chng kt
tp tiu cu ca indometacin.
X l: Phi hp ny khng c khuyn co, ch yu i vi latamoxef,
v tng nguy c chy mu. Phi d chng c bit vi liu cao cc khng sinh ny.
Dn cht pyrazol
Phn tch: Phi hp ny khng hp l: thm tc nhn gy lot v tng nguy c
chy mu ng tiu ho.
X l: K n tha. Nn thay i chin lc iu tr v phi hp ny cn trnh.
Dn cht salicylat
Phn tch: Phi hp thuc khng hp l: hip ng cc tc dng gy lot v gia
tng nguy c xut huyt ng tiu ho.
X l: K n tha. Nn thay chin lc iu tr, v khng khuyn co phi hp
thuc ny.
Dng c t t cung
Phn tch: Thuc chng vim khng steroid (nht l aspirin) lm tng nguy c mt
hiu qu ca dng c t t cung (do tc dng gim vim).
X l: Mc du nguy c th thai cn ang c tranh ci trong y vn, nhng cng
nn trnh k n cc thuc chng vim khng steroid cho ph n ang dng phng
tin nga thai ny. Nu dng cc thuc chng vim khng steroid khng lm gim hiu
396
qu ca dng c t t cung th nn bo cho Trung tm cnh gic thuc. Tng tc

ny vn cn c b sung t liu
397
Heparin; ticlopidin
Phn tch: Phi hp vi mi thuc c tc dng chng kt tp tiu cu hay chng
ng nh heparin, ticlopidin u lm tng nguy c chy mu. Nguy c ny tng do tc
dng xm hi nim mc d dy ca cc thuc chng vim khng steroid (chy mu
ng tiu ho).
X l: Vic phi hp thuc ny i hi phi theo di bng cc xt nghim ng
mu thch hp (thi gian Howell v thi gian cephalin kaolin) trong v sau thi gian iu
tr bng cc thuc chng vim khng steroid. Nu c th, nn tm mt gii php iu tr
khc i vi cc ngi bnh c tin s lot.
Phn tch: Phi hp ny khng hp l, thm tc dng gy lot v tng nguy c
chy mu ng tiu ho.
X l: K n tha; nn thay i chin lc iu tr, v phi hp ny khng c
khuyn co.
Thuc tan huyt khi
Phn tch: Phi hp vi mi thuc c tnh cht chng kt tp tiu cu hay chng
ng u lm tng nguy c chy mu.
X l: Nhn chung, k n v dng cc thuc tan huyt khi l thm quyn ca
cc thy thuc c o to chuyn khoa (cc thy thuc chuyn khoa tim v cc thy
thuc ca i cp cu) v phm vi iu tr ca cc thuc ny hp v cch dng cng
tinh t. Nu cn phi hp ny, phi theo di cc xt nghim ng mu thch hp (thi
gian Howell v thi gian cephalin - kaolin) trong v sau thi gian iu tr bng cc thuc
chng vim khng steroid. Nu c th, nn tm mt gii php iu tr khc.
Phn tch: Tng tc dng chng ng do y cc thuc chng ng ra khi lin
kt vi protein huyt tng v thm tc dng chng kt tp tiu cu. V cc thuc
chng vim khng steroid c tnh xm hi nim mc d dy, nn lm tng nguy c lot
chy mu d dy ngi bnh cao tui.
X l: Cn trnh k n ng thi cc thuc ny do nguy c gy chy mu. Vi
aspirin, mc du c phi hp ny, nhng ch c th cho liu thp
(c 200mg). Vi liu cao, cn trnh phi hp ny v vn l chng ch nh chnh thc.
Aminoglycosid
Phn tch: Nng huyt tng ca aminoglycosid c th tng tr non. C
ch thuc chng vim khng steroid c th gy tch lu aminoglycosid bng cch lm
gim tc lc cu thn.
X l: Gim liu aminoglycosid trc khi bt u cho thuc chng vim khng
steroid. iu chnh liu aminoglycosid da theo nng huyt thanh aminoglycosid v
gim st chc nng thn.
Biphosphonat
398
Phn tch: Tng nguy c lot d dy. Tng tc xy ra chm. C ch do tc dng

hip ng ca hai thuc gy lot d dy.
X l: Phi hp phi thn trng. Gim st cht ch pht hin cc phn ng c
hi ng tiu ho, c bit lot d dy.
Digoxin
Phn tch: Indometacin c th lm tng nng huyt thanh ca digoxin tr
non, c th lm tng tc dng dc l hoc c tnh. iu nay khng xy ra ng i
bnh c chc nng thn bnh thng. C ch v chc nng thn b gim, indometacin
c th lm gim o thi digoxin qua thn.
X l: Thn trng khi dng cho tr non c chc nng thn gim. Khi no
nh gi c lng nc tiu thi ra v nng huyt thanh digoxin, lc c th
cn nhc gim 50% liu digoxin khi thm indometacin cho tr thiu thng ang dng
digoxin.
Glucocorticoid
Phn tch: Tng cc tc dng khng mong mun do cng hp cc tc dng gy
lot nim mc d dy.
X l: Cn nhc tng quan li ch/ nguy c trc khi k n phi hp ny. S tng
nguy c gy lot i hi xem xt li cch iu tr ngi bnh cao tui v ngi c tin s
lot. Nu cn, phi hp thm mt cht bo v nim mc d dy.
Insulin
Phn tch: V cc prostaglandin tham gia vo c ch iu ho glucose mu nn c
th thy tng nguy c h glucose mu.
X l: Trong qu trnh iu tr bng cc thuc chng vim, c th c s thay i
nng glucose mu nht thi. Thng bo cho ngi bnh tng cng t theo di
glucose mu.
Phn tch: Nguy c c ch tc dng sinh hc ca interferon c m t vi
cc dn cht salicylat, nhng vn c th c vi cc thuc chng vim khng steroid
khc. C ch cha c bit.
X l: Phi tnh n gim hot tnh ny trc khi phi hp hai thuc. Cn nhc
tng quan nguy c/li ch v hiu qu/ph tn.
X l: Interleukin ch c dng ti c s chuyn khoa, do tnh cht bnh l nghim
trng. T cc tng tc phi c cn nhc, v tt c cc chc nng ca c th phi
c theo di lin tc. Vic theo di huyt l bt buc.
Lithi
Phn tch: Cc thuc chng vim c th lm gim thanh lc lithi qua thn, gy
tng ti hp thu lithi qua ng thn c th dn n qu liu lithi.
399
X l: S phi hp ny i hi phi iu chnh liu lithi khi bt u, khi kt thc

v trong qu trnh iu tr bng cc thuc chng vim. Nu cn, phi theo di cn thn
nng lithi trong mu.
Mifepriston
Phn tch: Nguy c gim hiu qu ca cc phng php iu tr.
X l: Ngng iu tr bng cc thuc chng vim khng steroid 24 gi trc khi
dng mifepriston.
Pentoxyfyllin
Phn tch: Tng nguy c chy mu.
X l: Nu phi hp thuc ko di, cn phi theo di thi gian chy mu. Hi
ngi bnh v tin s lot d dy t trng. Cn thn khi dng ngi bnh cao tui.
Reserpin hoc dn cht
Phn tch: Gim hiu qu chng tng huyt p do cc thuc chng vim khng
steroid c ch tng hp thn cc prostaglandin gin mch thn v/hoc ko theo
s gi natri v nc. C nguy c suy thn cp cc ngi bnh mt nc.
X l: Bo m chc chn ngi bnh c b nc y , theo di chc nng
thn ( thanh lc creatinin) v n nh ca huyt p, c bit lc bt u i u tr .
Khuyn ngi bnh theo di thng xuyn huyt p.
Phn tch: Cc prostaglandin tham gia vo c ch iu ho glucose mu, nn tng
nguy c h glucose mu.
X l: Trong qu trnh iu tr bng cc thuc chng vim, c th c s bin ng
glucose mu nht thi. Thng bo cho ngi bnh tng cng t theo di.
Tetracosactid
Phn tch: Nguy c tng tc dng gy lot d dy-t trng chy mu. Nhng trong
mt s dng vim khp, phi hp ny c th c li.
X l: Cn nhc nguy c/li ch trc khi k n. Nu k n phi hp thuc ny,
cn theo di lm sng. Thng bo nguy c cho ngi bnh bit.
Phn tch: Thuc khng acid v than hot lm gim hp thu ng tiu ho,
nn lm gim hiu qu ca thuc phi hp.
X l: Cn gi khong cch 1 n 2 gi gia lc dng thuc khng acid v thuc
phi hp. Cc thuc khng acid thng c ung 1gi 30 pht sau ba n v n ung
lm tng tit dch v.
Verapamil
Phn tch: Nguy c tng c tnh ca hai thuc do chuyn dch khi v tr lin kt
vi protein huyt tng. Tng tc dc ng hc v phn b thuc.
400
X l: Cn theo di p ng trn lm sng vi verapamil v iu chnh liu ca

cht c ch calci ny. Theo di cc tc dng khng mong mun ca indometacin c th
xy ra (au bng, tiu chy, to bn, bun nn, nn, chn n...).
Zidovudin
Phn tch: Tng c tnh ca mi thuc do c ch - cnh tranh s lin hp vi
acid glucuronic trong cc vi tiu th gan.
X l: Theo di cc tc dng khng mong mun lin quan n indometacin v
zidovudin: theo di huyt hc (s lng v cng thc mu) v lm sng (suy nhc,
bun nn, nn...).
Cht c ch enzym dng angiotensin; clonidin hoc thuc tng t;
diazoxyd; dihydropyridin; furosemid hoc thuc tng t; methyldopa; sotalol;
thuc chn beta; thuc gin mch chng tng huyt p; thuc li tiu gi kali;
thuc li tiu thi kali
steroid c tc dng c ch tng hp thn prostaglandin gin mch thn v / hoc
ko theo gi nc v natri. C nguy c suy thn cp nhng ngi bnh mt nc.
X l: m bo chc chn ngi bnh c b nc y ,theo di chc nng
thn ( thanh lc creatinin) v n nh ca huyt p, c bit lc bt u i u tr .
Khuyn ngi bnh theo di thng xuyn huyt p.
Desmopressin
Phn tch: Tng cng tc dng chng li tiu.
X l: Theo di lm sng v iu chnh liu desmopressin theo kt qu xt
nghim v lm sng.
Dipyridamol
Phn tch: Phi hp vi mi thuc c tc dng chng kt tp tiu cu hay chng
ng mu lm tng nguy c chy mu. Hin nay tng tc ny cn ang tranh ci, cha
c nhn xt lm sng no khng nh nguy c chy mu.
X l: Nu vn c th phi hp thuc, phi theo di cht ch thng qua cc xt
nghim ng mu thch hp trong v sau qu trnh iu tr bng cc thuc chng vim
khng steroid.
steroid c tc dng c ch tng hp prostaglandin gin mch thn v/hoc ko theo
gi nc v natri. C nguy c suy thn cp ngi bnh mt nc.
X l: Bo m chc chn ngi bnh c b nc y , theo di chc nng
thn ( thanh lc creatinin) v n nh ca huyt p, c bit lc bt u i u tr
Nn cn thn i vi ngi bnh cao tui (suy thn sinh l). Khuyn ngi bnh t theo
di thng xuyn huyt p.
401
INSULIN
Hormon tu gim glucose mu
CC THUC TRONG NHM
INSULIN hn dch tim 40 IU/mL; 100 IU/mL; dung dch tim 40 IU/mL; 100 IU/mL
Actrapid HM dung dch tim 40 IU/mL
Humulin 70/30 dung dch tim 100 IU/mL
Humulin hn dch tim 100 IU/mL
Humulin L hn dch tim 40 IU/mL
Humulin N hn dch tim 40 IU/mL
Humulin N thuc tim 100 IU/mL
Humulin N hn dch tim 100 IU/mL
Humulin R hn dch tim 40 IU/mL
Humulin R thuc tim 100 IU/mL
Humulin R dung dch tim 100 IU/mL
Mixtard 30 HM hn dch tim 40 IU/mL; 100 IU/mL
CH KHI CH NH THUC
Tiu ng km theo tng th trng hoc bo ph: Khng dng insulin tr
nhng trng hp ngoi l. C bin php phng cn thit cho ngi qu mn vi
thuc.
Thn trng: mc 2
n ung; ru: Ru phong b tn to glucose gan, lm gim glucose mu,
lm tng tc dng ca insulin, vi nguy c hn m do h glucose mu bao gi cng
nng. Ngi tiu ng phi bit nhng du hiu bo trc h glucose mu: i cn
co, yu c, mi mt, ti nht, v m hi.
TNG TC THUC
Danazol
Phn tch: Danazol lm tng glucose mu v khng insulin.
X l: Khi cn phi hp, phi theo di cht glucose mu. Khuyn ngi bnh tng
cng t theo di v c th phi iu chnh liu insulin lc bt u, trong qu trnh v
khi ngng iu tr bng danazol.
Glucococorticoid; tetracosactid
402
Phn tch: Gim tc dng ca insulin do tnh cht tng glucose mu gin tip ca
cc corticoid. Gim dung np glucid do corticoid v c nguy c xut hin tch ceton.
X l: Phi tnh n tc dng ca corticoid trong iu tr bng cc thuc chng
tiu ng. Cn thit lp c cn bng glucose mu khi bt u, trong v sau khi
iu tr bng corticoid. Thng bo cho ngi bnh v nguy c bin ng glucose mu
v lp k hoch dng thuc.
Ru
Phn tch: Ru to thun li cho cc thuc chng tiu ng gy h glucose
mu theo mt c ch cha xc nh y . Hnh nh ru c ch s tn to glucose
gan.
X l: Bao gi cng kh hn ch mt s ngi bnh ung ru. Tt hn, nn lm
cho h coi chng nguy c h glucose mu v hn ch ti a ung ru, nht l ung
lc i.
Asparaginase
Phn tch: Asparaginase c th lm ri lon cn bng glucose mu do c tnh
cht lm tng glucose mu.
X l: Theo di glucose mu trong v sau khi iu tr bng asparaginase, c bit
i vi ngi bnh tiu ng.
Diazoxyd
Phn tch: Tng tc dc lc gia mt thuc h glucose mu v mt thuc tng
glucose mu. i khng dc l.
X l: Trong trng hp tiu ng khng cn bng hay cn bng km, phi hp
ny l mt chng ch nh. Diazoxyd thng ch c dng c s chuyn khoa c
iu kin theo di lin tc.
Estrogen hoc thuc nga thai estroprogesteron
Phn tch: C th c bin ng glucose mu khng n nh, do tnh cht tng
glucose mu nh ca loi thuc ny; c th thy insulin gim tc dng.
X l: Thng bo cho ngi bnh kh nng bin ng glucose mu; iu chnh
liu theo p ng sinh hc.
Phn tch: Trong cc thuc li tiu quai, furosemid c tnh cht tng glucose mu
nn c th lm gim tc dng ca cc thuc chng tiu ng. C ch cha c
sng t.
X l: Thuc li tiu c th dng cho ngi bnh tiu ng, nhng phi ch
n nhng bin ng glucose mu v phi iu chnh liu theo cc kt qu xt nghim
sinh hc.
Glucagon
403
Phn tch: Tng tc dc lc. Glucagon ng thi gip cho c tn to glucose

v thu phn glycogen, bng cch kch thch adenylcyclase to AMP vng. Kt qu
l lm tng nng glucose trong huyt tng.
X l: Phi hp glucagon vi cc thuc gim glucose mu l khng hp l, tr khi
tm kim mt i khng dc l.
Phn tch: Tng tc dc ng hc. Insulin b y ra khi v tr lin kt vi
protein huyt tng.
X l: iu chnh liu insulin trong v sau khi iu tr bng guanethidin, nu cn
thit phi hp thuc ny.
Hormon tuyn gip
Phn tch: Dng hormon tuyn gip c th lm mt cn bng trong iu tr chng
tiu ng, do tng nhu cu insulin hay thuc gim glucose mu.
X l: Phi hp ny i hi phi iu chnh liu. Thng bo cho ngi bnh
tng cng t theo di ngay khi thay i liu hormon tuyn gip.
Indometacin hoc dn cht
Phn tch: Cc prostaglandin tham gia vo c ch iu ho glucose mu, nn c
th c nguy c h glucose mu.
X l: Trong khi iu tr dng thuc chng vim c th c thay i tam thi v
glucose mu, ngi k n nn thng bo cho ngi bnh tng cng t theo di.
Octreotid
Phn tch: ngi bnh tiu ng ph thuc insulin, nhu cu insulin c th
gim 30 n 50%.
X l: Phi tnh n h qu ca tng tc thuc xc nh liu. Thng bo cho
ngi bnh h tng cng t theo di v thch ng vi nhu cu insulin ca mnh.
Vi ngi bnh khng tiu ng, theo di glucose mu.
Phn tch: Cc progestogen liu cao c th gy tiu ng v c th i khng
tc dng ca cc thuc chng tiu ng.
X l: Thng bo cho ngi bnh cc nguy c bin ng glucose mu h
tng cng t theo di. Tu theo kt qu, iu chnh liu insulin lc bt u v sau khi
iu tr bng nhm progestogen. Lp mt k hoch dng thuc u n. Khuyn ngi
bnh i khm li, khi c vn .
Salicylat
Phn tch: Liu cao aspirin c th gy h glucose mu v lm tng tc dng ca
insulin.
X l: Nu phi iu tr di ngy mt s trng thi vim bng dn cht salicylat,
ngi tiu ng, cn bo trc cho ngi bnh bit tng cng t theo di. iu
chnh liu insulin nu cn, khi phi tip tc iu tr salicylat.
404
Sotalol
Phn tch: Thuc chn beta c th che lp cc triu chng ca h glucose mu
v tng tc dng ca cc sulfamid h glucose mu v ca insulin trong ti u ng.
iu ny c th dn n hn m h glucose mu m khng c du hiu bo trc.
X l: Nu cn phi hp thuc, phi thng bo cho ngi bnh c th b h
ng huyt m khng c cc du hiu h glucose mu (nhp tim nhanh, m hi,
run ry, nh trng ngc, cm gic i, lo u...) Khi iu tr tng huyt p ngi tiu
ng, nn dng cc thuc c ch enzym chuyn dng.
Thuc chn beta
Phn tch: Cc thuc chn beta (k c dng thuc nh mt) c th che lp cc
triu chng ca h glucose mu v lm tng tc dng insulin trong ti u ng. i u
ny c th dn n hn m h glucose mu m khng c du hiu bo trc.
X l: Nu cn phi hp thuc, phi thng bo cho ngi bnh nguy c xut hin cc
du hiu h glucose mu (nhp tim nhanh, ra m hi, run ry, nh trng ngc, cm gic i,
lo u...). Trong iu tr tng huyt p, i vi ngi bnh tiu ng thng a dng cc
cht c ch enzym chuyn dng angiotensin.
405

Phn tch: Gim tc dng ni chung ca cc thuc chng tiu ng do tnh cht
tng glucose mu ca cc thuc ging beta nh ritodrin, salbutamol v ephedrin.
X l: Theo di cht glucose mu v thng bo cho ngi bnh h tng cng
t theo di. Lp mt k hoch dng thuc u n. Lu n cc d ng bo ch c
thuc ging beta nh gi tm quan trng ca tc dng tng glucose mu.
Phn tch: Cc prostaglandin tham gia vo c ch iu ho glucose mu, nn c
th tng nguy c gim glucose mu.
X l: C th c bin ng tm thi glucose mu trong khi iu tr bng cc thuc
chng vim. Thng bo cho ngi bnh v nguy c ny h tng cng t theo di.
Phn tch: Tng tc c m t cho captopril v enalapril. Phi hp ny,
trong trng hp c bit, c th dn n h glucose mu ngi bnh tiu ng
ang iu tr bng insulin hay sulfamid h glucose mu.
X l: Phi hp ny l kinh in v vic chn dng cc thuc c ch enzym
chuyn cho ngi bnh tiu ng l thng gp. Hu nh him gp nhng bt n h
glucose mu. Thng bo cho ngi bnh h tng cng t theo di glucose mu,
nu cn.
Thuc c ch MAO
Phn tch: Lm tng tc dng gim glucose mu ca insulin v lm chm hi
phc khi b h glucose mu. Tng tc xy ra chm. C ch: kch thch bi tit insulin
v c ch tn to glucose.
X l: Phi gim st cht ch glucose mu v iu chnh liu insulin nu cn.
Diltiazem
Phn tch: Tc dng lm h glucose mu ca insulin c th b gim. Tng tc
xy ra nhanh. C ch: cha r
X l: Khng cn thn trng c bit. Nu nghi c tng tc, c th tng liu
insulin. Theo di glucose mu.
Thuc ng ho steroid, alkyl ho C17
Phn tch: Thuc ng ho steroid c th lm h glucose mu. Tng tc c
xc lp vi mt s thuc ng ho steroid.
X l: Tng cng theo di glucose mu, thng bo cho ngi bnh bit nguy c
(du hiu h glucose mu) v iu chnh liu. Cn nh cc du hiu h glucose mu:
hoc cc du hiu do tit qu nhiu adrenalin: ra m hi, run ry, nhp tim nhanh, lo u,
i; hoc cc du hiu do ri lon chc nng h thn kinh trung ng: cm gic kh ,
au u, ri lon th gic, gim tinh tng, l ln, hnh vi bt thng, co gi t, mt
thc.
406
Tetracyclin
Phn tch: Tng kh nng gy h glucose mu ca insulin. Tng tc xy ra
chm. C ch: Tng p ng ngoi tu i vi insulin.
X l: Cn theo di glucose mu cht. iu chnh liu insulin nu cn trnh b
h glucose mu.
407
INTERFERON ALPHA TI T HP
Protein sn xut bng cng ngh di truyn, c tnh chng virus,
chng tng sinh v iu ho min dch
CC THUC TRONG NHM

INTERFERON ALPHA 2B bt pha dung dch tim 5.000.000 IU/l; 3.000.000 IU/l
Intron A bt pha dung dch tim 5.000.000 IU/l; 3.000.000 IU/l
INTERFERON 2A dung dch tim 3 MIU; 4 MIU; 9 MIU; 5 MIU; 18 MIU
Roferon A dung dch tim 3 MIU; 4 MIU; 9 MIU; 5 MIU; 18 MIU
CH KHI CH NH THUC
Chng ch nh: mc 4
Qu mn vi thuc hay vi mt t dc (albumin). Cc ri lon tuyn gip
khng kim sot c. Suy tu nng.
Thi k cho con b: Hnh nh interferon khng vo sa: tuy nhin, do nguy c
tc dng ph, nn khng cho con b trong thi gian iu tr.
ng kinh: Nguy c h thp ngng gy ng kinh
Thi k mang thai: kh, thy tng sy thai m khng c tc dng gy qui
thai. Tuy vy tnh c hiu trn loi khng cho php kt lun trn ngi.
Suy tim: Nguy c c vi tim c th tng ngi bnh c tin s bnh tim.
Suy thn: Trng hp suy thn nng
Cn theo di: mc 1
Suy gan: Trng hp suy gan nng
Trng hp khc: Trng hp nhim virus Herpes v/hoc suy tu nng. Trnh
k n cho ngi bnh qu mn vi thuc ny.
TNG TC THUC
Benzodiazepin
X l: Lu nguy c ny iu chnh liu ca hai thuc. Cn ch n gim
tnh to ngi li xe v ngi vn hnh my. Khuyn khng ung ru v khng t
Ru
408
an thn bun ng. Vi mt s thuc, thy, nht l trong tun iu tr u tin, mt
s tc dng tm thn vn ng. Tng tc dc lc.
X l: Tt hn, khng phi hp hai cht ny, hn na, ngi k n khng th
kim sot c vic ung ru ca ngi bnh. Nguy c an thn bun ng c bit
nguy him vi ngi li xe v ngi iu khin my mc. Khuyn ng i bnh khng
Vaccin sng gim c lc
Phn tch: Nguy c nhim khun tng ng vi vaccin, do tc dng gim min
dch ca interferon.
X l: Cn tn trng khong cch dng hai thuc ny t 3 thng n 1 nm, tu
theo mc gim min dch.
Amineptin; thuc ch vn morphin
huyt p. Hn na nu ph thuc thuc, th s phi hp hai thuc ny c th lm
tng nguy c ph thuc thuc.
X l: Phi tnh n nguy c ny iu chnh liu hai thuc, nu cn phi hp.
Cn lu n gim tnh to ngi li xe v ngi iu khin my mc. Khuyn ngi
bnh khng ung ru v khng t dng thuc hoc ch phm c ru.
Amphotericin B
Phn tch: Phi hp amphotericin B tim vi cc thuc c vi tu khc, i hi
phi rt thn trng. Nguy c thiu mu hay cc ri lon huyt hc khc.
cn.
X l: Nu cn phi hp thuc, phi theo di cn thn huyt v gim liu, nu

cyclophosphamid hoc thuc tng t; dactinomicin; doxorubicin hoc dn
cht; ganciclovir; levamisol; melphalan; mercaptopurin; methotrexat; procarbazin;
thiotepa; thuc chng ung th cc loi; trimethoprim; vincristin hoc thuc
tng t
Phn tch: Nguy c tng c vi mu do hip ng tc dng c ch tu xng,
c th dn n mt bch cu ht.
X l: Nu c, nn trnh phi hp ny. Nu cn phi hp, phi dng liu thp
cho mi thuc v theo di cn thn huyt . S phi hp ny thng do cc thy thuc
chuyn khoa v phc iu tr thng c xc lp cn thn.
Baclofen; carbamat hoc thuc tng t; dn cht phenothiazin; thuc an
thn kinh cc loi; thuc chng ng kinh khng barbituric; thuc c ch h
thn kinh trung ng cc loi
409

to ngi li xe v ngi vn hnh my. Khuyn khng ung ru v khng t dng
Clozapin
c th dn n mt bch cu ht. Mt bch cu ht nghim trng, thm ch t vong c
th
xy
ra
khi
ch
dng
clozapin
n
c
(c
tnh
min dch).
X l: Trnh phi hp ny. Nu cn phi hp, nn dng liu thp cho mi thuc.
Khng c du hiu g cho php d on mt bch cu ht vi clozapin. Vic theo di
cn thn huyt , thng c thc hin khi s dng mt thuc km t bo, vn cn
gi tr. Ngi bnh c thng bo l khi ch hi st nh, vim hng v lot ming l
phi ngng iu tr ngay.
Dn cht pyrazol; dn cht salicylat; indometacin hoc dn cht; thuc
chng vim khng steroid
cc dn cht salicylat, nhng cng c th c gi tr i vi cc thuc chng vim khng
steroid khc. C ch cn cha r.
X l: Phi tnh n s gim hot tnh ny trc khi phi hp hai thuc. Cn nhc
cc tng quan nguy c / li ch v chi ph / hiu qu.
X l: Interleukin l thuc ch c s dng ti c s chuyn khoa do tnh trng
bnh l nng. Do tng tc phi c cn nhc v tt c cc chc nng ca c th
u phi theo di lin tc. Bt buc phi theo di huyt .
Pentostatin
Phn tch: S dng ng thi hai thuc c ch tu xng c th dn n nhng
ri lon huyt hc nghim trng tu theo thi gian iu tr.
X l: Khi phi hp thuc ny, phi theo di huyt hc.
Phenicol
Phn tch: Nguy c tng c vi mu do c ch tu xng, do tc dng hip
ng c th dn n mt bch cu ht. Ch dng n c dn cht phenicol cng c
th mt bch cu ht nghim trng, thm ch t vong (c tnh min dch).
X l: Nu cn phi hp thuc ny, nn dng liu thp cho mi thuc. Khng th
d on c mt bch cu ht vi cc phenicol. Vic theo di cn thn huyt
thng thc hin khi s dng mt thuc km t bo, vn c gi tr. Nhng ngi bnh
phi c thng bo l khi ch st nh, vim hng v lot ming l phi ng ng ngay
vic iu tr bng cc phenicol.
Zidovudin
410
Phn tch: Phi hp zidovudin vi cc thuc khc c vi tu phi rt cn thn.

Nguy c thiu mu hay cc ri lon huyt hc khc.
X l: Khi cn phi hp thuc ny, phi theo di cn thn huyt v gim li u
nu cn.
amphetamin.
X l: Phi tnh n tng tc dc lc ny xc nh mc ch iu tr chnh.
Khuyn ngi bnh gp li thy thuc nu iu tr c v khng n nh.
Barbituric; khng histamin khng H1 an thn; paroxetin; viloxazin
X l: Lu nguy c ny iu chnh liu ca 2 thuc. Cn ch n gim tnh
to ngi li xe v ngi vn hnh my. Khuyn khng ung ru v khng t dng
Citalopram
Phn tch: tng tc dng an thn bun ng ca thuc c ch ti thu nhn
serotonin.
X l: Coi chng vic ung ru ng thi, nht l ngi li xe v ngi iu
khin my mc.
Fluoro - 5 - uracil
c th dn n mt bch cu ht. Hn na, cn c tng c tnh ca fluorouracil vi d
dy- rut.
X l: Nu cn phi hp, phi dng liu thp cho mi thuc v theo di cn thn
huyt . Phi hp cc cht km t bo phi do cc nh chuyn khoa thc hin v phc
iu tr thng c xc lp cn thn.
Glucocorticoid
prednison nhng cng c gi tr cho cc corticoid khc. C ch cha bit r.
X l: S gim hot tnh ny phi c tnh n trc khi phi hp cc thuc.
Cn nhc nguy c / li ch v chi ph / hiu qu.
Methadon
Phn tch: Tng tc dng c ch h thn kinh trung ng, km theo tc dng an
thn bun ng mnh, c hi c bit cho ngi li xe v ngi iu khin my mc.
411
X l: Ngi k n phi tnh n tng tc dng an thn bun ng ny a ra

nhng li khuyn thch hp. Trnh li xe hoc vn hnh my. Thng bo cho ng i
xung quanh bit mi nguy him.
Theophylin
Phn tch: Tng tc dng dc l ca theophylin. Tng tc xy ra nhanh. C
ch: Cha r.
X l: Nu nghi c tng tc, nh lng nng huyt tng theophylin v iu
chnh liu cho ph hp.
huyt p. Hn na nu ph thuc thuc th phi hp hai thuc ny c th lm tng
nguy c ph thuc thuc.
X l: Phi tnh n nguy c ny iu chnh liu ca hai thuc nu cn phi
hp. Cn ch n gim tnh to ngi li xe v ngi s dng
my mc. Khuyn khng ung ru v khng t dng thuc hoc ch phm c ru.
INTERLEUKIN 2 TI T HP
Interleukin 2 ti t hp, cn c tn l aldesleukin, c cu trc
gn vi cu trc ca interleukin 2 ngi, c tnh cht iu ha min dich
v hin nay c dng ch yu trong iu tr ung th biu m dng tuyn thn di cn
CC THUC TRONG NHM
ALDESLEUKIN l bt ng kh 1mg
Proleukin l bt ng kh 1mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi thi k cho con b: Khng d liu.
ng kinh: Do nhiu tc dng khng mong mun, cn theo di cht ch tt c
cc chc nng.
Thi k mang thai: Thiu d liu: ph n ang tui sinh cn c
chng th thai c hiu qu.
Suy tim: V cc tc dng khng mong mun ca thuc (bin ng huyt p, lon
nhp tim, au tht...), nn chng ch nh trong cc trng hp suy tim khng b. Cn
vi nhng trng hp khc cn theo di cht.
412
Suy h hp; hen: V c nhng tc dng khng mong mun ca thuc (kh th,
ho, ph phi, suy h hp cp...), nn s dng thuc ny trong trng hp suy h hp
khng b l mt chng ch nh. Trong cc trng hp khc cn theo di cht ch.
Trng hp khc: Nhim khun tin trin, di cn no, cc bnh t min.
Thn trng: mc 2
Trm cm/ suy gan/ suy thn/ ngi cao tui : Do c nhiu tc dng khng
mong mun, nn cn theo di cht tt c cc chc nng ngi bnh.
TNG TC THUC
Amineptin; dantrolen; griseofulvin; isoniazid hoc thuc tng t;
methyldopa; natri valproat hoc dn cht; niridazol; nitroimidazol; noramidopyrin
hoc dn cht; paracetamol; progabid; rifampicin; thuc chng nm dn cht
Imidazol
Phn tch: Mc ch chnh l iu tr ung th biu m dng tuyn thn. Interleukin
t ra cn c vi gan. Vy y l s phi hp hai thuc c tim nng c vi gan.
X l: Cch iu tr ny ch c th thc hin ti c s chuyn khoa. Dng
Interleukin i hi phi theo di lin tc. Trong trng hp ny nn cn nhc d a trn
ton trng ca ngi bnh. Khi phi hp hai thuc c vi gan, hoc phi theo di st
chc nng gan (ASAT, ALAT, phosphatstase kim, bilirubin) hoc hon li mt trong hai
iu tr, nu c th c.
Aminosid tim hay dng ti ch; amphotericin B; ciclosporin; dn cht
salicylat; foscarnet; khng sinh polpeptid; lincosamid; pentamidin; thuc chng
vim khng steroid; vancomycin; vng
Phn tch: Interleukin ch c th c dng ti c s chuyn khoa. Nguy c cng
hp cc tc dng c vi thn ca hai thuc.
X l: Vic iu tr bng Interleukin ch c th c thc hin ti c s chuyn
khoa do tnh trng bnh l nng. Vic cn nhc cc tng tc phi da trn ton trng
ca ngi bnh. Cn theo ri cn thn ion v thanh lc creatinin, nu khng th
hon li mt trong hai iu tr.
Azathioprin; mercaptopurin
Phn tch: mc ch chnh l iu tr ung th biu m dng tuyn thn. Interleukin
t ra cn c vi gan. Vy y l s phi hp hai thuc c tim nng c vi gan v c
ch tu xng.
X l: Cch iu tr ny ch c th c thc hin ti c s chuyn khoa. Dng
interleukin i hi phi di lin tc. Trong trng hp ny nn cn nhc da trn ton
trng ca ngi bnh. Khi phi hp hai thuc c vi gan v c ch tu xng ny,
hoc phi theo di st huyt v chc nng gan (ASAT, ALAT, phosphatase ki m,
bilirubin) hoc hon li mt trong hai iu tr, nu c th c.
413
Phn tch: Mc ch chnh l iu tr ung th biu m dng tuyn thn. Interleukin

t ra cn c vi gan. Vy y l phi hp hai thuc c tim nng c vi gan, vi thn
v c ch tu xng.
X l: Cch iu tr ny ch c th thc hin ti c s chuyn khoa. Dng
Interleukin i hi phi theo di lin tc. Trong trng hp ny, nn cn nhc d a trn
ton trng ngi bnh. Trong khi phi hp hai thuc c vi gan, vi thn v c ch
tu xng ny, hoc phi theo ri st huyt , chc nng thn v gan (ASAT, ALAT,
phosphatase kim, bilirubin) hoc hon li mt trong hai iu tr, nu c th c.
Clozapin; colchicin hoc dn cht; cyclophosphamid hoc thuc tng t;
dactinomycin; fluoro -5 -uracil; indometacin hoc dn cht; interferon alpha ti t
hp; levamizole; melphalan; pentostatin; procarbazin; thiotepa; thuc chng ung
th cc loi; trimethoprim; vincristin hoc thuc tng t
X l: Interleukin l thuc ch c s dng ti c s chuyn khoa do tnh trng
bnh l nng. Do cc tng tc phi c cn nhc v tt c cc chc nng ca c
th u phi theo di lin tc. Theo di huyt d sao cng l bt buc.
Phn tch: Interleukin c th s dng ti c s chuyn khoa. Khi dng vi
cephalotin v cephaloridin, ta c s phi hp hai thuc c vi thn.
X l: iu tr bng Interleukin ch c th thc hin ti c s chuyn khoa do tnh
nghim trng ca cc ch nh. Vic cn nhc cc tng tc phi da trn ton tr ng
ca ngi bnh. Cn theo ri cn thn ion v thanh lc creatinin, nu khng th
hon li mt trong hai iu tr.
Phn tch: Interleukin ch c th dng ti c s chuyn khoa. Nguy c cng thm
tc dng c i vi thn v c ch tu xng ca hai thuc.
X l: iu tr bng Interleukin ch c th thc hin ti c s chuyn khoa do tnh
nghim trng ca cc ch nh. Vic cn nhc cc tng tc phi da trn ton tr ng
ca ngi bnh. Cn theo ri cn thn ion v thanh lc creatinin v huyt nu
khng th hon li mt trong hai iu tr.
Phn tch: Mc ch chnh l iu tr ung th biu m dng tuyn thn.
y l s phi hp hai thuc c tim nng c vi gan, vi tim v c ch tu xng.
X l: iu tr ny ch c th thc hin ti c s chuyn khoa. Dng Interleukin
i hi phi theo di lin tc. Trong trng hp ny, nn cn nhc da trn ton trng
ca ngi bnh. Trong khi phi hp hai thuc c vi gan, vi tim v c ch tu xng
ny, hoc phi theo di st huyt v chc nng gan (ASAT, ALAT, phosphatase
kim, bilirubin) hoc hon li mt trong hai iu tr, nu c th c.
Glucocorticoid
Phn tch: Cc glucocorticoid c m t l c tc dng gim hot tnh chng
u ca aldesleukin
414
X l: Mc du c tnh cht gim hot tnh chng u, dexamethason thng c

dng lm gim nhiu tc dng khng mong mun ca interleukin, c bit l s t,
suy thn, tng bilirubin huyt, kh th, l ln... Ngi k n phi lun lun cn nhc
tng quan nguy c/li ch.
Methotrexat
Phn tch: Mc ch ch yu l iu tr ung th biu m dng tuyn thn.
Interleukin cng c vi thn v gan. Nh vy s phi hp hai thuc c tim nng c
vi gan v thn v c ch tu xng
X l: Liu php ny ch c thc hin ti c s chuyn khoa. Dng interleukin
i hi phi theo di lin tc. Nh vy trong trng hp ny phi da vo th trng ca
ngi bnh quyt nh. Khi phi hp hai thuc c vi gan, thn v c ch tu
xng, phi theo di cht ch huyt v cc chc nng gan, thn (ASAT, ALAT,
phosphatase kim, bilirubin, creatinin mu), hoc phi hon dng mt trong hai thuc.
Phn tch: Interleukin ch c dng ti c s chuyn khoa. Nguy c cng hp
cc tc dng c vi thn v c ch tu xng ca hai thuc.
X l: iu tr interleukin ch c thc hin c s chuyn khoa, do tnh cht
nghim trng ch nh. Khi , cc tng tc thuc s c xem xt theo th tr ng
chung ca ngi bnh. Nu khng th hon dng c mt trong hai thuc, phi theo
di cn thn huyt , thanh lc creatinin v ion .
Thuc cn quang c iod
Phn tch: Cc thuc cn quang c iod, nu dng ngay sau interleukin, lm ti
xut hin cc triu chng in hnh do interleukin (mn cm vi thuc, au khp, chng
mt, h huyt p, bun nn...).
X l: C th cc triu chng ny t xut hin hn, thm ch khng xut hin, nu
m bo mt khong thi gian 6 tun l gia ln dng interleukin v l n dng thuc
cn quang c iod. Interleukin l mt sn phm mi, kh s dng v ch c dng c
s chuyn khoa c theo di lin tc v cc tc dng khng mong mun. Cn cn nh c
cc tng tc theo mc nng nh ca bnh, v ngi k n lun phi tnh n
tng quan nguy c/li ch.
Thuc chn beta
Phn tch: Tt c cc thuc chng tng huyt p v nht l cc thuc chn beta
c th lm tng tc dng chng tng huyt p ca interleukin
X l: Interleukin l mt thuc quan trng cn c bc s chuyn khoa s dng v
iu chnh. Cc tng tc phi c cn nhc v cc tc dng khng mong mun v
tnh trng bnh l nng. Cn theo ri lin tc tt c cc chc nng ca ngi bnh.
Thuc c ch protease (amprenavir, indinavir, nelfinavir, ritonavir,
saquinavir)
Phn tch: Nng trong huyt tng ca thuc c ch protease c th tng, lm
tng nguy c nhim c. Tng tc xy ra chm. C ch: Interleukin 2 (IL2; aldesleulin)
c th kch thch hnh thnh interleulin-6, l cht c th c ch chuyn ho (CYP 3A4)
thuc c ch protease.
415
X l: C th phi iu chnh liu thuc c ch protease khi bt u hoc ngng

iu tr interleukin.
ISONIAZID HOC THUC TNG T

Thuc chng lao c tc dng c ch enzym. Pyrazinamid, mc du c cu trc
ho hc gn ging isoniazid, nhng c xp vo nhm ring
CC THUC TRONG NHM

ISONIAZID vin nn 150 mg; 50 mg; dung dch tim 500 mg/5mL
Rimifon vin nn 150 mg; 50 mg
Rimifon dung dch tim 500 mg/5mL
Dexambutol INH vin nn
CH KHI CH NH THUC
Chng ch nh: mc 4
Cc trng hp: Trng hp qu mn bit vi thuc.
Thi k mang thai: Khng c dng INH trong ba thng u thai k, tr bnh
lao tin trin, v thuc ny gy cc d tt thn kinh loi gm nhm, nhng nguy c ny
hnh nh khng xy ra vi phi ngi. Nu cn k n, phi ch n phi hp v i
vitamin B6.
Suy gan: Nguy c vim gan tiu t bo do to thnh mt cht chuyn ho c
vi gan sau khi acetyl ho, ri thu phn v oxy ho. Tu theo ngi bnh l ngi c
phn ng acetyl ho nhanh hay chm, m na i ca thuc thay i rt nhi u. Nguy
c ny tng ln khi dng km rifampicin, mt cht cm ng enzym.
Cn theo di: mc 1
ng kinh: INH c th gy cc cn co git ngi ng kinh. Ngoi ra, khi dng
phi hp thuc INH v phenytoin, c nguy c ng c phenytoin
(INH c th c ch qu trnh lm bt hot phenytoin bng phn ng hydroxyl ho).
Suy thn: Suy thn t lm tng c tnh ca INH ngi c phn ng acetyl ho
nhanh. Ngc li, ngi c phn ng acetyl ho chm, nng thuc trong huyt
thanh tng, v do xut hin nhng tc dng c (vim gan, vim a dy thn kinh),
i hi phi hiu chnh liu lng. Pyridoxin lm gim c tnh thn kinh ca thuc ny.
Thng phong (gt): Do c ch o thi acid uric.
Trng thi khc: Bnh dy thn kinh ngoi bin. Khi cn, dng thm pyridoxin.
416
TNG TC THUC
Carbamazepin
Phn tch: Tng tc dng khng mong mun ca hai thuc ngi c phn ng
acetyl ho chm. c ch chuyn ho carbamazepin do isoniazid c th dn n cc
du hiu qu liu.
hin.
X l: Nn trnh phi hp thuc ny do tc dng khng mong mun c th xut

Disulfiram
Phn tch: Nguy c tch lu cc tc dng khng mong mun (vim a dy thn
kinh, vim dy thn kinh th gic).
X l: Do tnh nghim trng ca cc tc dng khng mong mun, chn mt liu
php khc.
Tacrin
X l: Khi cn, tng cng theo di chc nng gan. Trnh dng cc phi hp
thuc gy nguy c ngi cao tui.
Zalcitabin
Phn tch: C th xut hin bnh dy thn kinh ngoi bin.
X l: Theo di lm sng v xut hin cc d cm.
Ru
Phn tch: Ngi nghin ru chuyn ho isoniazid nhanh hn, nn lm gim tc
dng ca thuc. Ngoi nguy c c tnh vi gan, cn c tc dng antabuse.
(ASAT, ALAT, phosphatase kim, bilirubin), hoc phi hon dng
mt trong hai thuc nu c th. Kim tra chc chn ngi bnh khng thng xuyn
ung ru, v khng c tin s vim gan virus. Cc triu chng lm sng chnh khng
in hnh gm: bun nn, st, vng da... Nu thy ng thi pht ban ngoi da, nga,
hch to th hng n nguyn nhn do thuc. Cn phn bit theo cc test th sinh hc,
nguy c xut hin vim gan tiu t bo khng hi phc vi vim gan mt hi ph c
c sau khi ngng iu tr.
Amineptin; carmustin hoc dn cht; dantrolen; estrogen hoc thuc nga
thai estroprogestogen; fluvoxamin; griseofulvin; macrolid; progabid; rifampicin;
natri valproat hoc dn cht
Phn tch: Phi hp cc thuc c tim nng c vi gan (c s cng hp cc tc
dng khng mong mun).
(ASAT, ALAT, phosphatase kim, bilirubin), hoc nu c th, phi hon dng mt trong
417
hai thuc. Kim tra chc chn ngi bnh khng ung ru thng xuyn v khng c
tin s vim gan virus. Cc triu chng lm sng chnh khng c hiu: bun nn, st,
vng da Nu thy ng thi pht ban ngoi da, nga, hch to th hng v ngun
gc do thuc. Cn phn bit r,theo cc test th sinh hc, nguy c xut hin vim gan
tiu t bo khng hi phc vi vim gan mt hi phc c sau khi ngng iu tr.
Chlorzoxazon
Phn tch: Trong kt hp ny, isoniazid lm tng nng chlorzoxazon trong
huyt tng, lm tng tc dng dc l v c tnh ca n. C ch c th l isoniazid
c ch chuyn ho ca chlorzoxazon gan thng qua CYP2E1.
X l: Nhc nh bnh nhn ang dng isoniazid l tc dng c ch h thn kinh
trung ng ca chlorzoxazon c th tng. Nu nghi ng c tng tc thuc, cn phi
gim liu chlorzoxazon.
Cycloserin
Phn tch: Nguy c tng cc tc dng ph ca cycloserin trn h thn kinh trung
ng khi dng hai thuc ng thi (ng g, kh ming, chng mt).
X l: Ch c nhng hiu thuc bnh vin mi cung cp cycloserin. Tng tc
thuc ny lm xut hin cc tc dng khng mong mun kh chu. Phi theo di ng i
bnh trn lm sng v khi cn hiu chnh liu isoniazid, thm ch c th xem xt l i s
cn thit phi phi hp hai thuc ny.
Didanosin
Phn tch: Vin nn didanosin c cha mt cht khng acid nn c nguy c lm
gim hp th isoniazid theo s tng ca pH dch v.
X l: Khuyn ngi bnh ung hai thuc ny cch nhau t nht hai gi.
Glucocorticoid
Phn tch: y khng ni ti ton b h thuc, m ch ring vi prednisolon. C
nguy c tng chuyn ho isoniazid gan, km theo gim tc dng. Cng c gi m tc
dng ca corticoid.
X l: C nguy c tht bi iu tr vi isoniazid, nu phi s dng prednisolon di
ngy. Trong trng hp ny, phi tnh ti cc hu qu iu tr do tng tc ny gy ra
quyt nh c phi hp thuc hay khng. Vi cc corticoid khc, vn phi cnh gic.
Interleukin cng c vi gan. y l phi hp hai thuc c vi gan.
X l: Liu php ny ch c tin hnh c s chuyn khoa. Dng interleukin
i hi phi theo di lin tc. Trong trng hp ny, phi xt theo tnh trng chung ca
ngi bnh, Khi phi hp hai thuc c vi gan, phi theo di k chc nng gan
(ASAT, ALAT, phosphatase kim, bilirubin), hoc phi hon dng mt trong hai thuc,
nu c th.
Niridazol
Phn tch: Phi hp hai thuc c vi gan. Niridazol cng cn c vi thn kinh.
Nguy c xut hin co git, ri lon tm thn, v c tnh vi gan khi phi hp thuc.
418
(ASAT, ALAT, phosphatase kim, bilirubin), hoc phi hon dng mt trong hai thuc.
Kim tra chc chn bnh nhn khng thng xuyn ung ru v khng c tin s
vim gan virus. Cc triu chng lm sng chnh khng in hnh: bun nn, st, vng
da... Nu thy ng thi pht ban ngoi da, nga, hch to th hng v nguyn nhn do
thuc. Cn phn bit r theo cc test th sinh hc, nguy c xut hin vim gan tiu t
bo khng hi phc c vi vim gan mt hi phc c sau khi ngng iu tr.
Paracetamol
Phn tch: Dng paracetamol di ngy vi liu trn 6 gam/ngy (theo th trng)
c vi gan (vim gan tiu t bo). Khi phi hp vi mt thuc c vi gan khc, nguy
c c vi gan s tng.
nu c th. Kim tra chc chn bnh nhn khng thng xuyn ung ru v khng
c tin s vim gan virus. Cc triu chng lm sng chnh khng in hnh: bun nn,
st, vng da... Nu thy ng thi pht ban ngoi da, nga, hch to th hng t i
nguyn nhn do thuc. Cn phn bit theo cc test th sinh hc, nguy c xut hi n
vim gan tiu t bo khng hi phc c vi vim gan mt hi phc c sau khi
ngng iu tr.
Phenytoin
Phn tch: Nguy c qu liu phenytoin do cnh tranh cng mt con ng
chuyn ho, c th dn n c ch chuyn ho phenytoin. C nguy c nhim c
phenytoin.
X l: Cn c tnh hnh lm sng c th, cn hiu chnh liu lng trong v sau
khi iu tr bng isoniazid, c bit vi nhng ngi c phn ng acetyl ho chm.
Primidon hoc dn cht
Phn tch: Do cm ng enzym, hnh thnh cht chuyn ho c vi gan.
nu c th. Kim tra chc chn bnh nhn khng thng xuyn ung ru v khng
st, vng da... Nu thy ng thi pht ban ngoi da, nga, hch to th hng t i
nguyn nhn do thuc. Cn phn bit theo cc test th sinh hc, nguy c xut hi n
vim gan tiu t bo khng hi phc c vi vim gan mt hi phc c sau khi
ngng iu tr.
Pyrazinamid
Phn tch: Phi hp kinh in, nhng li l phi hp gia hai thuc chng lao c
vi gan.
X l: Ngoi iu cn thit phi theo di tc dng ca phi hp thuc trn vi
khun, cn phi theo di cht ch chc nng gan (ASAT, ALAT, phosphatase ki m,
bilirubin), hoc l phi hon dng mt trong hai thuc nu c th. Kim tra chc chn
bnh nhn khng thng xuyn ung ru v khng c tin s vim gan virus. Cc
419
triu chng lm sng chnh khng in hnh: bun nn, st, vng da... Nu thy ng
thi pht ban ngoi da, nga, hch to th hng ti nguyn nhn do thuc.
Phn tch: Ch c hai yu t phi xt ti khi dng isoniazid phi hp vi
ketoconazol (Nizoral): mt mt l s phi hp hai thuc u c tim nng c vi gan
(c th gy tiu t bo), mt khc thy gim ng k nng ketoconazol trong huyt
thanh.
nu c th. Kim tra chc chn ngi bnh khng thng xuyn ung ru v khng
st, vng da... Nu thy ng thi pht ban ngoi da, nga v hch to th h ng t i
nguyn nhn do thuc. Cn phn bit r qua cc test th sinh hc, nguy c xut hin
vim gan tiu t bo khng phc hi vi vim gan mt hi phc c sau khi ngng
iu tr. Tu theo mc ch ca liu php, chn mt thuc chng nm khc, nu c
th.
Phn tch: Cc thuc khng acid ung gy gim hp thu ng tiu ho, nn
lm gim tc dng ca thuc dng phi hp vi chng.
X l: Phi ung hai thuc cch nhau t nht 1 n 2 gi. Cc thuc khng acid
thng c ung 1 gi 30 pht sau ba n, v n chnh l nguyn nhn tng tit dch
v.
Thuc gy m halogen bay hi
Phn tch: C th tng to thnh cc hp cht fluor v c c vi thn, nht l khi
dng isoniazid cng vi enfluran.
X l: Khuyn ngi bnh phi phu thut thng bo cho bc s gy m t t c
cc thuc ang dng.
KALI (mui)
Dng di dng mui, l mt cht in gii thng dng
trong iu tr h kali mu
CC THUC TRONG NHM
KALI CLORID dung dch tim 14,9%; vin nn bao 600 mg; dung dch thm tch
mu 10% Aguettant
Potassium chloride dung dch tim 14,9%
Kaleorid vin nn bao 600 mg
420
Potassium chloride dung dch thm tch mu 10% Aguettant

Ringer lactate (kali clorid 0,04 g)
KALI IODID vin nn bao 100 mg; 200 mg
Jolid vin nn bao 100 mg; 200 mg kali iodid
CH KHI CH NH THUC
Chng ch nh: mc 4
Tng kali mu.
Tiu ng: Do nguy c tng kali mu trong bnh tiu ng.
Suy thn: Suy thn km theo gi kali v tng kali mu. a kali t ngoi vo c
th lm tng gi kali, ko theo cc ri lon c tim (nhp tim nhanh, lon nhp, thm ch
try mch v ngng tim) v ri lon thn kinh-c ngoi vi nng, thm ch t vong nu
kali mu vt qu 6,5 - 7mmol/lt.
Suy tuyn thng thn.
Cn theo di: mc 1
Hi chng Addison; lon trng lc c bm sinh.
TNG TC THUC
Thuc li tiu gi kali
Phn tch: Phi hp mui kali vi mt thuc li tiu gi kali c nguy c dn n
tng kali mu.
X l: Trnh cng k n hai thuc ny, do nguy c tng kali mu v cc
ri lon dn truyn tim, c bit ngi cao tui, ngi suy thn v ngi suy tim.
Phn tch: Thm kali vo mt thuc c th gy tng kali mu. C ch gi kali ny
l v gim aldosteron trong mu do c ch angiotensin 2.
X l: Trnh cng k n hai thuc ny v c nguy c tng kali mu v cc r i
lon dn truyn tim, c bit l ngi cao tui, ngi suy thn v ngi suy tim.
Tacrolimus
Phn tch: Nguy c tng kali mu c th cht ngi do cng hp tc dng tng
kali mu ca hai thuc ny (nht l trong trng hp suy thn; ch ngi cao tui).
Tng tc dc lc.
X l: Nu khng trnh c phi hp ny, phi theo di kali mu u n.
Glycosid tr tim
421
Phn tch: Khng nn b sung kali cho ngi bnh dng digitalis (tr trng hp
h kali mu) do nguy c xut hin v/ hay lm nng thm bloc tim nhng ngi bnh
c nguy c.
X l: nhng ngi bnh c nguy c (c mt bl c tim), nn b tr ph ng
tin theo di in tm v theo di r t c n th n kali mu. Ch khng ng i
bnh dng digitalis t b sung mui kali m khng theo di kali mu.
KHNG SINH POLYPEPTID

Thuc khng sinh c cht u bng l colistin. C rt nhiu bit dc dng ti
ch.
Cc nguy c tng tc xy ra ch yu vi cc thuc tim
CC THUC TRONG NHM
BACITRACIN
Izac v Lobacin vin ngm 100 IU phi hp vi neomycin v amylocain
Oropivalone vin nn (Bacitracin zinc 200 IU)
Lysopaine (Bacitracin 200 IU; Lysozym 5 mg; Papain 2mg)
POLYMYXIN
Atecortin thuc nh mt, tai 10.000 IU/1ml
Maxitrol m tra mt (bao gm polymyxin B; neomycin; dexamethason)
Maxitrol hn dch nh mt
Polydexa thuc nh tai, mi
Polygynax vin t m o
TYROTHRICIN vin ngm 1 mg
Mekotricin vin ngm 1 mg
Veybirol-Tyrothricine dung dch xc ming 2 g/100 ml
CH KHI CH NH THUC
Nhc c: Nguy c phong b dn truyn thn kinh - c, do tc dng trc
synap v sau synap (phong b cc th th acetylcholin, v i khi gy kh cc, c th
dn ti yu c ton thn v lit h hp).
Thn trng: mc 2
422
Suy thn: Tng c tnh vi thn ca cc khng sinh ny, vi nguy c vim thn
ng - k, xut hin m , thng trc c ri lon thn kinh (d cm u chi, suy
nhc c).
TNG TC THUC
Aminosid tim hay dng ti ch
Phn tch: Tng nguy c c vi tai v thn, do phi hp hai thuc c tim nng
c vi thn. C hip ng cc tc dng khng mong mun. Tuy nhin, phi hp ny
c th c ch trong mt s trng hp.
X l: Phi hp ny thng gp bnh vin. Mc du cch dng aminosid liu
duy nht hng ngy hn ch c tnh vi tai v thn, nhng khi cn phi hp thu c,
vn nn hiu chnh liu dng theo thanh lc creatinin (cng thc Cockroft v Gault).
c bit phi cn thn khi dng cho ngi bnh cao tui.
Phn tch: Phi hp cc thuc c vi thn khi dng cefalotin v cefaloridin.
X l: Nu cn phi hp thuc, phi theo di cn thn chc nng thn, c bit
vi ngi suy thn v ngi bnh cao tui. Hiu chnh liu lng theo thanh l c
creatinin.
Foscarnet
Phn tch: Dng ng thi hai thuc c tim nng c vi thn, v vy tng nguy
c suy thn.
X l: y l hai thuc c dng v theo di trong bnh vin. Phi theo di cht
ch ion v thanh lc creatinin v t iu chnh liu lng cho thch hp.
Phn tch: Interleukin ch c dng ti c s chuyn khoa. C nguy c hip ng
tc dng c vi thn ca hai thuc.
X l: Ch iu tr bng interleukin ti c s chuyn khoa, do tnh cht nghim
trng ca ch nh. Khi cc tng tc phi c cn nhc nh gi theo th trng
chung ca ngi bnh. Nu khng ngng dng c mt trong hai thuc, phi theo di
cht ch ion v thanh lc creatinin.
Phn tch: Tng nguy c phong b thn kinh - c, c th gy yu c, suy h hp,
thm ch lit, c bit khi dng enfluran v isofluran.
X l: Bc s gy m phi trnh nguy c ny v phi chun b thuc khng
cholinesterase v mui calci tim gii to phong b thn kinh - c. Nguy c s gim
thiu khi c h hp h tr. Phi ch khi ngi bnh tnh li.
Thuc loi curar
423
Phn tch: C th tng tc dng phong b thn kinh - c. Khng sinh polypeptid
tc ng hip ng vi cc thuc gin c khng kh cc phong b thn kinh - c
trc v sau sinp. Tng tc xy ra nhanh.
X l: Trong gy m, tng tc ny c trung ho nh th my. Tuy nhin, phi
theo di k ti phng hu phu, tu theo dng mt thuc hay phi hp c hai thuc.
424
LAMIVUDIN
Cht tng t nucleosid khng virus dng iu tr bnh AIDS
CC THUC TRONG NHM
LAMIVUDIN vin nn 150 mg; dung dch ung 10 mg/mL
Epivir vin nn 150 mg
Epivir dung dch ung 10 mg/mL
CH KHI CH NH THUC
Chng ch nh: mc 4
Trng hp: Qu mn vi thuc
Thi k cho b/ thi k mang thai: Do thiu thng tin.
TNG TC THUC
Trimethoprim
Phn tch: Trimethoprim c cng kiu o thi qua thn nh lamivudin (o thi
tch cc qua ng thn) ko theo gim 40% thanh lc lamivudin
thn.
X l: Phi hp ny khng i hi phi hiu chnh liu lng lamivudin, nu chc
nng thn bnh thng. Khi suy thn, phi hiu chnh liu lng lamivudin theo
thanh lc creatinin.
LANSOPRAZOL
Thuc c ch c hiu bm proton chng lot d dy t trng
c tnh cht cm ng enzym cytochrom P450
CC THUC TRONG NHM
LANSOPRAZOL
Amarin nang 30 mg
Interlansil nang 30mg
Lan-30 nang 30 mg
Lanprasol nang 30mg
Lansec nang 30 mg
Lansotop nang 30mg
425
Lansotrent nang 30mg

Lanzap nang 30mg
Lanprazol nang 30mg
Lasoprol nang 30 mg
Medamarin nang 30mg
Opelansol nang 30mg
Prevacid nang 30 mg
Pylokit gm c nang 30 mg + vin nn 250mg clarithromycin + vin nn 500mg
tinidazol
Salprol nang 30mg
Tatazol nang 30mg
CH KHI CH NH THUC
Thi k cho b: V thiu nhng nghin cu v thuc qua c sa m.
Thi k mang thai: Do thn trng, khi cha c thng tin.
Cn theo di: mc 1
Tr em: Hiu qu v tnh dung np ca thuc cn cha c nghin cu.
Suy gan: Theo nhng d liu dc ng hc, cn theo di chc nng gan trong
liu php di ngy.
Suy thn: Cn thn trng vi nhng trng hp suy thn nng.
TNG TC THUC
Pentagastrin
Phn tch: Cc cht c ch bm proton c th i khng vi tc dng dc l ca
pentagastrin.
X l: Phi ch 96 gi k t lc ung pentagastin n khi dng cc cht c
ch bm proton.
Benzodiazepin
Phn tch: Tng tc dc ng hc. Cn thn trng vi thuc b chuyn ho bi
cytochrom P450, v c nguy c gim hot tnh ca thuc do cm ng enzym, dn ti
tht bi trong iu tr.
X l: Lansoprazol l thuc tng i mi, v nhng nhn xt lm sng hy cn
thiu. y tng tc c th xy ra, v vic thng bo nhng nhn xt lm sng n
cc Trung tm cnh gic thuc cn c khuyn khch. Xem xt nguy c trong bi
426
cnh iu tr c th, thng bo cho ngi bnh, hiu chnh liu lng theo kt qu th
sinh hc khi bt u v khi ngng lansoprazol trnh tht bi trong iu tr.
Ketoconazol
Phn tch: Tc dng ca ketoconazol c th b gim khi kt hp vi lansoprazol. C
th sinh kh dng ca ketoconazol b gim i do vin thuc ny kh tan hn khi pH ca
d dy tng ln do ung thuc c ch bm proton.
X l: Nu cn dng kt hp thuc ny, th khi ung ketoconazol, dng km thm
nc ung c tnh chua.
Phenytoin
tht bi trong iu tr.
X l: Lansoprazol l mt thuc tng i mi, v nhng nhn xt lm sng hy
cn thiu. y tng tc c th xy ra, v vic thng bo nhng nhn xt lm sng
n cc Trung tm cnh gic thuc cn c khuyn khch. Xem xt nguy c trong bi
cnh iu tr c th, thng bo cho ngi bnh, hiu chnh liu lng theo kt qu nh
lng phenytoin trong mu lc bt u v khi ngng lansoprazol. Cn theo di lm
sng. Khuyn ngi bnh n khm li khi iu tr tht bi.
427

tht bi trong iu tr.
X l: Lansoprazol l thuc tng i mi v nhng nhn xt lm sng hy cn
thiu. y cc tng tc c th xy ra, v vic thng bo nhng nhn xt lm sng n
cc Trung tm cnh gic thuc cn c khuyn khch. Hiu chnh liu lng theo nng
theophylin trong mu khi bt u v khi ngng lansoprazol. nh gi nguy c theo
hon cnh iu tr c th v thng bo cho ngi bnh. Khuyn ngi bnh n khm
li khi iu tr tht bi.
Phn tch: Thuc khng acid ung hoc than hot u lm gim hp thu qua
ng tiu ho, do gy gim hiu qu ca thuc dng phi hp.
X l: Cn mt khong cch t 1 n 2 gi gia ln ung thuc khng acid hoc
than hot vi ln ung lansoprazol. Cc thuc khng acid thng c dng sau ba
n mt gi ri, v n l ngun gc tng tit dch v.
cytochrom P450, v c nguy c gim hot tnh ca cc thuc do cm ng enzym, dn
ti tht bi trong iu tr.
X l: Lansoprazol l mt sn phm tng i mi, v nhng nhn xt lm sng
hy cn thiu. y, cc tng tc c th xy ra v vic thng bo nhng nhn xt lm
sng n cc Trung tm cnh gic thuc cn c khuyn khch. Xem xt nguy c
trong bi cnh iu tr c th, thng bo cho ngi bnh, hiu chnh liu lng theo kt
qu th sinh hc khi bt u v khi ngng lansoprazol. Khuyn ngi bnh n khm
li, nu thy thay i t l chun ha quc t -INR), thi gian prothrombin (TP).
tht bi trong iu tr.
X l: Lansoprazol l sn phm tng i mi v nhng nhn xt lm sng hy
cn thiu. y tng tc c th xy ra, v vic thng bo nhng nhn xt lm sng
n cc trung tm cnh gic thuc cn c khuyn khch. Xem xt nguy c trong bi
cnh ngi ph n dng thuc nga thai estroprogestogen liu thp cm thy tht bi.
V thn trng, nn thay cht c ch bm proton hay cht chng lot.
428
LEVODOPA
Thuc chng Parkinson, l tin cht sinh hc ca dopamin
CC THUC TRONG NHM
LEVODOPA nang 250 mg phi hp vi benserazid 50 mg; vin nn 250 mg phi
hp vi carbidopa
Modopar 250, nang 250 mg phi hp vi benserazid 50 mg
Sinemet CR vin nn 250 mg phi hp vi carbidopa
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: Levodopa qua c sa m, nn khng c dng cho
ngi m trong thi k cho con b.
Trm cm: Levodopa gy ri lon tm thn (cn l ln, hoang tng km theo
o gic) nht l khi c tin s bnh tm thn. Cc hi chng trm cm, thng i km
vi bnh Parkinson, s nng thm khi dng levodopa, lm ngi bnh thm lo u.
Thi k mang thai: Tt nht, khng k n levodopa trong nhng thng u thai
k ( thy d tt xng v ni tng sc vt).
Cc trng hp khc: Levodopa c th lm u hc t c tnh pht trin, cho nn
khng c dng trong trng hp ny. Qu mn vi thuc.
Suy tim: Levodopa c th gy cn nhp nhanh kch pht, v nht l h huyt p
th ng c hi cho nhng bnh tim mch khng b. Dng phi hp vi mt cht c
ch dopa - decarboxylase ngoi bin cho php m rng ch nh i vi suy tim va
phi.
Suy ng mch vnh: Lon nhp tht c m t nhng ngi bnh c
ri lon dn truyn c tim hay nhng ngi trc y c au tht ngc. Ch ng ch
nh dng thuc ny trong giai on cp tnh tai bin ng mch vnh.
Cn theo di: mc 1
Tng nhn p: Levodopa b kh carboxyl thnh dopamin, mt amin cng giao
cm c th gy gin ng t v lm nng thm bnh tng nhn p gc ng.
Ngi cao tui: Do tnh nhy cm c bit ngi cao tui vi mt s tc dng
khng mong mun ca thuc.
Lot d dy - t trng/vim d dy: Nguy c bin chng lot d dy t trng do
levodopa, cc ri lon tiu ho (bun nn, nn, chn n) khi levodopa khng c dng
phi hp vi mt cht c ch dopa decarboxylase.
TNG TC THUC
Benzamid; butyrophenon; thuc an thn kinh khc
429
Phn tch: Phi hp levodopa vi mt s thuc i khng dopamin c th dn

n tc dng i khng.
X l: Chng ch nh phi hp thuc, tr khi cn i khng dc l , v iu ny
ch c thc hin mt c s chuyn khoa.
Cc thuc c ch MAO khng chn lc
Phn tch: Tng tc dc lc. Cc thuc c ch MAO ngn chn ging ho
adrenalin. Levodopa l tin cht ca dopamin. Adrenalin v dopamin l hai amin tng
huyt p. Phi hp thuc c ch MAO vi levodopa c th gy tng huyt p nghim
trng.
X l: Khng phi hp hai thuc ny. Dng hai thuc cch nhau 15 ngy trnh
tai bin.
Cc phenothiazin
Phn tch: Tng tc dc lc. Phi hp levodopa vi cc thuc an thn kinh loi
phenothiazin l loi c tc dng i khng dopamin c th lm gim tc dng ch vn
dopamin ca levodopa.
X l: Chng ch nh phi hp, tr khi cn i khng dc l, v iu ny ch
c thc hin mt c s chuyn khoa.
Procarbazin
Phn tch: Tng tc dc lc. Procarbazin c nhng tnh cht thuc c ch
MAO khng bng cc thuc c ch MAO, nhng vn c ghi nhn. Thuc c ch
MAO ngn chn ging ho adrenalin. Levodopa l tin cht ca dopamin. Adrenalin v
dopamin l hai amin gy tng huyt p. Phi hp procarbazin vi levodopa c th gy
tng huyt p nghim trng.
X l: Khng phi hp hai thuc ny. Dng hai thuc cch nhau 15 ngy trnh
cc tai bin.
Pyridoxin
Phn tch: Gim tc dng ca levodopa, c th do tng chuyn ho (kch thch
dopa-decarboxylase ngoi bin).
X l: Nu khng c cht c ch dopa-decarboxylase (cht ny to iu kin cho
mt lng levodopa ln hn chuyn vo no), chng ch nh phi hp thuc. Phn ln
cc thuc levodopa c mt trn th trng u c phi hp vi cc cht c ch
dopa-decarboxylase (benzerazid hay carbidopa) nn khng chng ch nh.
Reserpin
Phn tch: Reserpin lm gim dopamin, v gy tc dng ging Parkinson, c th
c tc dng i khng levodopa.
X l: Thay i cch iu tr, trc nguy c ca phi hp thuc ny.
Vitamin nhm B hoc thuc tng t
Phn tch: Gim tc dng ca levodopa do tng chuyn ho (kch thch dopadecarboxylase ngoi bin).
X l: Trnh phi hp cc thuc ny.
430

Methyldopa
Phn tch: Tng tc dc lc. C th gy ri lon tc dng chng Parkinson ca
levodopa. Tng tc dng c ch h thn kinh trung ng km nguy c lon tm thn.
X l: Nn chn mt chin lc iu tr khc.
Papaverin hoc dn cht
Phn tch: Papaverin c th phong b cc th th dopamin, nh vy c ch tc
dng chng Parkinson ca levodopa, tin cht ca dopamin.
X l: Phi hp thuc nn trnh, chn mt liu php khc.
Phn tch: Phi hp thuc c th dng trong iu tr bnh Parkinson, nhng li
nn trnh ngi bnh tm thn hoc c tin s bnh tm thn.
X l: Nn trnh phi hp thuc ny i vi ngi bnh c tin s bnh tm thn.
Do , cn hi ngi bnh v nhng ngi c lin quan v vn ny.
Phn tch: Nguy c lon nhp tim c th tng ln.
X l: Gim liu lng amphetamin.
Benzodiazepin
Phn tch: Tc dng iu tr ca levodopa c th b gim, thm ch mt i mt
s ngi bnh dng benzodiazepin nh clordiazepoxyd, diazepam v nitrazepam.
X l: Tng tc c xc nh vi cc thuc k trn, v cn phi theo di
c th kim sot c liu php chng Parkinson. Vi cc benzodiazepin khc, c n
phi cnh gic v thng bo cho Trung tm cnh gic cc tht bi trong iu tr khi phi
hp thuc.
Phn tch: Do kch thch cc th th dopamin, cc cht ny tm khc phc s
gim dopamin, c trng ca bnh Parkinson. Mt khc, do levodopa l tin cht sinh
l ca dopamin, nn phi hp thuc c th gy tch lu dopamin.
X l: V c hip ng cc tc dng dc l, nn cn gim liu lng levodopa.
Cc cht ch vn morphin
X l: Phi theo di huyt p khi phi hp thuc ny. Tu theo cc thuc, h
huyt p c th nng nh khc nhau. Khi cn, hiu chnh liu lng mt hoc c hai
thuc. Lp mt k hoch dng thuc u n. Tng cng theo di ngi bnh cao
tui (nguy c ng) v khuyn h chuyn dn dn t th nm hoc ngi sang t th
ng. Khuyn ngi bnh gp li bc s iu chnh li liu lng khi thy chng mt
lc bt u iu tr.
431
Cc mui st
Phn tch: Kt hp thuc lm gim hiu qu ca levodopa. L do l levodopa c
th to phc chelat vi st, lm gim hp thu ca n, do hm l ng levodopa
trong huyt thanh s gim xung.
X l: Dng hai th thuc ny cng xa nhau cng tt. Theo di p ng ca bnh
nhn trn lm sng v khi cn th tng liu levodopa.
Cc thuc gy m khc nhau
X l: Do tnh chuyn khoa ho rt cao ca gy m, v do cc thuc gy m ch
yu ch dng cho khoa phu thut, nn cc tc gi a ra cc h thuc c th gy
nguy c theo loi thuc gy m s dng. Khuyn ngi bnh sp phu thut thng bo
cho bc s gy m nhng thuc ang dng.
Phn tch: Clonidin c m t c th c tc dng i khng vi levodopa.
X l: C ch ca tng tc ny cn cha r (kch thch cc th th alpha h
thn kinh trung ng, hay kch thch cc th th dopamin sau sinap thn kinh). Cn
phi nhy cm vi nguy c ny trong vic qun l iu tr bnh Parkinson, v thng bo
cho Trung tm cnh gic thuc cc nhn xt cho php tm hiu tt hn c ch tc
dng.
Dextropropoxyphen
Phn tch: Dextropropoxyphen lm h huyt p nh. Khi phi hp vi cc thuc
h huyt p khc, tng tc dng h huyt p v tng nguy c tt huyt p th ng.
X l: Phi theo di huyt p trong khi phi hp thuc (trong v sau khi ng ng
mt trong hai thuc). Tu theo loi thuc, h huyt p c th nng, nh khc nhau. Khi
cn, hiu chnh liu lng ca mt hay c hai thuc. Lp mt k hoch ung thu c
u n. Khuyn ngi bnh gp li bc s iu chnh li liu lng khi thy chng
mt lc bt u iu tr. Tng cng theo di i vi ngi bnh cao tui (nguy c ng)
v khuyn h chuyn dn dn t t th nm hoc ngi sang t th ng.
Furosemid hoc thuc tng t; thuc gin mch chng tng huyt p;
thuc li tiu gi kali; thuc li tiu thi kali
X l: Cn phi hiu chnh liu lng. Lp mt k hoch dng thuc v yu cu
ngi bnh phi tun th k hoch iu tr. Khi bt u iu tr, khuyn ngi bnh o
huyt p (hay nh o) u n cho n khi t c cn bng trong iu tr.
Hydantoin
Phn tch: Kt hp thuc lm gim hiu qu ca levodopa. C ch cha r.
X l: S dng kt hp thuc ny mt cch thn trng. Nu pht hin thy tng
tc thuc xy ra, thay hydantoin bng mt loi thuc khc.
432
Phn tch: Dng ng thi hai thuc ny c th gy nguy c lon nhp tim.
X l: Nu cn phi hp thuc, phi gim liu thuc cng giao cm.
Phn tch: Halothan lm cho c tim nhy cm vi cc tc dng cng giao cm,
c bit vi catecholamin, iu ny c th ko theo nhng nguy c lon nhp tht
nghim trng.
X l: Khuyn ngi bnh sp phu thut thng bo cho bc s gy m nhng
thuc ang dng.
Baclofen
Phn tch: Nguy c tng cc tc dng khng mong mun, nht l l ln, o gic,
kch ng.
X l: Nu cn phi hp thuc, phi theo di lm sng, km theo hiu chnh liu
lng nhm lm gim nguy c tc dng khng mong mun.
Macrolid
Phn tch: Spiramycin c th c ch hp thu carbidopa (thng c phi hp
lm cht c ch dopa-decarboxylase), gy tng nng levodopa trong huyt thanh,
ng thi lm lng thuc chuyn qua hng ro mu-no gim i, lm gim hot tnh
ca thuc.
X l: trnh tht bi trong iu tr, phi tnh n tng tc ny khi xc nh
chin lc iu tr. Nu c th, chn mt macrolid khc.
Phn tch: Dng ng thi hai thuc ny c th tng kh nng lon nhp tim.
X l: Nu cn, gim liu thuc cng giao cm. Khuyn ngi bnh nhanh
chng gp li thy thuc nu thy tim p bt thng.
Phn tch: Dng ng thi cc thuc chng tng huyt p hay cc thuc c th
gy h huyt p vi cc thuc gy m barbituric c th gy tt huyt p nghim trng.
X l: Khuyn ngi bnh phi phu thut, thng bo cho bc s gy m bit cc
thuc ang dng.
433
LIDOCAIN HOC THUC TNG T

Thuc chng lon nhp nhm Ib theo Vaughan - Williams
c tc dng n nh mng (mt s c tnh cht gy t)
CC THUC TRONG NHM
LIDOCAIN dung dch phun m 10%; thuc m 5%; dung dch tim 2%; gel 2%
Lidocain dung dch phun m 10%
Xylocain thuc m 5%; dung dch tim 2%; dung dch phun m 10%
Xylocain Jelly gel 2%
BUPIVACAIN dung dch tim tu sng 0,5%; dung dch tim 0,5%
Marcain dung dch tim tu sng 0,5%
Marcain dung dch tim 0,5%
CH KHI CH NH THUC
Chng ch nh: mc 4
Cc trng hp: Bloc nh -tht. Cn trnh dng cc cht cng h ho hc cho
nhng ngi qu mn vi mt trong cc cht . C tin s thn kinh-tm thn nng.
Qu mn vi thuc. Sc do tim.
Suy tim: Nguy c gy ri lon nhp dn truyn v tn s tim.
Suy gan: Do cc cht ny chuyn ho gan.
Suy thn: Nguy c tch lu cht ny, do o thi qua nc tiu.
Cn theo di: mc 1
Thi k mang thai: Do thn trng, v cn thiu thng tin.
TNG TC THUC
Amiodaron
Phn tch: Tng nguy c xut hin xon nh do cng hp cc tc dng. H kali
mu, nhp tim chm v khong QT di t trc (ch bit c trn in tm ) l
nhng yu t to iu kin xut hin xon nh. Xon nh l mt dng nhp tht c
bit, c th xut hin thnh cn rt ngn (vi giy, mt thu: c cm gic ngt, nhng
khng mt thc).
X l: Chng ch nh phi hp thuc v c tim nng gy t vong v khng c
k n.
Benzamid
434
Phn tch: y khng phi l mt tng tc ca c h thuc, m l tng tc

c m t vi sultoprid, thuc nhm benzamid. C nguy c xut hin xon nh (ri
lon nhp tht) do cng hp cc tc dng in sinh l.
X l: Chng ch nh phi hp, tr n v chm sc tng cng v tim mch.
Nu khng, thay i chin lc iu tr.
Flecainamid hoc thuc tng t
Phn tch: Phi hp hai thuc chng lon nhp, mt thuc nhm Ib theo VaughanWilliams, mt thuc nhm Ic (c ch dn truyn trong tht). Phi hp i hi phi theo
di in tm u n, v c nguy c tng tc dng khng mong mun v tim.
X l: Phi hp hai thuc chng lon nhp l vn ca cc bc s chuyn khoa,
v ch c thc hin vi s theo di bng in tm .
Mexiletin
Phn tch: Tng tc dc lc gia hai thuc chng lon nhp cng nhm Ib theo
Vaughan-Williams.
X l: Tr trng hp ngi bnh c iu tr ti mt c s chuyn khoa c th
c theo di lin tc, nn trnh phi hp hai thuc chng lon nhp cng nhm.
Barbituric
Phn tch: Tng chuyn ho lidocain gan do cm ng enzym, ko theo gim tc
dng lidocain.
X l: Ch cn quan tm n tng tc ny khi lidocain c dng thng xuyn
do cm ng enzym ch xut hin dn dn. Khi , phi hiu chnh li liu lng. Kim
tra nng lidocain trong mu nu cn, v phi cnh gic khi ngng iu tr.
Dextropropoxyphen
Phn tch: Dextropropoxyphen lm h huyt p nh. Phi hp vi cc thuc h
huyt p khc s lm tng tc dng h huyt p v tng nguy c h huyt p th ng.
X l: Phi theo di huyt p trong khi phi hp thuc (khi dng v khi ngng mt
trong hai thuc). Tu theo thuc dng, h huyt p c th nng hay nh. Khi cn, hi u
chnh liu lng mt hay c hai thuc. Lp mt k hoch dng thuc u n. Khuyn
ngi bnh gp li bc s iu chnh liu lng nu thy chng mt lc bt u
dng thuc. Tng cng theo di ngi bnh cao tui (nguy c ng) v khuyn h
chuyn dn dn t t th nm hoc ngi sang t th ng.
Disopyramid
Phn tch: Phi hp vi cc thuc chng lon nhp khc nhm theo phn loi
Vaughan-Williams i hi phi tng cng theo di (in tm ), nht l vi
disopyramid.
X l: Phi hp cc thuc chng lon nhp vi nhau i hi phi c trnh chuyn
khoa tim mch, v thit b theo di t ng (n v hi sc tim mch).
435
Furosemid hoc thuc tng t; thuc ch vn morphin; thuc gin mch

chng tng huyt p
X l: Theo di huyt p trong thi gian dng phi hp thuc. Tu theo thuc, h
huyt p c th nng nh khc nhau. Khi cn, hiu chnh liu lng ca mt hay c hai
thuc. Xy dng mt k hoch dng thuc u n. Khuyn ngi bnh gp li bc s
iu chnh liu lng, nu thy chng mt lc bt u iu tr. Tng cng theo di
ngi bnh cao tui (nguy c ng) v khuyn h chuyn dn dn t th nm hoc ngi
sang t th ng.
Phenytoin
Phn tch: S dng ng thi hai thuc ny khoa tim mch c th lm tng tc
dng c ch tim. Ngoi ra, phenytoin cn c th lm tng chuyn ho gan, nh vy
lm gim nng lidocain huyt thanh.
X l: Khi phi hp thuc ny, phi c sn thit b theo di. Nu cn, theo di
nng lidocain trong mu, hoc lm in tm nu lm sng i hi, nht l khi
dng dng tim.
Quinidin hoc dn cht
Phn tch: Nguy c xut hin xon nh v khong QT b di trn in tm .
X l: Phi hp thuc ny cn c theo di c bit (in tm ). V nguyn
tc chung, phi trnh phi hp cc thuc chng lon nhp nhm I theo VaughanWilliams, do ko di thi gian dn truyn tim.
Succinylcholin
Phn tch: C th xy ra hin tng ko di phong b thn kinh c do
succinylcholin. C ch cha r.
X l: Bnh thng khng cn phi thay i liu php. Tuy nhin cn phi theo
di k ngi bnh dng lidocain vi liu cao di dng tim truyn, ngi bnh m
nng lidocain trong huyt tng cao hn d kin do gim hiu sut tim, v ng i
bnh dng lidocain tim truyn lu di. Cn phi chun b thit b tr gip h hp cho
nhng trng hp suy h hp ko di.
Thuc chn beta
Phn tch: Thuc chn beta (bao gm c loi thuc nh mt) lm gim lu lng
mu gan, do lm gim o thi lidocain v lm tng nng ca cht ny trong
mu. Tng tc ny c m t vi propranolol, metoprolol, nadolol.
X l: Hiu chnh li liu lng. Theo di in tm v nng lidocain trong
huyt tng trong khi v c khi ngng iu tr.
Thuc chng lot khng H2, kiu cimetidin
Phn tch: Cimetidin c ch oxydase gan (cytochrom P450), l enzym c trch
nhim trong chuyn ho sinh hc ca mt s thuc. Ngoi ra, n lm gim lu l ng
mu gan. Do nng mt s thuc trong huyt tng tng ln (nguy c qu liu),
v do c ch mt s qu trnh chuyn ho sinh hc, nn cimetidin ngn cn mt s c
436
ch gii c. Chuyn ho gan chm do c ch enzym, nn tng nng lidocain

trong mu, v nguy c c cc tc dng v thn kinh v tim.
X l: Lidocain c phm vi iu tr hp nn c ch qu trnh bin i sinh hc s
dn n nguy c qu liu. Nu cn, tng cng theo di nng thuc trong huy t
tng. D lidocain c ch nh phng v iu tr lon nhp tim do tm tht d b
kch thch, hay c ch nh lm thuc gy t, u ch dnh ring cho bnh vin. Khi
phi theo di cht ch nng lidocain trong mu, bt k ch nh no. Cc d u
hiu qu liu lidocain l d kch ng, m sng, l ln, thm ch co git, hn m, tru
tim mch.
Thuc loi cura
Phn tch: Tc dng c ch trung tm h hp ca cc thuc gim au trung tm
c th cng thm nguy c gy lit h hp do thuc loi cura.
X l: Trong gy m, tng tc ny c th khc phc bng thng kh t ng. Tuy
nhin cng vn phi theo di hu phu cht ch ngi bnh ty theo dng mt
thuc hay phi hp c hai thuc.
LINCOSAMID
Khng sinh dit khun
CC THUC TRONG NHM
LINCOMYCIN nang 500 mg; dung dch tim 300 mg/mL; dung dch tim 600
mg/2mL
Lincocin nang 500 mg; dung dch tim 300 mg/mL
Lincople dung dch tim 600 mg/2mL
CLINDAMYCIN nang 300 mg; 150 mg; siro 75 mg/5mL; dung dch tim 300
mg/2mL; dung dch dng ngoi; kem m o
Dalacin C nang 300 mg; 150 mg
Dalacin C siro 75 mg/5mL
Dalacin C dung dch tim 300 mg/2mL
Dalacin T dung dch dng ngoi 1%
Dalacin V kem m o 2%
CH KHI CH NH THUC
Thi k cho con b: Lincosamid qua c sa m.
437
Bnh i trng: Chng ch nh s dng lincosamid cho nhng ngi vim rut
do nguy c gy tiu chy nng v ko di.
Cc trng hp khc: Nhim khun mng no, bt k do chng gy bnh no,
u chng ch nh dng lincosamid do khuch tn vo dch no tu rt t. Trnh dng
khi qu mn vi licosamid.
Thn trng: mc 2
Suy gan/suy thn: Suy gan hay suy thn nng lm tng na i ca cc
lincosamid, km theo nguy c c tnh ng tiu ho (vim i trng lot gi, thng
lnh tnh, hoc vim i trng mng gi thng gp hn v nng hn) c c ch cha
r ( ngun gc min dch hay c tnh trc tip). Gim liu lng v nh lng thuc
trong huyt thanh.
Thi k mang thai: Tnh an ton tuyt i ca vic dng cc lincosamid cho
ngi mang thai cha c xc nh chc chn.
Cn theo di: mc 1
Suy h hp; hen: Bnh hen hay cc tin s d ng i hi phi thn trng khi s
dng lincosamid.
TNG TC THUC
Aminosid tim hay dng ti ch; Foscarnet
Phn tch: Tng nguy c c vi thn khi phi hp hai thuc c tim nng c vi
thn. Cng hp cc tc dng khng mong mun.
X l: Phi hp thuc ny c th hay gp, nht l ti bnh vin. Mc d u cch
dng mt liu duy nht trong ngy s lm gim c tnh vi tai v thn, nhng khi c n
phi hp thuc, vn nn iu chnh liu lng theo thanh lc creatinin (cng thc
Cockroft v Gault). c bit cn theo di ngi bnh cao tui.
Phenicol
Phn tch: Tc dng km khun ca cc phenicol c th i khng tc d ng dit
khun ca h thuc phi hp ny. Tc dng dit khun ny bi u
hin trn nhng vi khun giai on pht trin theo hm m. Tnh i khng ny c
th gy hi cho iu tr vim mng no, v cn can thip nhanh v mnh.
X l: Cn tnh ti nguy c ny theo hon cnh sinh bnh l c th. C th phi
hp thuc ny tu theo thuc dng c th v chng gy bnh (ch n nng t i
thiu c ch-MIC).
Phn tch: Nguy c phong b thn kinh-c tng, c th ko theo yu c v suy h
hp, thm ch lit h hp, c bit vi enfluran v isofluran.
X l: Bc s gy m phi trnh nguy c ny, v phi chun b cc thuc khng
cholinesterase v cc mui calci tim gii to phong b thn kinh c. Nguy c gim
khi h tr h hp. Cn thn khi ngi bnh tnh dy.
438
Cc thuc loi cura

Phn tch: Tng tc dng cc thuc cura, c th gy nguy c phong b thn kinh c, tin trin n lit h hp.
X l: Phi hp thuc phi do bc s gy m c s chuyn khoa theo di. Tu
theo ngi bnh c c h tr h hp hay khng m nguy c ny c th nng nh
khc nhau.
Phn tch: Ch c dng interleukin ti c s chuyn khoa. C nguy c cng hp
cc tc dng c vi thn ca hai thuc.
X l: iu tr bng interleukin ch c thc hi n t i m t c s chuyn khoa,
do tnh cht nghim trng ca ch nh. Khi t ng tc thu c c xem xt tu
theo th trng chung ca ngi bnh. Nu khng th hon dng m t trong hai
thuc, phi theo di cht ch ion v thanh l c creatinin.
Thuc ch vn morphin
Phn tch: Tc dng c ch h hp ca cc thuc c tc dng phong b ch ni
thn kinh-c cng thm vo tc dng c ch h hp ca cc thuc gim au trung
ng.
X l: Bc s gy m cn lu n tng tc ny, v khi cn phi h tr h hp.
Ch khi tnh dy v khi ngng h tr h hp. Khuyn ngi bnh thng bo cho bc
s gy m cc thuc ang dng.
Phn tch: Kaolin lm gim hp thu cc lincosamid theo ng tiu ho v do
lm gim tc dng ca cc thuc ny.
X l: Cn phi c mt khong cch t nht hai gi gia ln dng thuc khng
acid v ln dng licosamid. Thng thng thuc khng acid c dng sau ba n 1
gi 30 pht, v n l nguyn nhn tng tit dch v.
LIPID (nh dch tim truyn)

Nh dch lipid dng cung cp nng lng trong nui dng ngoi ng tiu
ho
CC THUC TRONG NHM
Nh dch du u tng tinh ch nh dch tim truyn 10 mg, 20 mg; 30 mg
Intralipid nh dch tim truyn 10 mg, 20 mg; 30 mg
Intralipos nh dch tim truyn 10 mg, 20 mg; 30 mg
439
Vitrimix KV (intralipid 20% + dung dch acid amin)

CH KHI CH NH THUC
Chng ch nh: mc 4
Ri lon ng mu.
Suy gan: Nguy c mt.
Cn theo di: mc 1
Thi k cho con b/ thi k mang thai: V thiu d liu.
Trng hp khc: Trng hp tng lipid mu, d ng vi lecithin lng trng
v thn h nhim m.
440
LITHI (mui)
Thuc iu tr cc trng thi hng trm cm
CC THUC TRONG NHM
LITHIUM CARBONAT vin nn 250 mg; 400 mg
Teralithe vin nn 250 mg
Teralithe LP vin nn 400 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai: Nu t l cc tr em c d tt do cc b m c iu tr
bng lithi cng ging nh t l ny trong dn chng ni chung, th tn s xut hin cc
d tt v tim mch nghim trng (bnh Ebstein) khin phi ngng iu tr trong giai
on u thai k, d sau phi iu tr li trong giai on sau, c kim tra nghim
ngt nng lithi trong mu.
Thi k cho con b: Do lithi qua c sa m, nn bt buc phi ngng cho tr
b m.
Suy thn: Mi nguyn nhn lm gim bi tit thuc qua thn u c nguy c lm
tng lithi mu (xem phn: thc n; ru).
Thn trng: mc 2
Thc n; ru: i vi ngi bnh dng lithi, yu cu ch n c mui nh
bnh thng. Ti hp thu lithi v natri ng thn gn lin quan cht ch vi nhau. H
natri mu c th gy tng lithi mu, th hin: chng mt, run, nn, tiu chy, ni kh, ri
lon thc v thm ch hn m.
Cn theo di: mc 1
Suy tim: Lithi lm nng thm mt cn bng mui v nc khi suy tim. Ngoi ra,
iu tr suy tim (ch n nht, v dng cc thuc li tiu thi mui) lm tng nguy c
nhim c do tng lithi mu (xem phn: thc n; ru).
TNG TC THUC
Benzamid; butyrophenon; cc thuc an thn kinh khc
Phn tch: c thng bo v cc tai bin c thn kinh kiu hi chng l ln
ngi bnh dng phi hp thuc ny.
X l: Nn trnh phi hp thuc ny. Thay i chin lc iu tr, tr trng hp
ngi bnh nm trong mt c s chuyn khoa, c theo di lin tc.
Carbamazepin
441
Phn tch: Nguy c c vi thn kinh, ngay c vi liu bnh thng, do tc dng
hip ng. Ngi gim nng tuyn gip c bit d nhy cm.
X l: Nn trnh phi hp thuc ny, nhng mt s bc s chuyn khoa c
dng trong mt s trng hp trm cm kh cha.
Furosemid hoc thuc tng t; thuc li tiu gi kali; thuc li tiu thi
kali
Phn tch: Do s cnh tranh gia ion lithi v natri, nn ch n nht dn n
gim bi tit lithi qua nc tiu. Cc thuc li tiu quai v cc thuc li ti u thiazid lm
gim natri mu, v v vy lm tng lithi mu, km theo nguy c qu li u. Tng tc
dc ng hc v o thi thuc.
X l: Lithi c phm vi iu tr hp, do phi theo di cht ch v u n nng
lithi trong huyt thanh (nng cn bng trong huyt tng khong 0,5 n 1
mEq/lit). Trong s nhng du hiu qu liu lithi, c hin tng suy nhc, run ry, yu
c, bun nn, tiu chy, ni kh, mt phi hp vn ng... ngi bnh c chc nng
thn bnh thng, nu cn phi hp thuc, phi tng cng theo di lithi mu, v tin
hnh hiu chnh liu cho tht chnh xc trong v khi ngng iu tr bng thuc li tiu.
Haloperidol
Phn tch: Kt hp thuc c th gy suy gim thc, bnh v no, cc tc dng
ngoi thp, st, tng bch cu, v hot tnh enzym huyt thanh tng.
X l: Nu phi kt hp thuc ny, phi theo di ngi bnh cht ch, c bit
trong vng ba tun l u dng liu php kt hp. Nu nghi ng c tng tc thuc,
ngng dng mt trong hai th thuc , iu tr cc triu chng xut hin.
Phenothiazin
Phn tch: c bo co v cc tai bin c thn kinh kiu hi chng l ln, i
vi ngi bnh dng phi hp thuc lithi - thuc an thn kinh loi phenothiazin (c
m t vi chlorpromazin, fluphenazin, thioridazin).
X l: Nn trnh phi hp thuc. Thay i chin lc iu tr, tr khi ngi bnh
nm trong mt c s chuyn khoa v c theo di thng xuyn.
Sibutramin
Phn tch: C th xy ra hi chng serotonin bao gm d kch thch h thn kinh
trung ng, yu c vn ng, git rung c, suy gim thc. Cc tc dng
serotoninergic ca sibutramin v lithi cng vi nhau.
X l: Trnh s dng ng thi hai thuc ny. Nu khng th trnh c iu
ny, phi theo di cht bnh nhn v cc tc dng ph c th xy ra.
Thuc i khng th th angiotensin II
Phn tch: Phi hp thuc lithi vi cc thuc i khng th th angiotensin II (nh
losartan, valsartan) c th lm tng nng lithi trong huyt tng, km theo tng tc
dng dc l v c tnh, nh l ln, mt iu ho, hoang tng. C ch l do cc
thuc i khng th th angiotensin II c th lm gim o thi lithi qua thn do lm ti
hp thu nguyn t ny.
442
X l: Phi theo di nhng triu chng nhim c lithi bnh nhn v nu cn,
th hiu chnh liu.
Phn tch: Tng nng lithi trong mu, c th dn n hi chng l ln chng
t qu liu do gim bi tit qua thn.
X l: Thay i chin lc iu tr; nn trnh phi hp thuc ny.
Verapamil
Phn tch: C th c nhiu loi tng tc, theo nhng c ch cn cha bit, trong
c: Tng c tnh ca lithi; gim nng lithi trong huyt thanh; c hai tr ng hp
nhp tim chm (trong c mt trng hp dn ti nhi mu c tim gy t vong).
X l: Ngay ban u, xt xem phi hp thuc ny c tht cn khng. Nu ng
nh vy, phi theo di nhng phn ng ca tng ngi bnh (cho n nay, nhng
phn ng ny vn cha d kin trc c), c bit ca nhng ngi bnh cao tui
v/hoc ngi c ri lon tim mch. m t c tnh thn kinh kiu bun nn, nn,
tiu chy, mt phi hp vn ng... Thng bo mi hin tng bt thng cho Trung
tm cnh gic thuc.
443

Cc thuc kim ho nc tiu
Phn tch: Khi kim ho nc tiu, nng lithi trong huyt tng gim v lm
gim tc dng ca lithi. C ch l s thanh lc lithi qua thn s tng khi kim ca
nc tiu tng.
X l: Khi iu tr bng lithi, trnh dng thng xuyn cc thuc kim ho nc
tiu, hoc dng t xut loi thuc ny vi liu cao. Mt s thuc khng acid c cha
natri bicarbonat c tc dng kim ho nc tiu, do cn phi c k n thuc.
Cafein
Phn tch: nhng ngi nghin c ph, c nguy c tng o thi lithi qua nc
tiu, lm gim tc dng iu tr.
X l: Khuyn ngi bnh gim, thm ch khng ung c ph trnh nhng dao
ng lithi mu v t c cn bng iu tr.
Clozapin
Phn tch: Nguy c tng c tnh thn kinh (bt tnh, l ln, lon vn ng) do
mt c ch cn cha r.
X l: Nu vn gi phi hp thuc ny, nht thit phi theo di lm sng. Khi
xut hin cc triu chng, thay i liu php.
Didanosin
Phn tch: Vin didanosin cha mt cht khng acid, nn c nguy c gim hp
thu lithi qua ng tiu ha theo s tng pH d dy.
Diltiazem
Phn tch: Tng tc cn ang tranh ci. C nhng trng hp c thng bo
tng hay gim nng lithi trong huyt thanh, gy c tnh vi thn kinh, th hi n:
bun nn, nn, tiu chy, mt phi hp vn ng, run.
X l: Trc mu thun ny, cn theo di chnh xc lithi mu lc bt u, trong v
sau khi iu tr bng diltiazem. Chuyn cc nhn xt, nu c, n Trung tm cnh gic
thuc.
Fluoxetin; fluvoxamin; paroxetin
Phn tch: Cng hp cc tc dng khng mong mun: tng c tnh thn kinh ca
cc mui lithi vi nguy c xut hin hi chng serotonin (kch ng, run ry, cng nhc,
tng hoc h huyt p, nhp tim nhanh, tot m hi, rt run..).
X l: Nu cn phi hp thuc, phi theo di u n lm sng. Khi cn, hiu
chnh liu lng trong v sau khi iu tr vi thuc chng trm cm, v kim tra nng
lithi trong huyt thanh.
Iod hoc mui iodid
Phn tch: Lithi hoc cc mui iodid c th c tc dng hip ng lm gim nng
tuyn gip. C ch cha r.
444
X l: Cc bnh nhn iu tr bng lithi ni chung cn trnh dng iod hoc cc

mui iodid. Nu c hin tng gim nng tuyn gip hoc xut hin bu c, th cc
hormon tuyn gip c th lm gim nh triu chng v ht bu c.
steroid
Phn tch: Cc thuc chng vim c th lm gim thanh lc ca lithi qua thn,
gy tng ti hp thu lithi ng thn, ko theo qu liu lithi.
X l: Phi hp thuc ny i hi phi hiu chnh liu lng lithi lc bt u,
trong khi, v c khi ngng dng thuc chng vim. Nu cn, nn theo di cht ch lithi
mu.
Methyldopa
Phn tch: Methyldopa c th lm tng lithi mu, v gy qu liu lithi, vi cc du
hiu thn kinh.
X l: Kt hp thuc ny i hi phi hiu chnh liu lng lithi khi bt u, trong
v khi ngng methyldopa. Nu cn, phi theo di cht ch lithi mu.
Phn tch: Tng tc dc ng hc. Tng o thi lithi qua nc tiu.
tr.
X l: Theo di lm sng. Nu cn, hiu chnh li liu lng theo nng iu

Phn tch: Dng ng thi hai thuc ny lm tng nguy c gim nng gip v dn
ti bu c.
X l: Kim tra u n trong v sau khi iu tr vi lithi, nng iod trong mu
lin kt vi protein v TSH huyt tng.
Phn tch: Cc tc dng kch thch h thn kinh trung ng ca amphetamin c th
b lithi i khng.
X l: Tnh ti tng tc ny xc nh hoc xc nh li chin lc iu tr.
Citalopram
Phn tch: Nguy c xut hin hi chng serotonin kinh in gm cc triu chng
tm thn (kch ng, l ln, thm ch hn m), vn ng (git c, run r y, hot ng
qu mc...), thc vt (tng hay h huyt p, rt run, rng mnh, st cao, tot m hi),
tiu ho (tiu chy).
X l: Nu khng th trnh c phi hp thuc, bt buc phi theo di lm
sng.
445
LOPERAMID
Loperamid l thuc iu tr tiu chy kiu morphin tc ng bng cch lm chm
s chuyn vn ca ng tiu ho. Vi liu iu tr, loperamid khng c c tnh
gy nghin v gim au ca thuc h opi trn h thn kinh trung ng
CC THUC TRONG NHM
Loperamid v dn cht vin nn 2 mg; nang 2 mg
Arestal vin nn 1 mg (dng oxid monohydrat)
Eldoper nang 2 mg
Imodium nang 2 mg
Lomedium nang 2 mg; Lormide nang 2mg
Novo-Loperamid v Stopare nang 2mg
CH KHI CH NH THUC
Tr em: Khng dng cho tr em di 6 tui.
Cc trng hp khc: t kch pht cp tnh vim i-trc trng chy mu,
trng bng.
Cn theo di: mc 1
Thi k cho con b: V thn trng, khng nn dng loperamid trong thi k cho
con b.
Thi k mang thai: V thn trng, khng nn dng loperamid trong thai k.
TNG TC THUC
Cholestyramin
Phn tch: Tc dng ca loperamid c th b gim do cholestyramin. C th do
cholestyramin gn vo loperamid rut non, nn lm gim tc dng ca thuc ny.
Tng tc xy ra chm.
X l: Nn ung hai thuc cch nhau cng xa cng tt, hoc tng liu
loperamid.
Theophylin
Phn tch: Lm chm hp thu theophylin dng gii phng chm. Loperamid lm
cho rut chm chuyn vn, nn lm chm ho tan vin theophylin gii phng chm.
X l: Nn ung hai thuc ny cch xa nhau.
446
Co-trimoxazol
Phn tch: Co-trimoxazol c th lm tng nng ca loperamid trong huyt
tng, nhng c th t gy nh hng v lm sng. Co-trimoxazol c th c ch
chuyn ho ca loperamid.
X l: Loperamid c phm vi an ton rt rng, nn c th khng cn phi i u
chnh liu, m ch cn theo di lm sng.
Desmopressin
Phn tch: Nng trong huyt tng ca desmopressin c th tng, nn tng
tc dng dc l v tc dng c hi, do loperamid lm chm s chuyn vn ca ng
tiu ho, nn lm tng hp thu desmopressin.
X l: Da trn thng tin hin c, khng cn phi x l g c bit, ngoi theo di
lm sng.
LI TIU GI KALI
Thuc tc dng ng ln xa, c ch ti hp thu natri bng cch trao i vi
kali,
trc tip ln cc t bo (triamteren, amilorid) hoc bng cch i khng vi aldosteron
(spironolacton, canrenon, kali canrenoat)
CC THUC TRONG NHM
SPIRONOLACTON vin nn 25 mg
Verospiron vin nn 25 mg
TRIAMTEREN vin nn 100 mg
Dyrenium vin nn 100 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: Cc khng aldosteron qua c sa m i hi cch n
ung khc cho tr ang b.
Trng hp khc: Qu mn vi mt trong cc thnh phn. Tng kali mu.
Suy thn: Suy thn lm tng nguy c tng kali mu, c th dn n tai bin cht
ngi.
Thn trng: mc 2
Thi k mang thai: Vic dng nhng thuc li tiu ny cng nh vic dng cc
thiazid h kali mu khng c minh chng trong iu tr ph v tng huyt p ngi
447
mang thai, v c th dn n thiu mu cc b thai-nhau thai, km theo nguy c suy

dinh dng thai.
Tiu ng: Tng glucose mu to thun li cho tng kali mu, vic dng nhng
thuc li tiu ny c th nguy him cho ngi tiu ng.
Suy gan: Cc khng aldosteron gi c th gy thiu ht acid folic ngi
x gan.
Trng hp khc: Triamteren c tnh cht khng folic c th dn n thiu mu
nguyn hng cu khng l v khng c phi hp vi cc thuc khng folic khc
(trimethoprim, pyrimethamin, methotrexat, zidovudin). Trng hp qu mn vi thuc,
nn trnh k n thuc ny.
TNG TC THUC
Kali
Phn tch: Phi hp cc mui kali vi thuc li tiu gi kali c nguy c dn n
tng kali mu.
X l: Trnh cng k n hai thuc ny v nguy c tng kali mu v ri lon dn
truyn tim, c bit ngi bnh cao tui, ngi suy thn v suy tim.
Tacrolimus
Phn tch: Nguy c tng kali mu c tim nng gy t vong, do cng hp cc tc
dng gy tng kali mu ca hai thuc ny (nht l trong trng hp suy thn; ch n
ngi bnh cao tui). Tng tc dc lc hc.
X l: Nu khng th trnh c phi hp ny, theo di kali mu u n.
Thuc c ch enzym chuyn dng engiotensin
Phn tch: Chn h renin-angiotensin, dn n tch lu renin lu thng, h thng
ny ph thuc natri. Nguy c tng kali mu nghim trng.
X l: Thay i phi hp do nguy c tng kali mu.
Acid folic hoc dn cht; pyrimethamin; trimethoprim
Phn tch: Ch ring triamteren trong nhm thuc li tiu gi kali c tnh cht i
khng acid folic, do c ch dihydrofolat reductase. Tng tc ny cng c ngha nu
dng liu cao v iu tr ko di.
X l: Kim tra huyt v tu trng hp, cho dng acid folinic nht l ngi
dng liu cao cht khng folic, hoc ngi iu tr di ngy. nhng ngi bnh ny,
khuyn nn b sung acid folinic, nht l trong thi k mang thai.
Phn tch: Cc thiazid trong s cc thuc li niu thi kali v triamteren trong s
cc thuc li niu gi kali c m t l lm gim thanh l c ca amantadin
thn, c ch cha bit r, do c th lm tng c tnh ca amantadin.
448
X l: Nu phi hp, phi iu chnh liu ca amantadin. Nn lu l tng tc

c m t ny cn c xc nhn.
Phn tch: Amphetamin l thuc cng giao cm trc tip, v do d c tnh cht
gy tng huyt p. Phi hp vi cc thuc chng tng huyt p dn n i khng tc
dng v rt kh t cn bng huyt p.
X l: ngi tng huyt p, nn trnh k n cc sn phm amphetamin.
Baclofen; phenothiazin; thuc ch vn morphin
X l: Theo di huyt p trong khi phi hp hai thuc. Tu theo thuc, h huyt
p c th nng nh khc nhau. Tu trng hp, iu chnh liu ca mt hoc hai
thuc. Xy dng mt k hoch dng thuc u n. Khuyn ngi bnh nu b chng
mt khi bt u iu tr, nn gp li bc s iu tr nu cn, iu chnh liu ca mt
hoc hai thuc. Tng cng theo di ngi bnh cao tui (nguy c ng) v khuyn h
khi t th nm hoc ngi m chuyn sang t th ng th phi t t.
Biguanid
Phn tch: Khi suy thn chc nng, sinh l v / hoc lin quan n thuc li tiu,
c nguy c tng trng thi nhim acid lactic do metformin (Stagid, Glucophage,
Glucinan).
X l: Lu tng tc ny v trnh k n metformin nu ngi bnh b suy thn,
c creatinin mu ln hn 15mg/ lit (135 micromol/ lt) nam, v 12mg/lt (110 micromol /
lt) n. c bit ch n vic k n metformin km vi thuc li tiu ngi bnh
cao tui. Phi theo di thn ngi bnh khi bt u iu tr. Nn nh nhng du hiu
bo trc trng thi nhim acid lactic: bun nn, nn, co cng c, tng thng kh, cm
gic mt nhc, au bng.
Butyrophenon
X l: Nu cn phi hp ny, tng cng theo di huyt p trong v sau khi
ngng iu tr bng mt trong hai thuc. Tu trng hp, iu chnh liu. Nhn mnh
v k hoch dng thuc v s tun th. c bit cnh gic ngi bnh cao tui.
Ciclosporin
Phn tch: ghi nhn c tng creatinin mu m khng thay i ciclosporin mu.
X l: Theo di creatinin mu v chc nng thn khi cn phi hp.
Cht cn quang cha iod
Phn tch: Tng nguy c suy thn cp, nu b mt nc do thuc li tiu (c bit
l vi cc cht cha 3 iod ion ho v cc cht 6 iod).
X l: Nn tip nc cho ngi bnh trc khi dng cht cn quan cha iod.
Khuyn ngi bnh bo cho thy thuc X quang bit l ang iu tr thuc li tiu
c bin php x l.
449
Clonidin hoc thuc tng t; furosemid hoc thuc tng t; levodopa;

methyldopa; thuc chn beta; thuc gin mch chng tng huyt p; thuc li
tiu thi kali
X l: Cn phi iu chnh liu, xy dng k hoch dng thuc v nhn mnh vi
ngi bnh v s tun th. Lc u iu tr, cn o huyt p u n cho ti khi t
cn bng iu tr.
Clozapin
X l: Theo di huyt p v iu chnh liu ca thuc li tiu gi kali trong v sau
khi ngng iu tr bng clozapin. Thn trng c bit ngi bnh cao tui.
Colchicin hoc dn cht; probenecid
Phn tch: Thuc li tiu gi kali lm tng acid uric mu v lm gim tc dng
iu tr chng gt.
X l: Tt nht, nn trnh dng hai thuc trong cng thi gian, nu khng s thy
iu tr chng gt tht bi.
Corticoid-khong
Phn tch: Hiu lc ca thuc chng tng huyt p gim c th do tc dng gi
X l: Nu cn phi hp, tng cng theo di huyt p, trong v khi ng ng iu
tr bng mt trong hai thuc. C khi phi iu chnh liu. Nhn mnh v k hoch v
tun th dng thuc. c bit cnh gic khi dng vi ngi bnh cao tui.
Corticosteroid
Phn tch: Phi hp mt thuc li tiu c tc dng h huyt p vi corticoid c tc
dng gi mui v nc. Tc dng gi mui v nc c th lm gim tc dng chng
tng huyt p.
X l: Lu nhng tc dng dc l ny iu chnh liu thng xuyn. Thng
tin cho ngi bnh tng cng t theo di huyt p. Xy dng k hoch dng thuc
ng gi gic u n.
Dextropropoxyphen
Phn tch: Tc dng h huyt p nh ca dextropropoxyphen. Tng tc dng h
huyt p v tng nguy c h huyt p th ng.
X l: Cn phi theo di huyt p trong khi phi hp (trong khi iu tr v sau khi
ngng mt trong hai thuc).
Diazoxyd
Phn tch: Phi hp hai thuc c tnh cht lm h huyt p.
450
X l: Diazoxyd gy tng glucose mu, nn cnh gic khi phi hp hai thuc tu
theo mc tiu iu tr chnh cn t. Theo di huyt p ng mch u n nu phi
hp t ra cn thit.
Digoxin
Phn tch: Spironolacton c th lm gim nh lc co c dng tnh ca digoxin.
Nng digoxin trong huyt thanh cng c th tng. Ngoi ra, spironolacton c th nh
hng n xt nghim min dch phng x o digoxin, dn n tng gi to lng
digoxin trong huyt thanh. C ch: tc dng lc co c dng tnh ca digoxin c th b
gim bt bi lc co c m tnh ca spironolacton. Ngoi ra, spironolacton c th cn s
o thi digoxin ng thn, lm gim thanh lc v lm tng nng ca thuc ny
trong huyt tng.
X l: C th phi iu chnh liu ca digoxin trong thi gian ung cng vi
spironolacton; theo di ngi bnh cht ch. Cng nn nhn bit v nng cao gi
to ca digoxin trong xt nghim min dch phng x khng cn c vo m iu
chnh liu.
Pyrazol; indometacin hoc dn cht; salicylat; thuc chng vim khng
steroid
Phn tch: Gim tc dng h huyt p: Thuc chng vim khng steroid c ch
tng hp prostaglandin thn (cht gy gin mch) v/ hoc dn n gi mui v
nc. Nguy c suy thn cp ngi bnh mt nc.
X l: Cn bo m tip nc tt cho ngi bnh; theo di chc nng thn (
thanh lc creatinin); kim tra s n nh huyt p ng mch, c bit khi bt u iu
tr. Khuyn ngi bnh theo di u n huyt p.
Phn tch: S tng tc dng h huyt p, thng c s dng trong iu tr v
cn phi dng liu thch hp.
X l: Tng cng theo di huyt p. Nhn mnh v s tun th v gi gic dng
thuc u n, khi p dng liu php hai thuc. Cnh gic khi s dng ngi bnh
cao tui.
Nicorandil; nitrat chng au tht ngc
lm tng nguy c h huyt p i khi dn n sc.
X l: Theo di huyt p trong khi iu tr v sau khi ngng mt trong hai thuc.
Thn trng c bit ngi bnh cao tui.
Reserpin
Phn tch: Nguy c tng tc dng h huyt p, c th s dng trong iu tr.
huyt p la chn ban u, trong khi iu tr v sau khi ngng reserpin.
Sotalol
Phn tch: Tng tc dng h huyt p. Sotalol thng ch c dng lm thuc
chng lon nhp.
451
X l: Cn phi iu chnh liu; xy dng k hoch dng thuc v nhn mnh

cho ngi bnh v s tun th dng thuc. Lc u iu tr, cn o u n huyt p
ng mch cho ti khi t cn bng iu tr.
Tetracyclin
Phn tch: Nguy c tng ure mu ngi suy thn, c ch khng r; ch ring
tetracyclin c th gy tng ure mu. Tng tc ny hnh nh t ngha lm sng.
X l: Nu ure mu tng ngi bnh, c th do mt trong hai thuc hoc do
phi hp hai thuc.
X l: Nu cn phi hp, phi tng cng theo di huyt p, trong v khi ng ng
iu tr bng mt trong hai thuc. C khi phi iu chnh liu. Nhn mnh v k hoch
dng thuc v vic tun th. c bit cnh gic ngi bnh cao tui.
Phn tch: Dng cc thuc chng tng huyt p hoc cc thuc c th dn n
h huyt p ng thi vi cc thuc gy m barbituric c th gy tt huyt p nng.
X l: Khuyn ngi bnh bo cho thy thuc gy m bit cc thuc mnh ang
dng.
Thuc cng giao cm alpha hoc beta
Phn tch: Tc dng chng tng huyt p ca thuc li tiu gi kali c th gim
khi dng ng thi vi cc thuc cng giao cm.
X l: Theo di huyt p phi thng xuyn. Tt c ph thuc vo bi cnh iu
tr v dng bo ch dng. Nu c th, phi trnh phi hp ngn nga nguy c bin
ng huyt p nhiu.
Thuc gy m cc loi
Phn tch: V c th c ri lon nc-in gii.
X l: Khuyn ngi bnh phi can thip ngoi khoa bo cho thy thuc gy m
nhng thuc ang dng.
Thuc m bay hi cha halogen
Phn tch: Nguy c gim huyt p do gim th tch mu.
X l: Theo di huyt ng hc v hiu chnh cc ri lon chuyn ho. Khuyn
ngi bnh phi can thip ngoi khoa bo cho thy thuc gy m nhng thuc m bn
thn ang dng.
LI TIU THI KALI

Thuc c ch ti hp thu natri phn trn ca ng ln xa v lm tng o thi
kali, km theo nguy c h kali mu. Furosemid v cc thuc tng t
v c acid etacrynic c trnh by ring
CC THUC TRONG NHM
452
CLOROTHIAZID vin nn 0,2 g

Chlotride vin nn 0,2 g
Diurilix vin nn 0,2 g
HYDROCHLOROTHIAZID vin nn 25 mg; 50 mg; 100 mg
Apo-Hydro vin nn 25 mg, 50mg; 100mg
Apo-Amilzide vin nn 50 mg v 5 mg amilorid
Linoritio Forte vin nn 25 mg v 20 mg lisinopril
CYCLOTHIAZID vin nn 2 mg
Anhydron vin nn 2 mg
Doburil vin nn 2 mg
Fluidil vin nn 2 mg
ACETAZOLAMID vin nn 250 mg; thuc tim 500 mg
Diamox vin nn 250 mg; thuc tim 500mg
Apo-Acetazolamide vin nn 250mg
INDAPAMID vin nn 2,5 mg
Fludex vin nn 2,5 mg
Lorvas vin nn 2,5 mg
CHLORTHALIDON vin nn 25 mg; 50 mg; 100 mg
Hygroton vin nn 100 mg
BENDROFLUMETHIAZID vin nn 2,5 mg; 5 mg; 10 mg
Moduretic vin nn 5 mg; 10 mg
XIPAMID vin nn 20 mg; 40 mg
Diurex vin nn 20 mg
Zipix vin nn 40 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Khng k n khi c qu mn cm vi thuc nhm ny.
Thi k cho con b: Cn trnh cho con b, v mt s thuc li tiu qua c
sa m do khuch tn th ng.
Thi k mang thai: Khng dng cc thuc li tiu trong iu tr ph v tng
huyt p ngi mang thai, v c th dn n thiu mu cc b nhau thai km theo
nguy c suy dinh dng thai.
453
Suy thn: Bt k thuc li tiu mnh no u c th gy suy thn chc nng lin
quan n mt mui km vi gim lc cu thn v tng ure mu. Tn thng chc nng
ny c th lm nng thm suy thn sn c.
Thn trng: mc 2
Bnh gt: Nguy c tng acid uric mu, buc phi theo di cht ch ngi bnh
gt, nu phi hp l cn thit.
Suy gan: Cc thuc li tiu thi kali c th khi pht hn m gan. Chng lm tng
nguy c nhim kim chuyn ho, tnh trng ny lm thn tng sn sinh amoniac v lm
cht ny chuyn d dng vo no.
Cn theo di: mc 1
Tiu ng: Cc thuc li tiu thiazid hoc thuc tng t v c acid etacrynic
c th gy tiu ng, c gim dung np glucose, cn glucose mu khi i thng
tng. Vic s dng chng c th lm tiu ng mt cn bng v to thun l i xut
hin hn m tng glucose mu.
TNG TC THUC

Cisaprid
Phn tch: Tng nguy c lon nhp tim e do tnh mng bao gm xon
nh. C ch do mt in gii, c th ko di thm khong QT.
X l: Chng ch nh dng cisaprid ngi bnh b gim nhanh kali trong
huyt tng, th d ngi ang dng thuc li tiu thiazid.

Benzamid
Phn tch: Nguy c xut hin xon nh khi dng phi hp ny. Ch ,
tng tc ch m t vi ring sultoprid (barnetil) trong nhm benzamid. H kali
mu, nhp tim chm v khong QT di c t trc (ch nhn c trn in tm
) l nhng yu t thun li cho s xut hin xon nh. Xon nh l mt kiu
nhp tht c bit c th xut hin tng cn rt ngn (vi giy, mt thu: cm
gic ngt m khng mt thc). Cc thuc dn n h kali mu to thun l i
cho xut hin xon nh vi cc thuc khng chng lon nhp.
X l: Phi hp ny cn trnh. Nn s dng cc thuc khng d n n
xon nh. Nu cn phi hp, nn theo di thng xuyn khong QT v ti n
hnh kim tra u n kali mu. Ch cc du hiu lm sng c th bo hi u
h kali mu nh mt mi, yu c, chut rt.
Bepridil; halofantrin; pentamidin; vincamin
Phn tch: Nguy c xut hin xon nh khi dng phi hp ny. H kali
mu, nhp tim chm v khong QT di c t trc (ch nhn c trn in tm
) l nhng yu t thun li cho s xut hin xon nh. Xon nh l mt kiu
454
nhp tht c bit c th xut hin tng cn rt ngn (vi giy, mt thu: cm
gic ngt m khng mt thc) i khi tin trin n rung tht gy cht.
X l: Phi hp ny cn trnh. Nn s dng cc thuc khng dn n
xon nh. Nu cn phi hp, theo di thng xuyn khong QT v kim tra
u n kali mu. Ch cc du hiu lm sng c th bo hiu h kali mu,
nh mt nhc, yu c, chut rt.
Phn tch: Phi hp bt hp l gia cc thuc cng mt nhm dc l. K
n rm r v ch.
Lithi
Phn tch: S cnh tranh gia cc ion natri v lithi c gii thch l vi
ch n thiu mui, c s gim o thi lithi ra nc tiu. Cc thuc li niu
quai v thiazid dn n gim natri, do lm tng lithi mu, km vi nguy c
qu liu. l mt tng tc dc ng hc v o thi thuc.
X l: Lithi c phm vi iu tr hp, nn cn theo di cn thn v u n
nng trong huyt thanh (nng cn bng trong huyt tng khong 0.5
n 1 mEq/ lt). Du hiu qu liu lithi c: suy nhc, run, gim trng lc c,
bun nn, tiu chy, lon vn ngn, mt iu vn. ngi c chc nng thn
bnh thng, nu phi hp ny t ra cn thit, th cn tng cng theo di lithi
mu v iu chnh liu chnh xc, trong v sau khi ngng iu tr thuc li tiu.
Macrolid
Phn tch: Nguy c xut hin xon nh khi dng phi hp m t vi ring
erythromycin tim tnh mch. H kali mu, nhp tim chm v khong QT di c
t trc (trn in tm ) l nhng yu t thun li cho xut hin xon nh.
Xon nh l mt kiu nhp tht c bit c th xut hin tng cn rt ngn (vi
giy, mt thu: cm gic ngt m khng mt thc). Cc thuc dn n h kali
mu to thun li cho xut hin xon nh vi nhng thuc khng chng lon
nhip. Tng tc ch c m t c nht vi sultoprid trong nhm benzamid
hoc erythromycin tim tnh mch i vi nhm macrolid.
X l: Phi hp ny cn trnh. Nn dng cc thuc khng dn n xon
nh. Nu cn phi hp, phi theo di thng xuyn khong QT v tin hnh
kim tra u n kali mu. Ch n cc du hiu lm sng c th bo hiu h
kali mu, th d mt nhc, yu c, chut rt.
Methenamin
Phn tch: Trong nc tiu acid, methenamin phn gii thnh formol c
nguy c ta vi cc sulfamid km ho tan, c th dn n tinh th niu v si
thn.
X l: Tt nht l nn thay i thuc. Tnh acid ca nc tiu c th nh
gi bng cc bng giy th.
455
Sparfloxacin
Phn tch: Tng tc ny ch c gi tr vi sparfloxacin (zagam): tng nguy
c xon nh do cng hp cc tc dng in sinh l. H kali mu, nhp tim chm
v khong QT di c t trc (trn in tm ) l nhng yu t thun li cho
xut hin xon nh. Xon nh l mt kiu nhp tht c bit c th xut hin
X l: Phi hp ny cn trnh. Nn dng cc thuc khng dn n xon
nh. Nu cn phi hp, nn theo di thng xuyn khong QT v kim tra u
n kali mu. Ch n cc du hiu lm sng c th bo hiu h kali mu, th
d mt nhc, yu c, chut rt.
Phn tch: Tng tc ch c ghi nhn vi ring mt thuc khng
histamin khng an thn: astemizol (Hismanal). H kali mu (v c tiu chy ko
di c th gy mt nc v in gii) l yu t thun li cho xut hin xon
nh. Nguy c tng khi cc thuc gy h kali mu c phi hp vi cc thuc
khc c th gy xon nh. Xon nh l mt kiu nhp tht c bit, c th xut
hin tng cn rt ngn (vi giy, mt thu: cm gic ngt m khng mt thc).
X l: Phi hp ny cn trnh; nn thay i chin lc iu tr v chn
nhng thuc khng c bt li gy xon nh. Nu cn gi phi hp, theo di kali
mu v b sung kali nu cn.
Phn tch: S dng thuc nhun trng lm trn di hn (cng ging nh
tiu chy nng) c th gy h kali mu.
X l: Nu cn phi hp gia thuc nhun trng lm trn v thuc li niu
thi kali, phng nga h kali mu bng cch b sung kali v nu cn, tu theo
lm sng, theo di in tm (nguy c h kali mu xy ra t hn so vi thuc
nhun trng kch thch). Khuyn ngi bnh b sung kali (chui, mn...) v nu
cn cho theo di kali mu (nn nh rng h kali mu th hin bng tnh tr ng
mt nhc, yu c, thm ch co cng c). Khuyn ngi bnh gp li thy thuc
iu tr nu triu chng ny xut hin.

Alopurinol hoc dn cht; colchicin hoc dn cht; probenecid
Phn tch: Thuc li tiu thi kali lm tng acid uric mu v lm gim tc
dng iu tr chng gt.
X l: Tt nht, nn trnh dng hai thuc trong cng thi gian, nu khng
s thy iu tr chng gt tht bi.
Phn tch: Cc thiazid trong nhm thuc li tiu thi kali v triamteren
trong nhm thuc li tiu gi kali c m t l gy gim thanh lc
amantadin thn bng c ch cha r, do c th lm tng c tnh ca
amantadin.
456
X l: Khi phi hp, cn iu chnh liu ca amantadin. Tng tc ny

cn c xc nhn thm.
Phn tch: c tnh vi tai ca cc aminosid v ca thuc li tiu thi kali
c th tng ln khi hai nhm thuc ny c dng phi hp. Mt thnh lc mc
khc nhau, i khi khng hi phc c th xut hin. C ch khng r, c l
do hip ng tc dng khu c vi thnh gic. Tim tnh mch v suy thn l
nhng yu t to thun li cho c tnh.
X l: Nu cn phi hp, khuyn nn theo di u n chc nng thnh
gic. C th cn phi gim liu mt trong hai thuc, hoc c hai ngi suy
thn.
Amiodaron
Phn tch: Nguy c xon nh c to thun li bi h kali mu. H kali
mu, nhp tim chm v khong QT di c t trc (in tm ) l nhng yu t
thun li cho xut hin xon nh. Xon nh l mt kiu nhp tht c bit c
th xut hin tng cn rt ngn (vi giy, mt thu: cm gic ng t m khng
mt thc).
X l: Nu cn phi hp cc thuc gy h kali mu vi amiodaron, phi
ngn nga h kali mu bng cch tng cng theo di v theo di in tm .
Trng hp xut hin xon nh, khng dng thuc chng lon nhp. Nn nh
rng h kali mu th hin bng trng thi mt nhc, yu c, chut rt. Nu
nhng triu chng ny xut hin, khuyn ngi bnh gp li thy thuc iu tr.
Phn tch: Amphetamin l thuc cng giao cm trc tip, v vy c tnh
cht tng huyt p. Phi hp vi cc thuc li tiu thi kali c tc dng h
huyt p dn n i khng tc dng v rt kh t cn bng huyt p.
X l: Vi ngi bnh tng huyt p, nn trnh k n amphetamin.
Amphotericin B
Phn tch: Tng tc dng h kali mu vi dng tim. Amphotericin B rt t
uc hp thu nu ung hoc dng ti ch trong cc iu kin bnh thng.
X l: Theo di kali mu. nh gi cc nguy c ca tng tc ty theo
ng dng thuc amphotericin B.
Baclofen; phenothiazin; thuc an thn kinh cc loi; thuc ch vn
morphin
ng.
Phn tch: Tng tc dng h huyt p v tng nguy c h huyt p th
X l: Theo di huyt p trong khi phi hp. Tu theo thuc dng, h

huyt p c th nng nh khc nhau. iu chnh liu ca mt hoc hai thuc,
tu trng hp. Xy dng k hoch dng thuc u n. Khuyn ngi bnh,
nu b chng mt khi bt u iu tr nn gp li thy thuc iu tr iu
457
chnh liu mt hoc hai thuc, tu trng hp. Tng cng theo di ngi
bnh cao tui (nguy c ng) v khuyn h cn thn khi ang t th nm hoc
ngi m chuyn sang t th ng th phi t t.
Biguanid
Phn tch: Trong trng hp suy thn chc nng, sinh l v / hoc lin
quan n thuc li tiu, c nguy c tng nhim acid lactic do metformin (Stagid,
Glucophage, Glucinan).
X l: Lu tng tc ny v trnh k n metformin nu ngi bnh suy
thn, vi creatinin mu trn 15 mg/lt (135 micromol/lt) nam v 12 mg/lt (110
micromol/lt) n. c bit ch n k n ng thi metformin v thuc li
tiu, ngi bnh cao tui. Nn nh cc du hiu bo trc nhim acid lactic
gm: bun nn, nn, co cng c, gim thng kh, cm gic mt nhc, au bng.
Butyrophenon
Phn tch: Tng tc dng lm h huyt p ca nhng thuc ny.
X l: Nu cn phi hp, tng cng theo di huyt p ng mch trong
khi iu tr v sau khi ngng mt trong hai thuc. iu chnh li u tu trng
hp. Nhn mnh v k hoch v s tun th dng thuc. c bit cnh gic
ngi bnh cao tui.
Cholestyramin
Phn tch: Gim hp thu thuc li tiu thi kali ng tiu ho, do
cholestyramin gn thuc li tiu.
X l: Nu k n hai thuc, khuyn dng thuc li tiu thi kali trc
cholestyramin 2 gi hoc sau khi dng cholestyramin 4 gi.
Ciclosporin
Phn tch: Nguy c tng creatinin mu, nht l vi cc thuc li tiu
thiazid. Tng tc ny cn c thm t liu, cc cng b cn him.
X l: Theo di chc nng thn khi phi hp hai thuc ny.
Clonidin hoc thuc tng t; guanethedin hoc thuc tng t;
levodopa; methyldopa; reserpin; spironolacton; thuc gin mch chng tng
huyt p
X l: Cn phi iu chnh liu, xy dng k hoch dng thuc v nhn
mnh v tun th dng thuc. Lc u iu tr, cn o u n huyt p ng
mch cho ti khi t cn bng iu tr.
Clozapin
X l: Theo di huyt p ng mch v iu chnh liu ca thuc chng
tng huyt p la chn ban u, trong v sau khi ngng iu tr vi clozapin.
458
Corticoid - khong; tetracosactid

Phn tch: Phi hp hai ch phm gy h kali mu dn n tng nguy c
h kali trong mu, v nguy c xut hin xon nh.
X l: Theo di kali mu v hiu chnh bng mui kali, nu cn. H kali
mu th hin lm sng bng mt nhc, thm ch co cng c v i khi ri lon
nhp tim. Ch n mt nc qu mc (khi gng sc hoc nng nhi u ho c
tiu chy ko di), lm trm trng thm s mt kali. Trng hp cn thit, c
th khuyn b sung tm thi kali (chui, mn hoc mui ka li).
Cura cc loi
Phn tch: Nguy c tng chn thn kinh-c, do h kali mu, nht l vi cc
thuc loi cura khng kh cc.
X l: nh lng kali mu c th cn, trc khi dng thuc loi cura
khng kh cc.
Dextropropoxyphen
Phn tch: Tc dng h huyt p nh ca dextropropoxyphen. Vi cc
thuc h huyt p khc, s tng tc dng h huyt p v tng nguy c h huyt
p th ng.
X l: Cn thit phi theo di huyt p trong khi phi hp (trong khi iu
tr v sau khi ngng mt trong hai thuc.) Tu theo thuc dng, h huyt p c
th nng hay nh. iu chnh liu, ca mt hoc hai thuc nu cn. Xy dng
k hoch dng thuc u n. Khuyn ngi bnh, nu b chng mt lc bt
u iu tr, nn gp li thy thuc iu chnh liu ca mt hoc hai thuc,
tu trng hp. Tng cng theo di ngi bnh cao tui (nguy c ng) v
khuyn h khi t th nm hoc ngi m chuyn sang t th ng th phi t
t.
Diazoxid
Phn tch: Tng tc 3 khu: 1/ Tng tc dng lm tng glucose mu;
2/ Tng tc dng lm tng acid uric mu;
3/ Tng tc dng lm h huyt p.
X l: Phi hp ch c th thc hin ti bnh vin. Tu theo mc tiu iu
tr v sinh bnh l ca ngi bnh, lu ba tc dng ny theo di lm sng
v sinh hc ph hp.
Didanosin
Phn tch: Cng hp cc tc dng khng mong mun: tng nguy c vim
tu do thuc.
X l: Theo di lm sng, v nu cn, theo di sinh hc chc nng tu
(amylase mu v amylase nc tiu) khi b au bng.
459
Disopyramid
Phn tch: Nguy c xon nh khi phi hp cc thuc ny. H kali mu,
nhp tim chm v khong QT di c t trc (in tm ) l nhng yu t
thun li cho xut hin xon nh. Xon nh l mt kiu nhp tht c bit c
th xut hin tng cn rt ngn (vi giy, mt thu: cm gic ng t m khng
mt thc).
X l: Nu cn phi hp, ngn nga h kali mu bng cch tng cng
theo di v theo di in tm . Trng hp xut hin xon nh, khng dng
thuc chng lon nhp. Nn nh rng h kali mu th hin bng: mt nhc, yu
c thm ch chut rt). Nu nhng triu chng ny xut hin, khuyn ngi
bnh gp li thy thuc iu tr.
Fibrat
Phn tch: Cnh tranh cc v tr gn vi protein huyt tng km vi
tng tc dng li tiu v tng mt kali. Tng tc ny c nu trong y vn vi
ring furosemid (thuc li tiu thi kali), cn c tha nhn vi cc thiazid li
tiu.
X l: Theo di phi hp ny v thng bo cho Trung tm cnh gic thuc
mi bt thng sinh hc hoc lm sng. Tng cng theo di ngi suy thn.
Insulin
Phn tch: Trong nhm cc thuc li tiu quai, c m t nhng tnh cht
gy tng glucose mu ca furosemid, c th dn n gim tc dng ca cc
thuc chng tiu ng. C ch cha sng t.
X l: C th dng thuc li tiu ngi tiu ng, nhng ngi k n
phi ch v nhng bin i glucose mu c th c v iu chnh liu tu theo
kt qu sinh hc.
Nicorandil; nitrat chng au tht ngc
Phn tch: Phi hp vi bt k thuc no c tnh cht chng tng huyt p
c th lm tng nguy c tt huyt p, i khi dn n sc.
X l: Theo di huyt p trong khi iu tr v sau khi ngng mt trong hai
thuc. c bit thn trng ngi bnh cao tui.
Glycosid tr tim
Phn tch: Ri lon in gii do thuc li tiu gy nn c th dn n lon
nhp tim do digitalis. C ch do s tng bi xut kali v magnesi lm nh hng
n hot ng ca c tim.
X l: Khi dng phi hp nhng thuc ny, o hm lng kali v magnesi
trong huyt tng. Trnh tnh trng h kali hoc h magnesi huyt bnh nhn
iu tr glycosid tr tim bng cch gim natri trong n ung, b sung hoc dng
thuc li tiu gi kali/magnesi thay cho thuc li tiu thi kali.
460
Quinidin hoc dn cht ; sotalol

Phn tch: Nguy c xut hin xon nh (ri lon nhp tht) khi phi hp
mt thuc li tiu thi kali v mt thuc chng lon nhp. H kali mu, nhp tim
chm v khong QT di c t trc (ch nhn c trn in tm ) l nhng
yu t thun li cho s xut hin xon nh. Xon nh l mt kiu nhp tht
c bit, c th xut hin tng cn rt ngn (vi giy, mt thu: cm gic ng t
m khng mt thc).
X l: Nu cn phi hp cc thuc li tiu thi kali vi thuc chng lon
nhp ny, phi ngn nga h kali bng cch b sung kali c tnh ton v nu
cn thit, lm in tm . Trng hp xut hin xon nh, khng dng thuc
chng lon nhp. H kali mu th hin bng tnh trng mt nhc, yu c thm
ch co cng c. Nu nhng triu chng ny xut hin, khuyn ngi bnh gp
li thy thuc iu tr.
Sulfonylurea
Phn tch: Cc thuc li tiu thiazid lm tng glucose mu khi i v c
th lm gim h glucose mu do sulfonylurea. Tc dng ny c th xy ra sau
nhiu ngy hoc nhiu thng sau khi dng thiazid. H natri mu cng c th xy
ra. C ch do thuc li tiu thiazid c th lm gim s nhy cm ca m i vi
insulin, gim s tit insulin hoc lm tng s mt kali, gy ra tng glucose mu.
X l: Theo di cht ch glucose mu ngi bnh. Nu thy tng
glucose mu, c th phi tng liu ca sulfonylurea.
Tetracyclin
Phn tch: Nguy c tng ure mu ngi suy thn, c ch cha r. Ring
tetracyclin c th gy tng ure mu. ngha lm sng ca tng tc ny c
l khng ln.
X l: Nu ure mu tng ngi bnh, c th do mt hoc hai thuc ny.
C l khng cn phi can thip lm sng. Nhng nu tng ure mu chng t c
ri lon chc nng th nn cn nhc ngng mt hoc c th c hai thuc.
Thuc c tc dng cng giao cm alpha hoc beta
Phn tch: Tc dng lm h huyt p ca thuc li niu thi kali c th
gim khi dng ng thi vi cc thuc cng giao cm.
X l: Vic theo di huyt p phi thng xuyn. Mi s u ph thuc
vo bi cnh iu tr v dng bo ch dng. Nu c th, phi trnh phi hp
ngn chn nguy c quan trng v bin ng huyt p.
Phn tch: Tng tc kiu i khng dc l. Cc thuc ging beta c tc
dng tng huyt p, tc dng ny c th gim khi dng ng thi vi cc thuc
li tiu thi kali.
X l: Theo di u n huyt p. Thng tin cho ngi bnh v nguy c
bin i huyt p, xy dng k hoch dng thuc u n v tnh n dng
461
thuc s dng nh gi mc nng nh v bin ng huyt p (dng cc

thuc ging beta trong hen hoc trong do non)
X l: Theo di huyt ng hc v iu chnh cc ri lon chuyn ho.
Khuyn ngi bnh phi can thip ngoi khoa thng tin cho thy thuc gy m
nhng thuc ang dng.
Thuc i quang c iod
Phn tch: Tng nguy c suy thn cp, nu b mt nc do thuc li
tiu (c bit khi phi hp vi cc cht cha ba iod ion ho v cht cha su
iod).
X l: Nn tip nc cho ngi bnh trc khi dng thuc i quang c
iod. Khuyn ngi bnh thng tin cho bc s X quang l ang iu tr thuc l i
tiu c nhng bin php cn thit.
Phn tch: Phi hp hai thuc gy h kali mu dn n tng nguy c h
kali mu, nht l khi cc thuc nhun trng c dng di ngy.
X l: Theo di kali mu v hiu chnh li bng b sung mui kali, nu
cn. H kali mu th hin lm sng bng mt nhc, thm ch co cng c v i
khi ri lon nhp tim. Ch n mt nc qu mc (khi gng sc hoc nng
nhiu hoc tiu chy ko di) lm trm trng thm s mt kali. Nu cn, c th
khuyn b sung tm thi kali (chui, mn hoc mui kali).
Phn tch: Nguy c h huyt p nng v / hoc suy thn cp, trong trng
hp h natri mu. Mt mui v nc quan trng hoc hp ng mch thn dn
n tng kch thch h renin - angiotensin; do chn h ny, thuc c ch enzym
chuyn c th dn n tt huyt p t ngt ngay t ln ung thuc u tin v
suy thn cp, nhng him hn.
X l: Nu iu tr li tiu c tin hnh trc , cho ngng thuc li
tiu trong hai n ba ngy trc khi bt u iu tr bng thuc c ch enzym
chuyn, ri dng li thuc li tiu sau , nu cn. Lun lun bt u i u tr
bng cc thuc c ch enzym chuyn vi liu thp, ri tng dn liu, nu cn
thit. iu thn trng ny c gi tr c trong iu tr tng huyt p ng mch v
iu tr suy tim. Theo di chc nng thn trong nhng tun u iu tr bng
cc thuc c ch enzym chuyn. Phi nh rng c s phi hp cc thuc li
tiu thi kali vi cc thuc c ch enzym chuyn trong mt s bit dc, vi
liu ti u.
462

Calci
Phn tch: Vi cc thiazid li tiu, s phi hp u n c th dn n
tng calci mu, do gim o thi calci nc tiu.
X l: Lu tng tc ny trc khi b sung calci cho ngi bnh. Ch
nht l ngi bnh cao tui ang iu tr digitalin v polyvitamin (vitamin D).
steroid
Phn tch: Gim tc dng chng tng huyt p: Cc thuc chng vim
khng steroid c ch s tng hp thn ca cc prostaglandin gy gin mch
v / hoc dn n gi mui v nc. Nguy c suy thn cp ngi b mt
nc.
X l: Cn m bo tip nc tt cho ngi bnh, theo di chc nng
thn ( thanh lc creatinin), huyt p n nh, c bit khi bt u i u tr.
Khuyn ngi bnh theo di u n huyt p. Thn trng c bit khi phi
hp vi indometacin v cc salicylat liu cao.
Phn tch: Tng tc dng h huyt p ca nhng thuc ny. H huyt p
l mt tc dng khng mong mun ca cc thuc chng trm cm ba vng.
X l: Nu cn phi hp, tng cng theo di huyt p ng mch, trong
v sau khi ngng iu tr bng mt trong hai thuc. iu chnh liu lng, nhn
mnh k hoch dng thuc v s tun th. c bit cnh gic ng i bnh
cao tui.
Phn tch: Dng ng thi cc thuc chng tng huyt p hoc cc thuc
c th dn n h huyt p cng vi cc thuc gy m barbituric c th gy tt
huyt p nng.
X l: Khuyn ngi bnh bo cho bc s gy m bit cc thuc ang dng.
LI TIU THM THU

Cht phn t lng thp, c tc dng chng ph nhanh v ko di
CC THUC TRONG NHM

MANITOL dung dch tim truyn 20%
Mannitol dung dch tim truyn 20%
463
CH KHI CH NH THUC
Chng ch nh: mc 4
Trng hp: Tng thm thu ca huyt tng c t trc; mt nc ch yu
trong t bo.

Suy tim: Nguy c ri lon nc in gii.
Trng hp: Tng thm thu ca huyt tng, mt nc trong t bo
464
LU HUNH
Nguyn t v c c tc dng chng vim.
Dng trong bnh thp, bnh mi v bnh ngoi da
CC THUC TRONG NHM

Lu hunh
Sacnel kem bi da 0,5%
Sulfothiorine pantothnique vin bc 0,3g
Sulfonyl Monal vin nhai 0,20g
Thiofon vin hon 0,02g
CH KHI CH NH THUC
Thn trng: mc 2
Cc trng hp: Khng dung np lu hunh.
MACROLID
Khng sinh c hot ph gii hn i vi vi khun Gram dng.
Tri vi nhng gi thuyt trc y, khng c mi quan h no gia cu trc
v tc dng cho php gii thch nhng tng tc khc nhau lin quan n macrolid
CC THUC TRONG NHM

ERYTHROMYCIN
Apo - Erythro base vin nn 250mg
Apo - Erythro S vin nn 250mg (dng stearat)
Ery vin bao 500mg (dng ethylsuccinat)
Gi cm pha hn dch ung 125 mg; 250mg (dng ethylsuccinat)
Eryacne 4% Gel bi da (dng base)
Erycin vin nn bao phim 500mg
Eryderm dung dch bi da
465
Erylik gel bi da 4% (+ tretinoin)

Erythrocine vin nn bao phim 500 mg; cm pha hn dch ung 250 mg/ml
Erythromycin Domesco gi bt pha ung 250mg (dng ethylsuccinat)
Stiemycin dung dch dng ngoi 2%
Clarithromycin
Caricin vin nn bao phim 250 mg; 500 mg
Clar 250 hoc 500 vin nn 250 mg; 500 mg
Claranta vin nn 250 mg; 500 mg
Clari vin nn 250 mg
Claricin vin nn 500 mg
Clariom vin nn bao phim 250 mg
Clarisol vin nn 250 mg
Claritek vin nn 250 mg
Clarithromycin vin nn 250 mg; 500 mg
Clathrimax vin nn bao phim 250 mg
Cleron vin nn 500 mg, bt pha hn dch ung 125mg/5ml
Crixan vin nn 500 mg
Cyta vin nn 250 mg
Dorobit vin nn 250mg (dng phi hp vi tipidazol + omeprazol)
Klacid vin nn 250mg
Klacid fort v Klacid MR vin nn bao phim 500mg
Opeclacine vin nn bao phim 250 mg; 500mg
Roxithromycin
Arbid 150 vin nn 150mg
Dorolid vin bao 150mg, gi bt ung 150mg
Roxitacin vin bao 150mg
Roxithromycin vin nn 150mg
Rulid vin nn 150 mg
Spiramycin
Doropycin vin bao phim 1,5 M.IU- Gi bt ung 7500.000 IU
Neumomicid vin bao phim 1,5 v 3 M.IU.
Novomycine vin bao phim 1,5 M.IU gi bt ung 750.000 IU.
Rodogyl vin bao phim 750.000 IU + metronidazol 125 mg; cc bit d c
phi hp spiramycin vi metronidazol (xem mc Nitromidazol)
466
Rovamycine vin bao phim 1,5 v 3 M.IU.

Josamycin
Josacine vin nn 50mg; 200 mg, nang 500mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Trng hp qu mn vi cc macrolid, dng chin lc iu tr bng khng sinh
khc.

Thi k cho con b: Phn ln macrolid (josamycin, spiramycin, troleandomycin,
midecamycin, roxithromycin) u qua c sa m.
Thi k mang thai: Tnh v hi cha c xc nh.
Suy gan: Mt s dn cht (erythromycin estolat v nht l triacetyloleandomycin) c vi gan v gy vim gan mt, i khi tng transaminase, c th l do
phn ng qu mn.
TNG TC THUC

Amiodaron; bretylium; disopyramid; halofantrin; pentamidin; quinidin hoc
dn cht; sotalol; vincamin
Phn tch: Tng nguy c xut hin xon nh do cng hp tc dng, v
ch c m t c nht vi erythromycin tim tnh mch. H kali mu, nhp tim
chm v khong QT di t trc (ch bit c trn in tm ) l nhng yu
t to iu kin xon nh. Xon nh l mt dng nhp tht c bit, c th
xut hin thnh cn rt ngn (vi giy, mt thu: c cm gic ngt nhng khng
mt thc). Trong h macrolid, ch c erythromycin, c bit dng tim tnh
mch l c th gy nn lon nhp tim (ko di khong QT, ngoi tm thu tht,
xon nh, bloc nh tht).
X l: Chng ch nh phi hp thuc c tim nng gy t vong ny, v
khng c k n. Ngay khi dng n c, erythromycin tim tnh mch cng
c th gy lon nhp tim. Do , khuyn khng nn tim nhanh c liu, m phi
tim truyn tnh mch lin tc hay gin on thi gian truyn mi ln ti thiu
60 pht.
Benzamid
Phn tch: Theo hiu bit hin nay, trong nhm macrolid ch c
erythromycin tim tnh mch l c th to i u ki n xu t hi n xo n nh khi
phi hp vi duy nht mt cht trong nhm benzamid l sultoprid (Barnetil). H
kali mu, nhp tim chm v khong QT di t trc (ch bi t c trn i n
tm ) l nhng yu t to iu kin xut hin xon nh. Xon nh l mt
dng nhp tht c bit, c th xut hin thnh cn r t ng n (vi giy, m t
thu: c cm gic ngt nhng khng mt thc). Trong nhm macrolid, ch c
467
erythromycin, c bit dng tim tnh mch c th gy lo n nhp tim (ko di

on QT, ngoi tm thu tht, xon nh, blc nh tht).
X l: Chng ch nh phi hp thuc c tim nng gy t vong ny v
khng c k n. Ngay khi dng n c, erythromycin tim tnh mch cng
gy lon nhp tim. Khuyn khng nn tim nhanh c liu, m phi tim truyn
tnh mch lin tc hay gin on, thi gian truyn mi ln ti thiu 60 pht.
Bepridil
Phn tch: Theo hiu bit hin nay, trong nhm macrolid, ch c
erythromycin dng tim tnh mch l c th gy lon nhp tim (ko di on QT,
ngoi tm thu tht, xon nh, bloc nh tht). H kali mu, nhp tim chm v
khong QT di t trc (ch bit c trn in tm ) l nhng yu t to
iu kin xut hin xon nh. Xon nh l mt dng nhp tht c bit, c th
mt thc).
X l: Chng ch nh phi hp thuc c tim nng gy t vong ny v
khng c k n. Ch ring erythromycin di dng tim tnh mch cng c
th gy lon nhp tim. Do khuyn khng nn tim thuc ny c liu qu
nhanh mt ln, m phi tim truyn tnh mch lin tc hoc ngt on, thi gian
truyn mi ln t nht phi ko di 60 pht.
Cisaprid
Phn tch: Tng tc dc ng hc, c th dn n xut hin xon nh
ngi c t bm. C l l do cc macrolid ni chung, v erythromycin tim
tnh mch ni ring c ch c enzym chuyn ho cisaprid (Prepulsid). Ch
spiramycin (Rovamycin) l khng thuc trong trng hp ny.
X l: Hoc tm thi ngng cisaprid, hoc k n mt khng sinh thuc
h khc (th d beta lactamin).
Phn tch: Nguy c tai bin thiu mu cc b nng cc u chi, c th
dn ti hoi t, do c ch chuyn ho ergotamin gan (hin nay, cha c
m t vi spiramycin, roxithromycin, clarithromycin).
X l: Phi ht sc thn trng, v thng ip chnh thc c p dng cho
tt c cc macrolid. Cc bc s k n u trnh phi hp thuc ny, cho nn
hu nh khng c kin v nhn xt gi v Trung tm cnh gic thuc. Chng
ch nh phi hp thuc vi tt c cc macrolid, tr spiramycin. Cc d n cht
hydrogen ho khc ca ca lo mch (dihydroergocornin, dihydroergocristin,
dihydroergotoxin ) khng gy tng tc thuc ny
Statin; thuc c ch HMG-CoA reductase
Phn tch: Kt hp thuc c th gy bnh v c nng hay tiu c vn do
nng cc thuc c ch HMG-CoA reductase tng ln trong huyt tng. C
ch c th do c ch chuyn ho thuc qua CYP3A4.
468
X l: Nu c th, dng mt thuc khc thay th. Cn phi nhc nh cc

bnh nhn dng cc thuc c ch HMG-CoA reductase bo co mi trng hp
au c, yu c khng r nguyn nhn.
Phn tch: Trong hiu bit hin nay v nhm macrolid, erythromycin tim
tnh mch, josamycin c th to iu kin xut hin xon nh khi dng cng vi
astemizol (Hismanal) (gim d ho cc khng histamin gan).
X l: Chng ch nh phi hp thuc. Thay i chin lc iu tr. Chn
mt cht khng sinh khc c th tim c hoc chn mt khng H 1 khng an
thn khc, khng c nhng nhc im ni trn: cetirizin, loratadin.

Benzodiazepin
Phn tch: Tng cng cc tc dng (ch ca triazolam v midazolam)
khi phi hp vi erythromycin, hoc roxythromycin hoc clarithromycin ( c ch
enzym).
X l: Tu theo benzodiazepin c dng, mc nng nh ca tng
tc c thay i: Vi midazolam phi tnh n tng tc la chn liu lng.
Vi triazolam, cn trnh phi hp thuc do trong y vn m t nhng ri lon
ng x.
Buspiron
Phn tch: Dng kt hp vi cc khng sinh macrolid, nng buspiron
trong huyt tng c th tng cao, lm tng tc dng dc l v c tnh ca
thuc. C ch c th do cc khng sinh macrolid c ch CYP 3A4, l enzym
xc tc cho chuyn ho buspiron.
X l: Theo di cht ch p ng ca ngi bnh khi bt u dng, khi
ngng hay khi thay i liu ca khng sinh macrolid ngi bnh ang dng
buspiron. Cn nu ngi bnh ang dng khng sinh macrolid, m dng thm
buspiron th nn thn trng ch dng vi liu thp, v hiu chnh li u nu cn
thit. Azithromycin v dirithromycin khng b chuyn ho qua CYP3A4, nn c th
khng tng tc vi buspiron.
Carbamazepin
Phn tch: Tng nng carbamazepin trong huyt thanh do c ch
enzym, c th dn ti ri lon thng bng, bun nn, nn, ng g. Tng nng
ny c m t vi erythromycin, TAO, josamycin v clarithromycin.
X l: Chn mt khng sinh khc hay mt macrolid khc khng gy tng
tc (roxithromycin...), hoc hiu chnh liu lng carbamazepin theo kt qu
nh lng nng trong huyt tng. Theo di cht ch cc du hiu nhim
c c th xut hin.
469
Cc cht c ch ti thu nhn serotonin

Phn tch: Cc cht c ch ti thu nhn serotonin, c th l sertralin,
fluoxetin dng kt hp vi khng sinh macrolid s b c ch chuyn ho, c th
gy nn hi chng serotonin: d kch ng, tng trng lc c, git rung c,
gim thc.
X l: Nu khng trnh c kt hp thuc ny, cn hiu chnh liu
sertralin, fluoxetin khi bt u, khi ngng dng, khi thay i liu dng khng sinh
macrolid. Theo di cht ch trng thi ca ngi bnh.
Cilostazol
Phn tch: Khi dng cilostazol ng thi vi mt s khng sinh macrolid
(c th erythromycin, clarithromycin, troleandomycin) th nng ca cilastazol
trong huyt tng tng ln, lm tng tc dng dc l v c tnh. C ch l do
khng sinh macrolid c ch CYP3A4 c trch nhim trong chuyn ho
cilostazol.
X l: Cn phi gim liu cilostazol nu dng ng thi vi cc khng sinh
macrolid k trn.
Corticoid - khong; glucocorticoid
Phn tch: Nguy c xut hin xon nh khi phi hp thuc ny. Tng tc
ch mi c ghi nhn vi erythromycin tim tnh mch trong h macrolid. H
kali mu, nhp tim chm v khong QT di t trc (ch bit c trn in tm
) l nhng yu t to thun li xut hin xon nh. Xon nh l mt dng
nhp tht c bit, c th xut hin thnh cn rt ngn (vi giy, mt thu: c
cm gic ngt nhng khng mt thc). Cc thuc gy h kali mu to thun
li cho xut hin xon nh vi cc thuc khng chng lon nhp.
X l: Nn trnh phi hp thuc ny. Dng cc thuc khng gy xon
nh. Nu cn phi hp thuc, phi theo di lin tc khong QT v kim tra u
n kali mu. Cn ch nhng du hiu lm sng, bo hiu h kali mu nh:
mt mi, yu c, chut rt.
Furosemid hoc thuc tng t; tetracosactid; thuc nhun trng kch
thch
Phn tch: Tng nguy c xon nh do cng hp cc tc dng, ch mi
c m t vi erythromycin tim tnh mch. H kali mu, nhp tim chm v
khong QT di t trc (ch bit c trn in tm ) l nhng yu t to
iu kin xut hin xon nh. Xon nh l mt dng nhp tht c bit, c th
mt thc). Trong nhm macrolid, ch c erythromycin, c bit dng tim tnh
mch c th gy lon nhp tim (ko di on QT, ngoi tm thu tht, xon nh,
blc nh tht).
X l: Chng ch nh tng tc c tim nng gy t vong ny, v khng
c k n. Ngay khi dng mt mnh, erythromycin tim tnh mch c th
gy lon nhp tim. Khuyn khng nn tim nhanh c liu mt ln, m phi
truyn tnh mch lin tc hay tng t, thi gian truyn mi ln t nht l 60
pht.
470
Penicilin
Phn tch: Tc dng km khun ca macrolid c th i khng vi tc
dng dit khun ca penicilin. Tc dng dit khun ny th hin trn vi khun
ang trong giai on pht trin theo hm m. Tnh i khng ny c th c hi
trong iu tr vim mng no, v cn can thip nhanh v mnh.
X l: Tnh ti nguy c ny theo bi cnh sinh - bnh l c th. C th
thc hin phi hp thuc ny tu theo thuc v cc chng gy bnh (cn ch
n nhng nng c ch ti thiu - MIC).
Pimozid
Phn tch: Cc khng sinh macrolid c ch s chuyn ho pimozid gan
qua xc tc ca CYP3A4, lm tng nng thuc ny trong huyt tng, c th
gy c vi tim.
X l: Trnh dng khng sinh macrolid cng vi pimozid.
Repaglinid
Phn tch: Mt s khng sinh macrolid, c th l clarithromycin,
erythromycin c th lm tng nng repaglinid trong huyt tng, lm tng tc
dng dc l v tc dng ph ca thuc. C ch c th l do cc khng sinh
macrolid ni trn c ch CYP3A4 xc tc cho chuyn ho repaglinid.
X l: Vi ngi bnh ang dng repaglinid, phi theo di cn thn nng
glucose mu khi bt u dng v khi ngng dng khng sinh macrolid. Hiu
chnh liu repaglinid nu cn.
Ritonavir
Phn tch: Ritonavir c i lc mnh vi isoenzym 3A 4 ca cc cytochrom
P450, nn c nguy c cao cnh tranh gia ritonavir vi cc thuc c chuyn
ho hay nghi ng c chuyn ho bi isoenzym ny. Cnh tranh ny lm gim
chuyn ho cc thuc v gy nguy c lm tng ng k nng thuc trong
huyt tng. C nguy c co cng bng km theo bun nn v nn ( c m
t vi erythromycin, azithromycin, clarithromycin). Tng tc dc ng hc v
chuyn ho.
X l:
Erythromycin: Theo di cht ch ngi bnh phng xut hin tc dng
c, v khi cn gim liu lng thuc khng sinh.
Clarithromycin: nh lng u n creatinin mu. Khng hiu chnh liu
lng nu chc nng thn bnh thng. Khi suy thn, hiu chnh liu lng theo
thanh lc creatinin. Ch n ngi bnh cao tui.
Sparfloxacin
Phn tch: Tng tc ny ch ng vi sparfloxacin (Zagam). Tng nguy
c xon nh do cng hp cc tc dng in sinh l khi phi hp v i
erythromycin tim tnh mch, nhng vi cc macrolid khc th hi n nay ch a
thy ni ti. H kali mu, nhp tim chm v khong QT di t tr c (ch bi t
c trn in tm ) l nhng yu t to i u kin xut hi n xo n nh.
471
Xon nh l mt dng nhp tht c bit, c th xut hin thnh cn rt ngn

(vi giy, mt thu: c cm gic ngt nhng khng mt thc).
X l: Nn trnh phi hp thuc. Dng cc thuc khng gy xon nh.
Nu cn phi hp thuc phi theo di lin tc khong QT v kim tra u n
kali mu. Cn ch cc du hiu lm sng, bo hiu h kali mu nh mt mi,
yu c, chut rt.
Tacrin
X l: Nu cn, tng cng theo di gan. Trnh dng nhng phi hp
thuc gy nguy c cho ngi bnh cao tui.
Tacrolimus
Phn tch: Tng nng tacrolimus v creatinin trong huyt thanh khi
dng erythromycin, clarithromycin, josamycin (v triacetyloleandomycin). C th
do c ch chuyn ho tacrolimus gan v rut. Tng tc dc ng hc v
chuyn ho.
X l: Cn phi gim liu tacrolimus v theo di chc nng thn thng qua
nh lng creatinin mu. Theo di nng tacrolimus trong huyt t ng khi
dng v khi ngng thuc.
Phn tch: Tng nng theophylin trong mu, km theo nguy c qu liu,
nht l tr em. iu ny cha c ni ti vi spiramycin, roxithromycin,
clarithromycin, azithromycin, dirithromycin v midecamycin.
X l: Hiu chnh li liu lng theo kt qu nh lng theophylin. Nu
khng, thay th bng khng sinh khc.
Phn tch: Nguy c xut hin xon nh khi phi hp ch c m t vi
erythromycin tim tnh mch. H kali mu, nhp tim chm v khong QT di t
trc (ch bit c trn in tm ) l nhng yu t to iu kin xut hin
xon nh. Xon nh l mt dng nhp tht c bit, c th xut hin thnh cn
rt ngn (vi giy, mt thu: c cm gic ngt nhng khng mt thc). Nhng
thuc gy h kali mu to iu kin xut hin xon nh khi phi hp vi cc
thuc khng chng lon nhp. Tng tc ch mi c ghi nhn vi sultoprid
trong nhm benzamid v erythromycin tim tnh mch trong nhm macrolid.
X l: Nn trnh phi hp thuc ny. Dng cc thuc khng gy xon
nh. Nu cn phi hp thuc, cn phi theo di lin tc khong QT v kim tra
u n kali mu. Cn ch nhng du hiu lm sng bo hi u h kali mu
nh mt mi, yu c, chut rt.
472

Amineptin; carmustin hoc dn cht; dantrolen; estrogen hoc thuc nga
thai estroprogestogen; fluvoxamin; griseofulvin; isoniazid hoc thuc tng t;
methotrexat; progabid; rifampicin; thuc chng nm dn cht ca imidazol
Phn tch: Phi hp cc thuc c tim nng c vi gan (cng hp cc tc
dng khng mong mun).
X l: Khi phi hp hai thuc c vi gan, phi theo di cht ch chc
nng gan (ASAT, ALAT, phosphatase kim, bilirubin), hoc phi hon dng mt
trong hai thuc. Kim tra chc chn ngi bnh khng thng xuyn ung ru
v khng c tin s vim gan virus. Cc triu chng lm sng chnh khng in
hnh: bun nn, st, vng da... Nu thy ng thi ban ngoi da, nga v
hch to th hng v nguyn nhn do thuc. Cn phn bit r, theo cc test th
sinh hc, nguy c xut hin vim gan tiu t bo khng phc hi vi vim gan
mt hi phc c sau khi ngng iu tr.
Phn tch: Tng nng cc cht ny trong mu: m t mt vn ng
v o gic khi phi hp thuc ny (cha m t vi roxithromycin, midecamycin
v spiramycin). C ch cn cha r. C th l macrolid (erythromycin v
josamycin) c ch chuyn ho bromocriptin.
X l: Tng tc ny c ni ti trong y vn, v cn c khng nh
bng cc nhn xt. Tuy nhin c nguy c tng nng bromocriptin trong mu.
Vn l tm hiu nng ny c tng n mc gy c theo liu lng dng
khng ? Cn theo di lm sng.
Ciclosporin
Phn tch: Tng nng ciclosporin trong huyt thanh v tng creatinin
mu do c ch chuyn ho ciclosporin gan. Tng tc ny c m t vi
erythromycin, TAO, v clarithromycin.
X l: Nn trnh phi hp ciclosporin vi erythromycin, TAO. i vi cc
macrolid khc, phi theo di.
Glycosid tr tim
Phn tch: Erythromycin v clarithromycin c lin quan n s tng nng
digoxin trong huyt thanh, c th n mc xut hin du hiu nhim c. C
ch ca tng tc ny kh c o: i vi erythromycin sinh kh d ng ca
digoxin tng, c th do erythromycin lm tng tho cc cht ra khi d dy,
ngoi ra, erythromycin v clarithromycin cn c ch vi khun kh kinh in c
trong rut bnh thng l Eubacterium lentum, vi khun ny chuyn ho digoxin
khong 10% s ngi bnh, nh vy, lm gim gin tip chuyn ho ca
digoxin.
X l: Theo di lm sng. Cn theo di nng digoxin trong v sau khi
iu tr vi erythromycin. i vi macrolid khc, vn phi cnh gic. Thng bo
cho ngi bnh bit nhng triu chng nhim c digoxin: bun nn, ri lon
th gic v mu sc...
473

Phn tch: Phi hp hai thuc c tim nng c vi gan. Erythromycin c
th l cht c ch enzym, c kh nng c ch chuyn ho acid valproic v dn
n ng c.
nng gan (ASAT, ALAT, phosphatase kim, bilirubin), hoc phi hon dng
mt trong hai thuc, nu c th. Kim tra chc chn ngi bnh khng thng
xuyn ung ru v khng c tin s vim gan virus. Cc tri u chng lm
sng chnh khng in hnh: bun nn, st, vng da... Nu thy ng thi pht
ban ngoi da, nga, v hch to th hng v nguyn nhn do thuc. Cn phn
bit r theo cc test th sinh hc, nguy c xut hin vim gan tiu t bo
khng hi phc vi vim gan mt hi phc c sau khi ngng iu tr.
Omeprazol
Phn tch: Tng pH d dy, nn omeprazol gp phn lm tng tnh vng
bn ca clarithromycin, km theo tng nng macrolid ny v cht chuyn
ho c hot tnh ca n trong cc m v d dy.
X l: Tng tc thuc ny c th c mt ngha lm sng tch cc,
nhng cn cn phi khng nh tip.
Rifabutin
Phn tch: Tng tc c m t vi clarithromycin, gy nguy c tng cc
tc dng khng mong mun ca rifabutin (vim mng mch nho) do nng
ca cht ny v cht chuyn ho c hot tnh ca n tng ln.
X l: m bo theo di lm sng u n.
Phn tch: Dng ng thi vi cc thuc khng acid, thy nng nh
ca azithromycin s gim ng k.
X l: Trnh k n mt thuc khng acid cng vi azithromycin. C th
khc phc tng tc ny bng cch ung 2 thuc cch nhau t nht 2 gi.
Phn tch: Tng nguy c xut huyt (c bit vi warfarin) do gim
chuyn ho v gim thanh lc cc thuc ny, c bit ngi bnh cao tui
(n nay cha c ti liu ni ti tng tc vi roxithromycin).
X l: Khi dng phi hp thuc ny, phi theo di t l chun quc t INR
hay t l prothrombin trong v sau khi iu tr bng macrolid (nht l vi TAO v
erythromycin). Tng tc ny i khi kh qun l trong mt giai on ngn.
Zidovudin
Phn tch: Clarithromycin c th lm gim nng zidovudin trong huyt
tng.
474
X l: Nu p ng vi zidovudin gim sau khi bt u iu tr vi

clarithromycin, phi tng liu zidovudin, hoc dng mt khng sinh khc, da
theo kt qu khng sinh .

Levodopa
Phn tch: Spiramycin c th c ch hp thu carbidopa l cht thng
c dng phi hp vi levodopa nh mt cht c ch dopa - decarboxylase,
do lm tng nng levodopa trong huyt thanh, ng thi hn ch
levodopa vt qua hng ro mu - no, v lm gim hot tnh ca thuc.
X l: trnh tht bi trong iu tr, tnh ti tng tc ny khi xc nh
chin lc iu tr. Chn mt macrolid khc nu c th.
MAGNESI (mui)
Cc mui magnesi c th ung hoc tim tnh mch
CC THUC TRONG NHM

MAGNESI HYDROXYD vin nn 400 mg; 250 mg phi hp vi Alusi hydroxyd
Maalox vin nn 400 mg phi hp vi Alusi hydroxyd
Macgel vin nn 250 mg phi hp vi Alusi hydroxyd
MAGNESI TRISILICAT vin nn ngm
Magnomint vin nn ngm
MAGNESI LACTAT vin nn bao; dung dch ung
Magn B6 vin nn bao
Magie B6 dung dch ung
MAGNESI CARBONAT vin nn
Topaal vin nn
MAGNESI SULFAT nang
Spasmag nang
CH KHI CH NH THUC
Thn trng: mc 2
Suy thn: Nguy c tng magnesi mu
TNG TC THUC
475

Cc thuc loi cura
Phn tch: Nguy c tng phong b thn kinh - c nng ln v khng tin
on c, nht l khi dng magnesi tim.
X l: Liu php thng thc hin bnh vin v trc khi phu thut.
Phi tnh n nguy c ny v phi chun b tht chu o trnh nguy c ny.
Glycosid tr tim
Phn tch: Tim tnh mch mui calci hay magnesi ng thi vi cc thuc
digitalis c th gy t vong. Dng calci hay magnesi hoc vitamin D ung phi hp
vi glycosid tr tim c th gy lon nhp tht (ngoi tm thu, nhp tim nhanh, rung
tht).
X l: Chng ch nh dng phi hp mui calci tim tnh mch vi digitalis.
Thay i chin lc iu tr. Phi hp calci hay magnesi ung v vitamin D vi
thuc digitalis cn c theo di (lm sng, v nu cn, lm in tm ).
Quinidin hoc dn cht
Phn tch: Cc mui magnesi (khng acid), do tc dng kim ho nc
tiu, c th lm tng nng quinidin trong huyt tng v ko theo qu liu.
X l: Xem xt nguy c ny da theo liu lng ca cc ch phm. Nu
cn, nghin cu mt chin lc iu tr khc. C th theo di pH nc tiu
bng cc bng giy ch th.

Tetracyclin
Phn tch: Tng tc ho - l. y c s to phc gia cc cation vi
cc tetracyclin, lm gim hp thu tetracyclin v gy nguy c iu tr tht bi
(Fe2+, Al3+, Ca2+).
X l: i vi tetracyclin th h I (terramycin...). nguy c ny ln: s hp
thu b c ch ti 75%. Vi cc tatracyclin th h II, gim hp thu khong 20% v
hu nh khng c ngha lm sng.
MEDIFOXAMIN
Thuc chng trm cm, khng thuc cc loi ba vng hay c ch MAO,
cng tham gia vi h dopaminergic, v mc t hn vi h noradrenergic
CC THUC TRONG NHM

MEDIFOXAMIN vin nn 50 mg
476
Cledial vin nn 50 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Ph i tuyn tin lit/u tuyn tin lit: Nguy c b tiu tin, do tc dng
khng cholinergic.
Cc trng hp khc: Qu mn vi thuc.

Thc n/ru: Phi trnh ung ru trong khi iu tr.
Thi k cho con b: Thuc vo sa chut cng.
Tng nhn p: Tc dng khng cholinergic th hin gin ng t c th dn ti
cn tng nhn p cp tnh ngi bnh c t bm gc mng mt - gic mc hp.
Thi k mang thai: Do khng c thng tin chnh xc.
Cn theo di: mc 1
Cc trng hp khc: Nh phn ln cc thuc chng trm cm, trong chng h
huyt p c th thy tng tc dng h huyt p.
TNG TC THUC

Ru
Phn tch: Tng tc dng c ch h thn kinh trung ng, ko theo tng
tc dng an thn. Vi mt s cht, c th thy mt s tc dng tm thn vn
ng, nht l trong tun l iu tr u tin. Tng tc dc lc.
X l: Tt nht, khng nn phi hp hai cht ny, v thy thuc k n
khng chc chn l ngi bnh khng ung ru. Nguy c an thn gy bun
ng c bit nguy him vi nhng ngi li xe v ngi ng my. Khuyn
ngi bnh khng ung ru v cc thuc hoc ch phm khc c ru.
tc dng an thn. Tng tc dc lc.
X l: Phi tnh n nguy c ny iu chnh liu lng ca hai thuc.
Phi ngh n gim tnh to ngi li xe v ngi ng my. Khuyn khng
nn dng thm ru, khng ung thuc hoc ch phm khc c ru.
477

Amineptin; thuc chng trm cm ba vng hoc tng t; thuc ch vn
morphin
Phn tch: Tng cc tc dng c ch h thn kinh trung ng, tc dng
c ch h hp v tc dng h huyt p. Ngoi ra khi b ph thuc thuc,
vic phi hp hai thuc c th lm tng tnh ph thuc .
X l: Phi tnh n nguy c ny hiu chnh liu lng ca hai thuc,
nu cn phi hp thuc. Ngh n gim tnh to ngi li xe v ngi ng
my. Khuyn ngi bnh khng ung ru v khng ung thm thuc v cc
ch phm khc c ru.
Buspiron
tc dng an thn. Vi mt s cht c th thy mt s tc dng tm thn vn
ng, nht l trong tun l iu tr u tin. Tng tc dc lc.
X l: Tt nht khng nn phi hp hai thuc, v thy thuc k n khng
th m bo ngi bnh khng ung ru. Nguy c an thn gy bun ng c
bit nguy him vi ngi li xe v ngi ng my. Khng ung ru v thuc
hoc cc ch phm khc c ru.
tc dng an thn. Tng tc dc lc. Cn ch rilmenidin dng vi liu bnh
thng khng lm tng tc dng c ch h thn kinh trung ng ca cc thuc
ny.
X l: Nu cn phi hp thuc, phi tnh ti nguy c ny tnh ton liu
lng ca hai thuc. Phi ngh ti gim tnh tnh to ngi li xe v ng i
ng my. Khuyn khng ung v khng t dng cc thuc hoc ch phm
c cha ru.
Disopyramid
Phn tch: Tng tc dng khng cholinergic kiu kh ming, b tiu tin v
to bn.
X l: Lu n nhng nhc im ny. Nu v mc ch iu tr m phi
phi hp thuc, bo cho ngi bnh bit nhng nhc im . Cn trnh dng
cho ngi c bnh tuyn tin lit v bnh tng nhn p.

Phn tch: Gluthetimid c tnh khng cholinergic v an thn. Nh vy phi
hp thuc lm tng tc dng khng cholinergic v an thn, th hin tc dng
478
c ch h thn kinh trung ng, v tng nguy c b tiu tin, kh ming v to

bn.
X l: Lu n nhng nhc im ny. Nu v mc ch iu tr m phi
phi hp thuc, bo cho ngi bnh bit nhng nhc im . Cn trnh dng
cho ngi c bnh v tuyn tin lit v bnh tng nhn p. Cn nhc nguy c
theo dng bo ch: cn cn thn vi thuc nh mt. Theo di cc thuc ngi
bnh t dng. Ch n ngi li xe v ngi ng my.
Phn tch: Tng tc dng khng cholinergic (nht l vi cc thuc
phenothiazin khng H1) do hip ng cc tc dng khng mong mun. Cc tc
dng ny biu hin tng nguy c b tiu tin, kh ming v to bn. Ch
ketotifen (Zaditen) v oxatomid (Tinset) c th khng c tc dng khng
cholinergic. Nh vy tng tc khng bao hm cc thuc ny.
X l: Cn lu n cc nhc im ca loi thuc ny. Nu v mc ch
iu tr m phi phi hp thuc, thng bo cho ngi bnh v cc nhc im
. Trnh dng cho ngi c bnh v tuyn tin lit v ngi tng nhn p. Cn
nhc nguy c c theo dng bo ch: Thn trng vi cc thuc nh mt. Theo
di c nhng thuc ngi bnh t dng.
Phn tch: Dng ng thi hai thuc ny c th dn n nhng bin ng
huyt p quan trng. Ngoi ra cn c thm tc dng c ch h thn kinh trung
ng.
X l: Thuc c ch MAO t c dng, cc tng tc c nhiu. Do t
c k n, nn nhng nhn xt v cnh gic thuc cng him. Tuy vy, cn
phi thn trng m bo t 2 n 3 tun sau khi ngng thuc mi k n l i
thuc c ch MAO.
Thuc chng ng kinh khng barbituric; baclofen; benzamid;
butyrophenon; carbamat hoc cht tng t; carbamazepin; thuc c ch h
thn kinh trung ng khc; mianserin; thuc an thn kinh khc; phenothiazin;
phenytoin; primidon hoc dn cht; viloxazin
Phn tch: Tng tc dng c ch h thn kinh trung ng, dn n lm
tng cc tc dng an thn. Tng tc dc lc.
X l: Tnh n nguy c ny hiu chnh liu lng ca hai thuc. Ngh
n gim tnh tnh to ngi li xe v ngi ng my. Khng nn ung ru;
khng ung thuc hoc ch phm khc c ru.
Thuc gy m khc hoc thuc gy m bay hi cha halogen
X l: Khuyn ngi bnh sp phu thut thng bo cho thy thuc gy
m cc thuc ang dng.
479

Phn tch: Tng tnh cht khng cholinergic (nht l vi phenothiazin
khng H1) do hip ng cc tc dng khng mong mun. Cc tc dng ny biu
hin tng nguy c b tiu tin, kh ming v to bn.
X l: Phi lu n nhng nhc im ca loi thuc ny. Nu v mc
ch iu tr m phi phi hp, thng bo cho ngi bnh nhng nhc im
. Trnh dng cho ngi c bnh tuyn tin lit v ngi tng nhn p. Cn
nhc nguy c c theo dng bo ch: thn trng vi cc thuc nh mt. Theo
di c nhng thuc m ngi bnh t dng.

Phn tch: Tc dng i khng. C kh nng tng tnh hung hn ngi
nghin amphetamin.
X l: Ch n tng tc dc lc ny xc nh mc ch chnh trong
iu tr. Khuyn ngi bnh gp li thy thuc, nu thy kt qu iu tr khng
n nh.
Barbituric
X l: Phi tnh n nguy c ny hiu chnh liu lng ca hai thuc.
Phi ngh n gim tnh tnh to ngi li xe v ngi ng my. Khuyn h
khng ung ru, v khng t dng thm thuc hoc cc ch phm khc c
cha ru.
Methadon
Phn tch: Tng tc dng c ch h thn kinh trung ng km theo tc
dng an thn rt mnh, rt nguy him vi ngi li xe v ngi ng my.
X l: Thy thuc k n phi ch ti s tng tc dng an thn ny
a ra nhng li khuyn thch hp cho ngi bnh: khng c li xe hoc
ng my; bo cho ngi xung quanh bit mi nguy him ny.
X l: Nu cn phi hp thuc, phi tnh n nguy c ny khi gy m v
la chn liu dng.
MELPHALAN
Thuc chng ung th, km t bo, alkyl ho
480
CC THUC TRONG NHM

MELPHALAN vin nn 2 mg; 5 mg; dung dch tim tnh mch 50 mg
Alkeran vin nn 2 mg; 5 mg; dung dch tim tnh mch 50 mg
Sarcolysin vin nn 2 mg
CH KHI CH NH THUC
Phi l bc s chuyn khoa mi k n s dng cc thuc ny cho ng i bnh.
Nh vy cc chng ch nh s c xem xt tu theo tnh trng ngi bnh v do bc
s chuyn khoa nh gi.
TNG TC THUC

Ciclosporin
Phn tch: Phi hp hai cht c ch min dch, c th dn ti pht trin u
lympho gi. C s hip ng cc tc dng khng mong mun nghim trng v
chc nng thn.
X l: Nn trnh phi hp thuc, nu c th, xem xt li chin lc iu
tr. Nu cn, phi hp thuc ny ch c thc hin ti mt c s chuyn khoa,
c s theo di u n chc nng thn.
Vaccin sng gim c lc
Phn tch: Nguy c pht trin nhim khun ng vi chng ca vaccin do
tc dng c ch min dch ca thuc phi hp.
X l: Khong cch gia lc dng hai th thuc t ba thng n mt nm,
v ty thuc vo mc c ch min dch.

Phn tch: Dng ng thi mt cht km t bo vi mt thuc chng
thng phong (gt) s lm tng nng acid uric. Ngoi ra, cn c nguy c
gim bch cu, gim tiu cu do cng hp cc tc dng khng mong mu n
ca cc thuc.
X l: Nn trnh dng hai thuc ny ng thi, v c th tht bi trong
iu tr bnh thng phong. Nn dng alopurinol (c ch tng hp acid uric) hn
l cc cht gy acid uric niu trnh cc bnh v thn.
Amphotericin B
Phn tch: Phi hp amphotericin B tim vi cc cht c vi ty khc, i
hi phi rt thn trng. C nguy c thiu mu hay cc ri lon huyt hc khc.
481
X l: Nu cn phi hp thuc, phi theo di cht ch huyt , v khi

cn, gim liu lng.
cyclophosphamid hoc thuc tng t; doxorubicin hoc dn cht; fluro 5;
ganciclovir; interferon alpha ti t hp; levamisol; mercaptopurin; methotrexat;
penicillamin hoc thuc tng t; procarbazin; thiotepa; thuc chng ung th
khc nhau; uracil; vincristin hoc thuc tng t
Phn tch: Nguy c tng c tnh vi mu, do c ch tu xng, do cng
hp cc tc dng, c th dn ti mt bch cu ht.
X l: Nu c th, nn trnh phi hp thuc ny. Nu cn phi hp thuc,
phi dng mi thuc vi liu thp , v theo di cht ch huyt . Phi hp ny
dnh cho cc thy thuc chuyn khoa, v cc phc iu tr thng c
xc nh r.
Clozapin
Phn tch: Nguy c tng c tnh vi mu do c ch ty xng, do hi p
ng cc tc dng, c th dn ti mt bch cu ht. Dng clozapin n c
cng c th lm mt bch cu ht nghim trng, thm ch t vong ( c tnh
min dch).
X l: Nn trnh phi hp thuc ny. Nu cn phi hp, vi mi thuc
phi dng vi liu thp. Khng c g cho php d bo mt bch cu ht xy ra
khi dng clozapin. Theo di cht ch huyt , thc hin bnh thng khi s
dng mt cht km t bo vn c gi tr. Tuy vy, ngi bnh vn cn c
cnh bo ch st nh, vim hng v lot ming l phi ngng iu tr.
Phn tch: Phi hp hai thuc c tc dng c ch tu xng.
X l: Interleukin l thuc ch c dng ti c s chuyn khoa, v mc
nghim trng ca bnh. Khi , nhng tng tc cn c cn nhc v tt
c cc chc nng ca c th u phi theo di lin tc. Theo di huyt l
bt buc.
482
Pentostatin
Phn tch: Dng ng thi hai cht c ch tu xng c th gy ri lon
huyt hc nghim trng ty theo thi gian iu tr.
X l: Phi hp thuc i hi phi theo di v mt huyt hc.
Phenicol
Phn tch: Nguy c tng c tnh vi mu do c ch tu xng, do cng
hp cc tc dng, c th dn ti mt bch cu ht. Vi cc phenicol, ngay khi
dng n c cng c th mt bch cu ht nghim trng, thm ch t vong
(c tnh min dch).
X l: Nu cn phi hp, vi mi thuc phi dng liu thp. Khng c g
c th d bo mt bch cu ht do cc phenicol. Theo di cht ch huyt ,
thc hin bnh thng khi dng mt cht km t bo, vn c gi tr. Tuy nhin,
ngi bnh cn c cnh bo ch st nh, vim hng v lot ming l phi
ngng dng phenicol.
Zidovudin
Phn tch: Phi hp zidovudin vi cc thuc c vi tu khc i hi phi
rt thn trng. C nguy c thiu mu hay nhng ri lon huyt hc khc.
X l: Nu cn phi hp thuc, phi theo di cht ch huyt v nu
cn, gim liu dng.
MERCAPTOPURIN
Cht km t bo, chng chuyn ho, tc dng khu chuyn ho cc purin
CC THUC TRONG NHM

MERCAPTOPURIN vin nn 50 mg
Purinethol vin nn 50 mg
CH KHI CH NH THUC
Phi l thy thuc chuyn khoa mi k n dng nhng thuc ny cho ngi
bnh. Nh vy, cc chng ch nh c xem xt theo tnh trng ca ngi bnh v
phi c thy thuc chuyn khoa nh gi.
TNG TC THUC
483

Cc cht c ch enzym HMG - CoA reductase
Phn tch: Dng ng thi cc cht c ch min dch lm tng nguy c
X l: Mc du nhng trng hp c thng bo ch lin quan n
lovastatin, nhng nguy c tim tng tn ti vi simvastatin v pravastatin. Nn
trnh phi hp thuc.
Olsalazin
Phn tch: Olsalazin lm tng tc dng dc l v c tnh cc thiopurin
(mercaptopurin, azathioprin). C th c s tch ly cc thiopurin, do olsalazin c
ch thiopurin methyltransferase trong hng cu.
X l: Theo di chc nng huyt hc mt cch cht ch v hiu chnh liu
lng thuc nu cn.
Tacrin
X l: Nu cn, tng cng theo di chc nng gan. Trnh nhng phi
hp thuc gy nguy c vi ngi bnh cao tui.
Phn tch: Khi kt hp vi mercaptopurin, azathioprin, th tc dng dc l
ca cc thuc gy th doi c c th b gim hay b o ngc. C th l do c
s c ch phosphodiestease tn cng thn kinh vn ng, to ra tc d ng
khng cura.
X l: iu ch yu phi theo di lin tc chc nng h hp. Nu kt hp
thuc, phi gim liu mercaptopurin, azathioprin.
Vaccin sng gim c lc
Phn tch: Nguy c pht trin nhim khun ng vi chng ca vaccin, do
tnh cht c ch min dch ca thuc phi hp.
X l: Phi bo m khong cch gia lc dng hai thuc ny l t ba
thng n mt nm, v ph thuc vo mc c ch min dch.

Phn tch: Alopurinol c ch chuyn ho oxy ho azathioprin v
mercaptopurin (tc dng nh cht c ch xanthin oxydase, l enzym xc tc cho
ging ho purin thnh acid uric), gy nguy c tch lu cc cht chng chuyn
ho gm cc base purin.
X l: Nu cn phi hp thuc, phi gim liu cht chng chuyn ho t
25% n 30%.
484
Amphotericin B
Phn tch: Phi hp amphotericin B tim vi cc thuc c vi tu khc i
hi phi rt thn trng. C nguy c thiu mu v cc ri lon huyt hc khc.
X l: Nu cn phi hp thuc, phi theo di cht ch huyt v, nu
cn, phi gim liu lng thuc.
cyclophosphamid hoc thuc tng t; doxorubicin hoc dn cht; fluoro 5
uracil; ganciclovir; interferon alpha ti t hp; levamisol; methotrexat; penicilamin
hoc thuc tng t; procarbazin; thiotepa; thuc chng ung th khc nhau;
vincristin hoc thuc tng t
Phn tch: Nguy c tng c tnh vi mu do c ch ty xng, do cng
X l: Nu c th, trnh phi hp thuc. Nu cn phi hp, vi mi thuc
phi dng liu thp, v theo di cht ch huyt . Phi hp thuc ny dnh
cho cc thy thuc chuyn khoa, v cc phc iu tr thng c xc
nh r.
Ciclosporin
Phn tch: Phi hp hai thuc c tnh cht c ch min dch. Do tnh cht
c ch min dch qu mnh, c nguy c pht trin cc u lympho gi.
X l: Cn suy ngh k v vic phi hp hai thuc c ch min dch ny,
phi cn nhc tng quan gia nguy c v li ch theo mc ch iu tr. Phi
hp thuc ny phi c thc hin ti mt c s chuyn khoa, v phi theo di
ngi bnh tht cht ch.
Clozapin
hp cc tc dng, c th dn n mt bch cu ht. Ch vi clozapin dng n
c, c th mt bch cu ht nghim trng, thm ch t vong (c tnh min
dch).
X l: Nu cn kt hp, vi mi thuc phi dng liu thp. Khng c g c
th bo trc xut hin mt bch cu ht do clozapin. Theo di cht ch huyt
, thc hin bnh thng khi dng mt cht km t bo, vn c gi tr. Tuy
nhin, ngi bnh cn c cnh bo ch st nh, vim hng v lot ming l
phi ngng iu tr clozapin.
Phn tch: Dng ng thi mt thuc km t bo vi mt thuc chng
bnh thng phong lm tng nng acid uric. Ngoi ra cn tng nguy c gi m
bch cu, gim tiu cu do cng hp cc tc dng khng mong mun ca cc
thuc.
485
X l: Nn trnh dng hai thuc ny ng thi, v c th iu tr bnh

thng phong s tht bi. Nn dng alopurinol (cht c ch tng hp acid uric)
hn l dng cc thuc gy acid uric niu, trnh cc bnh v thn.
Dactinomycin; pentostatin
Phn tch: Dng ng thi hai thuc c ch tu xng c th ko theo cc
ri lon huyt hc nghim trng tu theo thi gian iu tr.
X l: Phi hp thuc ny i hi phi theo di huyt hc.
Dantrolen; rifampicin; thuc chng nm dn xut imidazol
Phn tch: Phi hp hai thuc c tim nng c vi gan (cng hp cc tc
dng khng mong mun).
X l: Khi phi hp hai thuc c vi gan, phi theo di cht ch chc nng
gan (ASAT, ALAT, phosphatase kim, bilirubin), hoc phi hon dng mt trong
hai thuc, nu c th. Kim tra chc chn ngi bnh khng thng xuyn ung
ru v khng c tin s vim gan virus. Cc triu chng lm sng chnh khng
in hnh: bun nn, st, vng da... Nu thy ng thi pht ban ngoi da, nga
v hch to th hng v nguyn nhn do thuc. Cn phn bit r, theo cc test
th sinh hc, nguy c xut hin vim gan tiu t bo khng hi phc vi vim gan
Glycosid tr tim
Phn tch: Phi hp vi mt thuc km t bo gy gim hp thu khong
50% cc thuc h digitalis do tn thng nim mc rut.
X l: Theo di cht ch nng thuc digitalis huyt thanh trong sut
thi gian iu tr.
Interleukin cng c vi gan. Nh vy c s phi hp hai thuc c tim nng
c vi gan v c ch tu xng.
X l: Ch c th tin hnh iu tr c s chuyn khoa. Dng interleukin
i hi phi theo di thng xuyn. Trong hon cnh , phi xem xt tng tc
theo tnh trng chung ca ngi bnh. Khi phi hp hai thuc c vi gan v c
ch tu xng, phi theo di cht ch huyt v chc nng gan (ASAT,
ALAT, phosphatase kim, bilirubin), hoc phi hon mt trong hai thuc, nu c
th.
Phn tch: Vi s c mt ca hai thuc c vi gan, s c nguy c cng
hp cc c tnh vi gan. Vi natri valproat, thng gp vim gan tiu t bo
khng hi phc, nn rt nghim trng; tri li, vi mercaptopurin, i khi th y
vim gan mt hi phc c sau khi ngng iu tr, nhng li c th gy t
vong nu khng ngng iu tr. Du hiu lm sng bo trc, c th l suy
nhc, chn n, r, ng g, nn, au bng (v xut hin l i cc cn ng
kinh).
486
X l: Theo di cht ch chc nng gan (mi tun). Cc test th kinh in

bao gm cc test phn nh tng hp protein (ch yu test v t l prothrombin,
t l fibrinogen, cc yu t ng mu), bilirubin, transaminase, phosphatase
kim. Ch cc du hiu lm sng phn nh tn thng gan: suy nhc, chn
n, r, ng g, nn, au bng (v xut hin li cc cn ng kinh).
Niridazol
Phn tch: Phi hp hai thuc c vi gan. ng thi li c c tnh vi
thn kinh ca niridazol. C nguy c xut hin co git, lon tm thn v c vi
gan khi phi hp thuc.
gan (ASAT, ALAT, phosphatase kim, bilirubin), hoc phi hon mt trong hai
thuc, nu c th. Kim tra chc chn ngi bnh khng thng xuyn ung
Paracetamol
Phn tch: Paracetamol dng lu di vi liu trn 6 gam/ngy (tu theo th
trng) s gy c vi gan (vim gan kiu tiu t bo). Khi phi hp vi mt
thuc c vi gan khc, nguy c c vi gan tng thm.
gan (ASAT, ALAT, phosphatase kim, bilirubin), hoc phi hon mt trong hai
thuc, nu c th. Kim tra chc chn ngi bnh khng thng xuyn ung
Phenicol
hp cc tc dng, c th dn ti mt bch cu ht. Ngay vi cc phenicol ch
dng n c, cng c th mt bch cu ht nghim trng, thm ch t vong
(c tnh min dch).
X l: Nu cn phi hp, vi mi thuc nn dng liu thp. Khng c g
bo trc xut hin mt bch cu ht do cc phenicol. Theo di cht ch huyt
, thc hin bnh thng khi s dng mt cht km t bo, vn c gi tr. Tuy
nhin, ngi bnh cn c cnh bo ch st nh, vim hng, v lot ming l
phi ngng dng phenicol.
Vng
Phn tch: Phi hp hai thuc c tim nng c vi gan v vi mu.
487

nng gan (ASAT, ALAT, phosphatase kim, bilirubin) v huyt hoc nu c
th, phi hon mt trong hai thuc. Kim tra chc chn ngi bnh khng
thng xuyn ung ru v khng c tin s vim gan virus. Cc triu chng
lm sng chnh khng in hnh: bun nn, st, vng da... Nu thy ng thi
pht ban ngoi da, nga v hch to th hng v nguyn nhn do thuc. Cn
phn bit r, theo cc test th sinh hc, nguy c xut hin vim gan tiu t bo
Zidovudin
Phn tch: Phi hp zidovudin vi cc thuc c vi tu xng khc i
hi phi rt thn trng. C nguy c thiu mu hay cc ri lon huyt hc khc.
X l: Khi cn phi hp thuc, phi theo di cht ch huyt v nu
cn, gim liu lng thuc.
METHADON
Dn cht ca opi, dng cho cai nghin ma tu
CC THUC TRONG NHM

METHADON vin nn 10 mg
Methadon vin nn 10 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Tr em/tr b m: Chng ch nh vi tr di 15 tui v cha th nghim.

Thi k cho con b: Methadon qua c sa m. Methadon trong sa c th
trnh cho a tr mi sinh cc hu qu cai ma tu t ngt.
Thi k mang thai: Methadon qua hng ro nhau thai. Phi cn nhc tht chnh
xc tng quan nguy c/li ch i vi m v con. Nhiu khi phi dng li u cao h n
bnh thng trong thi k mang thai. Cn c nhng bin php i vi tr mi sinh
trnh cc tc dng ca cai thuc t ngt.
Suy h hp: Nguy c tng c ch h hp. Cm dng khi suy h hp nng.

Hen; tiu ng; suy gan; suy thn; ph i tuyn tin lit; ngi bnh cao
tui: Do cc tc dng khng mong mun ca methadon.
488
Cc trng hp khc: Suy tuyn thng thn. Gim nng gip.

TNG TC THUC

Cht ch vn ca morphin
h.
Phn tch: Tng tc dc lc. Hip ng cc tc dng ca hai thuc cng
X l: Trnh dng thm mt cht ch vn morphin cho ngi bnh ang

cai nghin ma tu.
Cht ch vn i khng morphin
Phn tch: Vi cc cht ch vn i khng morphin (kiu Temgesic), phi
ch n gim tc dng gim au do phong b cnh tranh cc th th morphin.
X l: Chn mt thuc gim au khc cho ngi nghin ma tu ang cai
nghin.
489

Hydantoin
Phn tch: Hydantoin lm gim tc dng ca methadon. Ngi bnh dng
methadon di hn c th xut hin triu chng cai thuc. Nguyn nhn c th
do hydantoin lm tng s chuyn ho v thanh lc methadon.
X l: Phi tng liu methadon khi iu tr cng vi hydantoin.
Thuc c ch enzym phin m ngc khng nucleosid (NNRT inhibitors)
Phn tch: Cc cht c ch NNRT lm tng chuyn ho methadon gan
qua xc tc ca CYP3A4, nn tc dng ca methadon b gim, th hin qua s
xut hin cc triu chng cai thuc.
X l: Khi bt u dng liu php thuc c ch enzym phin m ngc
khng nucleosid nh Efavirenz, Nevirapin, th phi d kin trc vic tng liu
methadon. Theo di s xut hin cc triu chng cai nghin, v khi ngng dng
cc cht c ch NNRT, phi theo di cc du hiu qu liu methadon. Hiu
chnh liu methadon khi cn.
Ritonavir
Phn tch: Ritonavir c i lc mnh vi isoenzym 3A4 ca cc cytochrom
P450: c nguy c cnh tranh mnh gia ritonavir vi cc thuc b hay nghi ng
b chuyn ho bi isoenzym ny. Cnh tranh ny lm gim chuyn ho, v vy
c nguy c tng ng k nng ca chng trong huyt tng. C nguy c an
thn rt mnh v suy h hp nng. Tng tc dc ng hc v chuyn ho.
X l: Theo di cht ch ngi bnh v xut hin cc tc dng c, v
nu cn, gim liu methadon.
Ru
Phn tch: Tng cng tc dng an thn ca ru do tng tc dng c
ch h thn kinh trung ng.
X l: Trnh k n cc thuc dng ru lm t dc. Khuyn khng nn
ung ru trong qu trnh cai nghin, nht l vi ngi li xe v ngi ng
my. Khuyn khng nn dng cc ch phm c ru.

Citalopram
liu.
Phn tch: Tng nng methadon trong huyt tng: C nguy c qu
X l: Theo di nng thuc trong huyt tng v theo di xut hin cc

du hiu qu liu (ng g, l ln...). Gim liu khi cn.
Griseofulvin
Phn tch: Tng chuyn ho gan do cm ng enzym, ko theo gim
hot tnh griseofulvin.
490
X l: Phi tnh ti nguy c ny hiu chnh liu lng ca hai thuc,

nu cn phi hp thuc. Tm quan trng ca tng tc ny cn cn phi xc
nh thm.
Rifabutin; rifampicin
Phn tch: Tng tc dc ng hc v chuyn ho thuc, gy gim
nng methadon trong huyt tng v nguy c xut hin hi chng cai
nghin.
X l: Tng s ln dng methadon, khong 2 n 3 ln mi ngy, thay
cho mt ln mi ngy.
Thuc an thn kinh khc nhau
Phn tch: Tng nguy c c ch h thn kinh trung ng.
X l: Nguy c an thn, gy bun ng c bit nguy him i vi ngi li
xe v ngi ng my. Khuyn khng dng ung, hoc thuc c ru, c
bit vi ngi li xe v ngi ng my.
Phn tch: Tng tc dc ng hc do c ch enzym. C nguy c qu
liu, nguy c suy h hp. Tng tc ny cn khng nh thm.
X l: Tng tc ny i hi phi cnh gic. Ngi bnh kh th chng t
qu liu methadon: iu tr bng naloxon nu cn ( c s chuyn khoa).
Thuc gy acid ho nc tiu
Phn tch: Thuc gy acid ho nc tiu lm tng s thanh lc methadon
thn do tng s ion ho ca thuc.
X l: C th tn dng tng tc ny khi dng methadon qu liu.
Zidovudin
Phn tch: Cc thuc ny lm tng nng zidovudin huyt tng, do
gim chuyn ho zidovudin.
X l: Gim liu zidovudin. Theo di cc tc dng khng mong mun ca
zidovudin (theo di huyt hc v lm sng).

Amineptin; baclofen; barbituric; benzamid; benzodiazepin; butyrophenon;
carbamat hoc thuc tng t; carbamazepin; cht c ch h thn kinh trung
ng khc nhau; clonidin hoc thuc tng t; dextropropoxyphen; fluoxetin;
fluvoxamin; gluthetimid hoc thuc tng t; interferon alpha ti t hp; khng
histamin khng H1 an thn; medifoxamin; oxaflozan; paroxetin; phenytoin;
procarbazin; reserpin; thuc chng ng kinh khng barbituric; thuc chng
trm cm ba vng hoc thuc tng t
491
Phn tch: Tng tc dng c ch h thn kinh trung ng km theo an

thn mnh, c bit c hi i vi ngi li xe v ngi ng my.
X l: Bc s k n phi lu n tc dng an thn mnh ny cho
ngi bnh nhng li khuyn thch hp: khng li xe, khng vn hnh my mc
t ng i hi phi tnh to theo di, thng bo cho ngi xung quanh bi t
nguy c.
Primidon hoc dn cht
X l: Nu cn phi hp thuc, phi tnh ti nguy c ny iu chnh
liu lng hai thuc. Phi ngh ti gim tnh to ngi li xe v ngi ng
my. Khuyn khng dng ru v cc ch phm c ru.
492
METHENAMIN
Thuc st khun ng tit niu, hay dng trong phi hp thuc
CC THUC TRONG NHM

METHENAMIN vin nn bao
Mictasol blue vin nn bao 50mg
CH KHI CH NH THUC
Thi k cho con b: Methenamin qua c sa m (khng thy hu qu r
rng).
Thi k mang thai: Methenamin qua hng ro nhau thai (khng thy hu qu r
rng).
Thn trng: mc 2
Suy thn: Nguy c tch lu trong mu (khng thy hu qu, tuy nhin nng
formol trong nc tiu s khng c tc dng).
TNG TC THUC

Sulfamid khng khun; sulfamid h glucose mu; sulfasalazin hoc dn
cht; thuc li tiu thi kali
Phn tch: Trong nc tiu acid, methenamin ging ho thnh formol, to
nguy c kt ta vi cc sulfamid t ho tan, c th gy tinh th niu v si thn.
X l: Nn thay bng cc thuc khc.
Phn tch: Trong nc tiu acid, methenamin ging ho thnh formol, to
nguy c kt ta vi sulfamid t ho tan (furosemid c cu trc sulfamid), gy nn
tinh th niu v si thn.
X l: Nn chn thuc khc thay th.

Cht kim ho nc tiu
Phn tch: Hot tnh ca methenamin l do thuc thy phn trong nc
tiu thnh formol (tc dng st khun) v amoni hydroxyd. Phn ng thy phn
ny ch xy ra khi nc tiu c pH acid. Nh vy, nn dng phi hp vi mt
cht acid ho nc tiu to iu kin cho phn ng thy phn ny. Khi nc
tiu c pH > 5, th tc dng methenamin b c ch.
493
X l: Trnh k n ng thi mt cht kim ho nc tiu v

methenamin. Cng ch trnh k nhng thuc khng acid c nhm, magnesi
hay calci hydroxyd... lm tng pH nc tiu. Khi dng methenamin phi hiu
chnh pH nc tiu 5.
494
METHOTREXAT
Thuc km t bo, khng folat
CC THUC TRONG NHM

METHOTREXAT dung dch tim 25 mg/mL; 100 mg/mL; vin nn 2,5 mg; dung
dch 50 mg/5mL; dung dch ng kh pha tim 50 mg/l
Methotrexat dung dch tim 25 mg/mL; 100 mg/mL; vin nn 2,5 mg
Methotrexat Ebewe dung dch 50 mg/5mL
Methotrexat Roger Bellon dung dch ng kh pha tim 50 mg/l
CH KHI CH NH THUC
Phi l bc s chuyn khoa mi k n loi thuc ny. Khi cc chng ch nh
phi c xem xt tu theo tnh trng ca ngi bnh, v phi c bc s chuyn
khoa nh gi.
TNG TC THUC

Indometacin hoc dn cht; salicylat; thuc chng vim khng steroid
Phn tch: Tng c tnh ca methotrexat vi mu do methotrexat b y
ra khi lin kt vi protein v/hoc do gim o thi thn. Tc dng ny ph
thuc vo liu (tc dng vi ketoprofen quan trng hn).
X l: C th gp tng tc ny c s bnh vin. Khi dng methotrexat
vi liu cao, phi ngng thuc chng vim khng steroid 12 n 24 gi tr c
, cho n khi nng methotrexat tr v tr s khng c. Mc du tng tc
ny cha c m t vi tt c cc thuc chng vim khng steroid, nhng nn
p dng quy tc ny, v trnh k n hai loi thuc ng thi.
Probenecid
Phn tch: Probenecid c ch s o thi methotrexat qua thn. C th
dng phi hp thuc ny gim liu methotrexat, nhng do c tnh ni t i
ca methotrexat, phi hp ny tr nn nguy him, nu c thc hin mt cch
v .
X l: Cch dng probenecid lm chm o thi nhiu thuc c th v
c p dng gim liu lng cc thuc . Nhng phi ht sc cnh
gic vi nhng nguy c tim n v vi tng c tnh ca thuc phi hp. Phi
nghin cu k hon cnh sinh bnh l c th.
495
Pyrazol
Phn tch: Tng nguy c mt bch cu ht v tng tc dng c vi mu
ca methotrexat, do b y khi cc lin kt vi protein v/hoc gim o thi
qua thn.
X l: Chng ch nh phi hp thuc ny. Chn mt thuc chng vim
khc, v tn trng cc quy tc k n: Khi dng methotrexat liu cao, phi
ngng thuc chng vim khng steroid 12 gi n 24 gi trc , cho n khi
nng methotrexat tr v tr s khng gy c.
Trimethoprim; zidovudin
hp cc tc dng trn dehydrofolat reductase, c th dn ti thiu mu nguyn
hng cu khng l.
X l: Nu cn phi hp thuc, nn dng liu thp cho mi cht, v theo
di cht ch huyt . Phi hp thuc ny dnh cho cc bc s chuyn khoa, v
cc phc iu tr thng c xc nh r rng. C th b sung thm acid
folinic.

Phn tch: Cc thuc trong nhm methotrexat ny tc ng nh nhng
cht i khng vi acid folic, do c ch dihydrofolat reductase. Tng tc cng
c ngha nu liu dng cng cao v thi gian iu tr cng di.
X l: Tng tc ny c s dng khi qu liu methotrexat. Dng acid
folinic thay cho acid folic.
Amiodaron
Phn tch: c tnh ca methotrexat c th tng ln khi dng kt hp vi
amiodaron. C ch cn cha r.
X l: Khi bt u dng amiodaron, phi theo di cht ch ngi bnh v
cc du hiu nhim c methotrexat.
Aminosid dng ng tim hay dng ti ch; foscarnet
Phn tch: Tng nguy c c vi thn, do phi hp hai thuc c tim nng
c vi thn. Cng hp cc tc dng khng mong mun.
X l: Loi phi hp thuc ny c th hay gp, nht l ti c s bnh
vin. Cch dng thuc ch mt ln trong ngy lm gim c tnh vi tai v thn,
nhng khi cn phi hp thuc, vn nn hiu chnh liu lng theo thanh lc
creatinin (cng thc Cockroft v Gault). c bit phi ch khi dng cho ngi
bnh cao tui.
Cc cht c ch enzym HMG - CoA reductase
Phn tch: S dng ng thi vi cc cht c ch min dch lm tng
nguy c xut hin tiu c vn v suy thn.
496
X l: D cho nhng trng hp thng bo ch lin quan n lovastatin,

nhng vn c nguy c tim tng vi simvastatin v pravastatin. Nn trnh cch
phi hp thuc ny.
Cc penicilin
Phn tch: Nng methotrexat trong huyt thanh c th tng, lm tng
nguy c c tnh. C ch c th do c ch cnh tranh s bi tit methotrexat
ng thn.
X l: Theo di ngi bnh v c tnh ca methotrexat v o hm lng
methotrexat 2 ln mi tun trong t nht 2 tun u. C th phi tng li u v
thi gian dng gii cu bng leucovorin. Nu cn dng mt khng sinh ph
rng, ceftazidim c th t gy tng tc hn.
Omeprazol
Phn tch: Dng kt hp, omeprazol c th lm tng nng methotrexat
trong huyt tng, lm tng c tnh ca thuc. C th l do omeprazol lm
gim s thanh lc methotrexat qua thn.
X l: Nu c th, ngng dng omeprazol vi ngy trc khi bt u dng
methotrexat. C th xem xt thay th omeprazol bng cc thuc i khng H 2
(nh cimetidin)
Tacrin
K n: Nu cn, tng cng theo di gan. Trnh cc phi hp thuc gy
nguy c vi nhng ngi bnh cao tui.
Tetracyclin
Phn tch: Dng chung vi cc tetracyclin, nng methotrexat c th tng
ln trong huyt tng, gy nguy c c (c ch tu xng). C ch cn cha r.
X l: Nu khng th trnh dng doxycyclin hay mt tetracyclin no khc
cng vi methotrexat liu cao, cn phi theo di cht ch nng
methotrexat trong huyt tng, v theo di nhng triu chng nhim c thuc
ngi bnh.
Vaccin sng lm gim c lc
Phn tch: Nguy c pht trin nhim khun ng vi chng ca vaccin, do
hot tnh c ch min dch ca thuc phi hp.
X l: Phi tim chng v dng thuc cch nhau t 3 thng n 1 nm,
tu theo mc c ch min dch.

Amineptin; dantrolen; estrogen hoc thuc trnh thai estroprogestogen;
etretinat hoc dn cht; fluvoxamin; griseofulvin; macrolid; natri valproat hoc
dn cht; procarbid; rifampicin; thuc chng nm dn xut imidazol
497
Phn tch: Phi hp thuc c tim nng c vi gan (cng hp cc tc

dng khng mong mun).
nng gan (ASAT, ALAT, phosphatase kim, bilirubin), hoc phi hon mt trong
hai thuc. Kim tra chc chn ngi bnh khng thng xuyn ung ru v
khng c tin s vim gan virus. Cc triu chng lm sng chnh khng i n
hnh: bun nn, st, vng da... Nu thy ng thi pht ban ngoi da, nga v
hch to th hng v nguyn nhn do thuc. Cn phn bit r, theo cc test th
sinh hc, nguy c xut hin vim gan tiu t bo khng hi phc vi vim gan
Aminosid ung
Phn tch: C th gim hp thu methotrexat v gim h vi khun ng
rut c nhim v chuyn ho methotrexat. Gim p ng vi methotrexat.
X l: Ti c s chuyn khoa, vic dng cc aminosid ung phi thn
trng, khi dng methotrexat. Cn ht sc cnh gic.
Amphotericin B
Phn tch: Phi hp amphotericin B tim vi cc thuc khc c vi tu
i hi phi ht sc thn trng. C nguy c thiu mu hay cc ri lon huyt
hc khc.
X l: Khi cn phi hp thuc, phi theo di cht ch huyt , v nu
cn, gim liu dng.
Cc thuc chng ung th khc; azathioprin; carmustin hoc dn cht;
cisplatin hoc dn cht; cyclophosphamid hoc thuc tng t; doxorubicin hoc
dn cht; fluoro 5 uracil; ganciclovir; interferon alpha ti t hp; levamisol;
melphalan; mercaptopurin; procarbazin; penicilamin hoc thuc tng t; thiotepa;
vincristin hoc thuc tng t
X l: Nu c th, trnh dng phi hp thuc ny. Nu cn phi hp
thuc, phi dng liu thp cho mi thuc, v phi theo di cht ch huyt .
Phi hp thuc ny dnh cho cc nh chuyn khoa, v cc phc iu tr
thng c xc nh r.
Ciclosporin
Phn tch: Phi hp hai thuc c tnh cht c ch min dch. Do tc dng
c ch min dch qu ln, c nguy c xut hin u lympho gi.
X l: Cn phi suy ngh k khi phi hp hai thuc c ch min dch, v
phi cn nhc tng quan nguy c/li ch theo mc tiu iu tr. Phi hp thuc
ch c thc hin c s chuyn khoa, v phi theo di ngi bnh cht ch.
Clozapin
hp cc tc dng, c th dn ti mt bch cu ht. Vi clozapin, c th mt
498
bch cu ht nghim trng, thm ch t vong ngay khi ch dng n c (c

tnh min dch).
X l: Trnh phi hp thuc ny. Nu cn phi hp thuc, phi dng liu
thp cho mi thuc. Khng c g bo trc mt bch cu ht khi dng clozapin.
Theo di cht ch huyt , thc hin bnh thng khi s dng mt cht km t
bo vn c gi tr. Tuy nhin, ngi bnh cn c cnh bo ch st nh, vim
hng, v lot ming l phi ngng iu tr.
Phn tch: Dng ng thi mt thuc km t bo v mt thuc chng
thng phong lm tng nng acid uric trong mu. Ngoi ra cn c nguy c
gim bch cu v gim tiu cu do cng hp cc tc dng khng mong mun
ca cc thuc.
X l: Nn trnh dng hai thuc ny cng lc, v c th liu php chng
bnh thng phong s tht bi. Nn dng alopurinol (cht c ch tng hp acid
uric), thay cho vic dng cc thuc bi acid uric ng niu trnh nhng
bnh v thn.
Dactinomycin D
X l: Nu cn phi hp thuc, phi dng liu thp cho mi thuc. Theo
di cht ch huyt .
Glycosid tr tim
Phn tch: Phi hp vi mt thuc km t bo s gy km hp thu cc
thuc digitalis khong 50%, do tn thng nim mc rut hi phc c.
X l: Theo di cht ch nng thuc digitalis trong huyt thanh trong
sut thi gian iu tr.
Phn tch: Mc tiu chnh iu tr ung th dng tuyn thn. Interleukin
cng c vi thn v gan. Nh vy, c phi hp hai thuc c tim nng c vi
gan v thn v c ch tu xng.
X l: iu tr ny ch c th thc hin ti mt c s chuyn khoa. Dng
interleukin i hi phi theo di lin tc. Khi , cn xem xt tt c theo tr ng
thi chung ca ngi bnh. Khi phi hp hai thuc c vi gan v thn v c
ch tu xng, phi theo di huyt v cc chc nng gan v thn (ASAT,
ALAT, phosphatase kim, bilirubin, creatinin mu), hoc, nu c th, hon mt
trong hai thuc.
Paracetamol
Phn tch: Paracetamol, khi dng lu di vi liu trn 6 gam/ngy (tu theo
th trng) c vi gan (vim gan kiu tiu t bo). Khi phi hp vi mt thuc
khc c vi gan, nguy c c vi gan tng ln.
499

hai thuc, nu c th. Kim tra chc chn ngi bnh khng thng xuyn
ung ru v khng c tin s vim gan virus. Cc triu chng lm sng chnh
khng in hnh: bun nn, st, vng da... Nu thy ng thi pht ban ngoi
da, nga v hch to th hng v ngun gc do thuc. Cn phn bit r, theo
cc test th sinh hc, nguy c xut hin vim gan tiu t bo khng hi phc vi
vim gan mt hi phc c sau khi ngng iu tr.
Phenicol
hp cc tc dng, c th dn n mt bch cu ht. Vi cc phenicol, ch dng
n c, cng c th mt bch cu ht nghim trng, thm ch t vong ( c
tnh min dch).
X l: Nu cn phi hp, phi dng mi thuc vi liu thp. Khng c g
bo trc c s mt bch cu ht do cc phenicol. Theo di cht ch huyt
, thc hin bnh thng khi s dng mt cht km t bo, vn c gi tr. Tuy
vy, ngi bnh cn c bo trc nu ch st nh, vim hng v lot ming
cng phi ngng dng phenicol.
Primidon hoc dn cht
Phn tch: Tng cc tc dng khng mong mun ca methotrexat, c th
l do tng c ch dihydrofolat reductase.
X l: Phi tnh ti nguy c ny khi iu tr methotrexat, thng thc hin
ti mt c s chuyn khoa.
Pyrimethamin
hp cc tc dng trn dihydrofolat reductase, c th dn ti thiu mu nguyn
hng cu khng l.
X l: Nu cn phi hp, phi dng liu lng thp cho mi thuc, v phi
theo di huyt . Phi hp thuc ny dnh cho cc bc s chuyn khoa, v cc
phc iu tr thng c xc nh r. C th b sung thm acid folinic.
Niridazol
Phn tch: Phi hp hai thuc c vi gan. Ngoi ra cn c c tnh vi
thn kinh ca niridazol. C nguy c xut hin co git, lon tm thn v c tnh
vi gan, khi phi hp thuc.
hai thuc, nu c th. Kim tra chc chn ngi bnh khng thng xuyn
khng in hnh: bun nn, st, vng da... Nu thy ng thi pht ban ngoi
da, nga v hch to th hng v ngun gc do thuc. Cn phn bit r, theo
cc test th sinh hc, nguy c xut hin vim gan tiu t bo khng hi phc vi
vim gan mt hi phc c sau khi ngng iu tr.
500
Ru
Phn tch: Tng nguy c x gan v y l hai cht c vi gan.
X l: Tnh ti mc tiu cui cng iu tr. Ngi bnh thng c nm
ti bnh vin, v khng c iu kin ung ru thng xuyn. Nu phi tip tc
iu tr ngoi tr, yu cu ngi bnh khng c ung ru.
Sulfamid chng nhim khun
Phn tch: Tng tc dng c vi mu ca methotrexat, do y cht ny
khi v tr lin kt vi protein huyt tng.
X l: Nu cn, nh lng nng methotrexat trong huyt tng. Hiu
chnh liu lng trong iu tr v khi ngng dng sulfamid chng nhim khun.
Phn tch: Sulfamid y thuc ny khi v tr lin kt vi protein huyt
tng v/hoc c ch d ho thuc ny, gy tng na i nng thuc trong
huyt thanh.
X l: Cn phi hiu chnh liu lng trong v sau iu tr sulfamid.
Thuc kim ho nc tiu
Phn tch: Natri bicarbonat lm tng o thi methotrexat qua thn.
X l: Tnh cht ny c th dng to iu kin o thi methotrexat
trong liu php dng liu cao, v trnh kt ta methotrexat trong cc
ng thn.
Vng
Phn tch: Phi hp hai thuc c tim nng c vi gan v mu.
X l: Khi phi hp hai thuc c vi gan v mu, phi theo di cht ch
chc nng gan (ASAT, ALAT, phosphatase kim, bilirubin), v huyt , hoc,
nu c th phi hon mt trong hai thuc. Kim tra chc chn ngi bnh
khng thng xuyn ung ru v khng c tin s vim gan virus. Cc triu
chng lm sng chnh khng in hnh: bun nn, st, vng da... Nu thy ng
thi pht ban ngoi da, nga v hch to th hng v ngun gc do thuc. Cn
phn bit r, theo cc test th sinh hc, nguy c xut hin vim gan tiu t bo

Barbituric
do tng c ch dihydrofolat reductase.
X l: Ghi nh nguy c ny khi iu tr bng methotrexat.
501
Phenytoin
do tng c ch dihydrofolat reductase.
X l: Khi cn phi hp thuc, phi tnh ti nguy c tng cc tc d ng
khng mong mun. Thay th thuc chng ng kinh khi cn, nu phi hp
thuc phi dng lu di.
METHYLDOPA
Thuc chng tng huyt p
CC THUC TRONG NHM

METHYLDOPA vin nn bao phim 250 mg; 125 mg; vin nn 250 mg
Aldomet vin nn bao phim 250 mg
Aldomet M vin nn bao phim 125 mg
Apo- Methyldopa vin nn 250 mg
Dopegyt vin nn 250 mg
Novo- Medopa vin nn 250 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Ri lon chuyn ho porphyrin: Tng cc cn.
Cc trng hp: Tai bin mch mu no v ng mch vnh mi xy ra l cc
chng ch nh dng methyldopa. Cng nh vy, nn trnh dng cht ny trong trng
hp: u t bo a crom, qu mn bit vi cht ny.

Trm cm: Methyldopa tc dng nh mt c cht cnh tranh ca dopadecarboxylase, lm gim nng noradrenalin v serotonin trong no. Thiu ht
monoamin ny c th l nguyn nhn cc ri lon tm thn v nht l cc t trm cm
hay xy ra.
Bnh v mu: Nguy c thiu mu tan mu khi iu tr ko di. C th
10-20% ngi bnh c phn ng dng tnh vi th nghim Coombs sau 6 n 12
thng iu tr.
Suy gan: Methyldopa c vi gan v l nguyn nhn hoi t t bo gan km vng
da.
502
Thn trng: mc 2
Thi k cho b: Methyldopa qua c sa m.
Cn theo di: mc 1
Thi k mang thai: Methyldopa khng gy qui thai, v v tc dng kh ngn nn
t nguy him, mc du thuc qua c hng ro nhau thai.
Suy thn: Cn gim liu lng.
Ngi bnh cao tui : Methyldopa gy h huyt p v an thn, do gim trng
lc giao cm. Cc tc dng ny c bit nguy him i vi ngi bnh cao tu i, do
x cng ng mch thng km theo tng huyt p. Phi gim liu.
TNG TC THUC

Cc estrogen hoc thuc nga thai estroprogestogen
Phn tch: Tng huyt p do cc thuc ung nga thai gy ra thng
khng li liu php dng methyldopa. C ch cn cha r.
X l: Vic khng ch huyt p trong trng hp ny rt kh khn, thm
ch khng thc hin c. Thay i chin lc iu tr.

Benzamid; phenothiazin; thuc an thn kinh khc nhau
Phn tch: Ni chung, vi cc thuc an thn kinh, c nguy c lm h huyt
p do phong b ti hp thu cc cht chuyn ho ca methyldopa trong cc
nron adrenergic. Nguy c h huyt p th ng tng ln vi tt c cc thuc
an thn kinh.
X l: Trong qu trnh tm kim mt trng thi cn bng v huyt p, bc
s k n phi tnh n nguy c c nhng bin ng v huyt p khi dng
nhng thuc an thn kinh, chn mt liu php thch hp. Nu cn phi hp
thuc ny, khuyn ngi bnh dng thuc u n vo gi nht nh v tng
cng t theo di. Nu khng, cn thay i chin lc iu tr. Khuyn ngi
bnh n khm li nu thy huyt p bin ng nhiu.
Butyrophenon
Phn tch: Ni chung, vi cc thuc an thn kinh, c nguy c lm h huyt
p do phong b ti hp thu cc cht chuyn ho ca methyldopa trong cc
nron adrenergic. Nguy c h huyt p th ng tng ln vi tt c cc thuc
an thn kinh. Ngoi ra, vi haloperidol (thuc h butyrophenon), thy c sa st
tr tu, mt phng hng, suy gim t duy. Tuy vy, tng tc ny cn c
khng nh, khi c cc nhn xt khc khng ni ti vn ny.
X l: Cn thn trng vi haloperidol, v phi nh gi y cc nguy
c do phi hp thuc ny. Nu thy ri lon tm thn , ngng ngay haloperidol
v chuyn ngay nhn xt n Trung tm cnh gic thuc. Nu cn phi hp
503
thuc, phi thng bo cho ngi bnh, dng thuc u dn vo nhng gi nht
nh v tng cng t theo di. Nu khng, cn thay i chin lc iu tr.
Khuyn ngi bnh n khm li nu thy huyt p bin ng nhiu.
Levodopa
Phn tch: Tng tc dc lc. C kh nng cn tr tc dng chng
Parkinson ca levodopa. Tng tc dng c ch h thn kinh trung ng, km
theo nguy c lon tm thn.
X l: Nn chn mt chin lc iu tr khc.
Ru
tc dng an thn. C th thy mt s tc dng tm thn - vn ng khi dng
mt s thuc, nht l trong tun l iu tr u tin. Tng tc dc lc.
X l: Khng nn phi hp hai cht ny, v bc s k n khng m bo
c ngi bnh khng ung ru. Nguy c an thn, gy bun ng c bit
nguy him vi ngi li xe v ngi ng my. Khuyn ngi bnh khng dng
cc ch phm c ru v khng nn ung ru.

Phn tch: Amphetamin l mt cht cng giao cm trc tip, v do c
tc dng lm tng huyt p. S phi hp vi cc thuc chng tng huyt p
dn ti i khng tc dng, v kh khn rt ln t cn bng huyt p.
X l: Vi ngi bnh tng huyt p, phi trnh k n cc amphetamin.
Baclofen
X l: Theo di huyt p v hiu chnh liu lng thuc chng tng huyt
p chnh trong n, trong khi iu tr v khi ngng phi hp thuc.
Cc cht c ch enzym chuyn dng angiotensin
Phn tch: C phi hp cc thuc chng tng huyt p, tng mnh nguy
c tt huyt p t th ng.
X l: Nhc ngi bnh tng cng t theo di v phn chia cc ln ung
thuc u n trong ngy. Ch n ngi bnh cao tui h hiu cch
phn chia liu.
X l: Khuyn ngi bnh sp qua phu thut thng bo cho bc s gy
m cc thuc ang dng.
504
Carbamat hoc thuc tng t

X l: Phi tnh ti nguy c ny hiu chnh liu lng ca hai thuc.
Ngh ti gim tnh tnh to ngi li xe v ngi ng my. Khuyn khng nn
ung ru, khng dng thuc v ch phm c ru.
Cht ch vn morphin
Phn tch: Tng tc dng lm h huyt p v tng nguy c h huyt p t
th ng.
X l: Theo di huyt p trong khi phi hp. Tu theo thuc dng, h
huyt p c th nng hoc nh khc nhau. Nu cn, hiu chnh liu lng ca
mt hoc c hai thuc. Lp mt k hoch dng thuc u n. Khuyn ngi
bnh gp li thy thuc hiu chnh li liu dng nu thy chng mt lc mi
dng thuc. Tng cng theo di ngi bnh cao tui (nguy c ng) v khuyn
h chuyn dn dn t t th nm hoc ngi sang t th ng.
Phn tch: Phi hp cc thuc chng tng huyt p c th thc hin. Tng
nguy c h huyt p th ng nghim trng v tc dng c ch h thn kinh
trung ng.
X l: Thng bo cho ngi bnh bit cc nguy c, v ri u cc l n
ung thuc trong ngy. Cn thn vi ngi li xe v ng my. Khuyn ngi
bnh khng ung ru, khng dng thuc v cc ch phm c ru.
Clozapin
X l: Theo di huyt p v hiu chnh liu lng thuc chng tng huyt
p chnh trong n, trong iu tr v khi ngng dng clozapin.
Dextropropoxyphen
Phn tch: Dextropropoxyphen c tc dng h huyt p nh. Khi phi hp
vi cc thuc h huyt p khc s tng tc dng h huyt p v tng nguy c
h huyt p th ng.
X l: Cn phi theo di huyt p khi phi hp thuc (trong iu tr v sau
khi ngng dng mt trong hai thuc). Tu theo thuc dng, h huyt p c
th nng hay nh khc nhau. Khi cn, hiu chnh liu lng mt hoc hai thuc.
Lp mt k hoch dng thuc u n. Khuyn ngi bnh gp li bc s
hiu chnh li liu lng nu thy chng mt lc bt u iu tr. Tng cng
theo di ngi bnh cao tui (nguy c ng) v khuyn h chuyn dn dn t t
th nm hoc ngi sang t th ng.
Diazoxyd
Phn tch: Phi hp hai thuc c tnh cht chng tng huyt p.
505
X l: Diazoxyd l mt thuc gy tng glucose mu, v vy cn phi cnh

gic khi phi hp hai thuc theo mc ch iu tr chnh v phi theo di u
n huyt p.
Didanosin
Phn tch: Hip ng cc tc dng khng mong mun: tng cc nguy c
xut hin vim tu, do thuc.
X l: Theo di lm sng v nu cn , khi thy au bng, theo di sinh
hc chc nng tu (amylase mu v amylase nc tiu).
Furosemid hoc thuc tng t; reserpin; thuc chn beta; thuc gin mch
chng tng huyt p; thuc li tiu gi kali; thuc li tiu thi kali
X l: Phi hiu chnh li liu lng, v phi thit lp mt k hoch dng
thuc. Cn nhn mnh ngi bnh phi tun th k hoch iu tr. Khi bt u
iu tr, khuyn ngi bnh t o (hay nh o) u n huyt p cho n khi
t cn bng huyt p.
Phn tch: Phi hp cc thuc lm h huyt p, tng nguy c h huyt p
th ng quan trng.
X l: Thng tin cho ngi bnh v chia nhiu ln ung trong ngy.
Phn tch: Tng tc dng lm h huyt p, thng hay dng trong iu tr
v cn liu thch hp.
X l: Tng cng theo di huyt p ng mch. Nhn mnh v s tun
th v gi gic ung thuc u n, khi dng liu php hai thuc. Cnh gic khi
dng ngi bnh cao tui.
Phn tch: Mc tiu chnh l iu tr ung th tuyn ca thn. Interleukin
cng c vi gan. Nh vy l s phi hp hai thuc c tim nng c vi
gan.
X l: Cch iu tr ny ch c tin hnh ti c s chuyn khoa. Dng
interleukin i hi phi theo di thng xuyn. Trong trng hp ny nn cn
nhc tu theo tnh trng chung ca ngi bnh. Khi phi hp hai thuc c vi
gan, phi theo di cht ch chc nng gan (ASAT, ALAT, phosphatase kim,
bilirubin) hoc hon mt trong hai liu trnh, nu c th.
Lithi
Phn tch: Methyldopa c th lm tng lithi mu v dn n qu liu lithi
cng vi cc du hiu c thn kinh.
506
K n: Phi hp ny cn c s iu chnh liu lithi lc bt u, khi ang v

c khi ngng iu tr bng methyldopa. Nu cn, nn theo di cn thn lithi mu.
Nicorandil
Phn tch: Phi hp vi bt k thuc chng tng huyt p no c th lm
tng nguy c h huyt p, i khi dn n sc.
X l: Theo di huyt p ng mch trong v khi ngng mt trong hai liu
trnh, c bit ngi bnh cao tui.
Niridazol
Phn tch: Phi hp hai thuc c vi gan. Niridazol cng gy c thn kinh.
Nguy c xut hin co git, ri lon tm thn v c vi gan, nu phi hp thuc.
nng gan (ASAT, ALAT, phosphatase kim, bilirubin) hoc hon nu c th, mt
trong hai liu trnh. Kim tra chc chn l ngi bnh khng ung ru thng
xuyn v khng c tin s vim gan virus. Cc triu chng lm sng chnh
khng c hiu: bun nn, st, vng da... Nu thy ng thi ban da, ng a v
hch to th phi hng v nguyn nhn do thuc. Cn c kt qu xt nghim
sinh hc, phn bit r nguy c xut hin vim gan tiu t bo khng phc h i
vi vim gan mt phc hi c sau khi ngng iu tr.
Phn tch: Dng ng thi hai thuc c th dn n thay i huyt p
quan trng. Ngoi ra cn thm cc tc dng c ch h thn kinh trung ng.
X l: Cc thuc c ch MAO t c s dng, tng tc li nhiu nn t
c k n, do c t nhn xt v cnh gic thuc. Tuy nhin vn nn thn
trng gi khong cch t 2 n 3 tun sau khi ngng thuc, trc khi k n li
thuc c ch MAO.
Sotalol
Phn tch: Phi hp hai thuc chng tng huyt p, mt phi hp c th
thc hin c v mt dc l v iu tr. Tuy nhin nn nh rng sotalol c
dng nhiu lm thuc chng lon nhp hn l thuc chng tng huyt p.
X l: Nu cn phi hp, tng cng theo di huyt p, trong v khi
ngng iu tr bng mt trong hai thuc. Tin hnh iu chnh liu. Nhn mnh
v k hoch dng thuc v s tun th. c bit cnh gic khi dng ng i
bnh cao tui.
Thuc c ch MAO typ B
Phn tch: c ch c hiu monoamin oxydase typ B dn n ko di tc
dng ca levodopa, iu gii thch vic cng k n vi cht ny. Cc tng
tc cng ging nh ca levodopa v nn c h thuc ny.
X l: Cn phi iu chnh liu, xy dng k hoch dng thuc v nhn
mnh ngi bnh phi tun th k hoch dng thuc. Khi bt u iu tr,
khuyn ngi bnh o (hoc nh o) huyt p u n cho ti khi t cn bng
iu tr.
507

Carbamazepin; thuc khng histamin khng H1 an thn
Phn tch: Tng tc dng c ch h thn kinh trung ng, dn n tng
X l: Lu nguy c ny iu chnh liu ca hai thuc, nu cn phi
hp. Ngh n gim tnh to ngi li xe v ngi vn hnh my mc. Khuyn
Phn tch: Methyldopa kch thch cc th th alpha-adrenergic, do lm
tng tc dng ca cc thuc cng giao cm.
X l: Nu dng thm thuc cng giao cm alpha1 sau methyldopa, c
th gim tc dng h huyt p cn tm kim. Nu methyldopa c thm vo
sau, tc dng h huyt p s tng. Khi phi hp, cn bt u bng liu thp.
Nn nh l cc dng ti ch c th c tc dng ton thn tu theo bi cnh s
dng.
Phn tch: Dng ng thi cc thuc chng tng huyt p hoc cc thuc
c th dn n h huyt p vi cc thuc gy m barbituric c th gy tt huyt
p nng.
X l: Phi ch n tng tc ny khi gy m. Nhc ngi bnh bo cho
ngi gy m bit cc thuc dng.
Phn tch: Tng tc dng h huyt p ca nhng thuc ny. H huyt p
l mt tc dng khng mong mun ca cc thuc chng trm cm ba vng.
X l: Nu cn phi hp, tng cng theo di huyt p trong v khi ngng
iu tr bng mt trong hai thuc. iu chnh liu nu cn, nhn mnh v k
hoch dng thuc v s tun th k hoch dng thuc. c bit cn phi thn
trng khi dng ngi bnh cao tui.
METHYSERGID
Cht i khng cnh tranh serotonin thuc nhm alcaloid nm ca g
CC THUC TRONG NHM

METHYSERGID vin nn 2,2 mg
Deseril vin nn 2,2 mg
CH KHI CH NH
508
Chng ch nh: mc 4
Thi k mang thai: V l do kh nng tr yu

Thi k cho con b: Do thn trng: cc dn cht nm ca g qua c sa m
c th gy cho tr s sinh cc triu chng ng c ergotin (nn, tiu chy).
Tng huyt p: Chng ch nh khi tng huyt p nghim trng.
Suy mch vnh: V tc dng co mch ca nhng thuc ny.
Suy gan: th nng.
Suy thn: th nng.
Trng hp khc: Ri lon tun hon ngoi vi c bit ng mch.
TNG TC THUC

Cc cht ch vn chn lc th th 5 HT1
Phn tch: Tng nguy c phn ng co cng mch. C ch c th do tc
dng hip ng co cng mch.
X l: Chng ch nh s dng cc cht ch vn chn lc th th
serotonin, tc 5 hydroxy tryptamin (5-HT1) nh Naratriptan, Sumatriptan,
Rizatriptan, Zolmitriptan trong vng 24 gi ang iu tr vi thuc cha nm ca
g. Tng t, dng ng thi hai cht ch vn chn lc th th 5 HT1 trong
vng 24 gi l chng ch nh.
Sibutramin
Phn tch: C th xy ra hi chng serotonin bao gm kch thch h thn
kinh trung ng, yu c vn ng, run ry, git rung c, gim thc. C ch
nhng tc dng serotoninergic ca nhng thuc ny c th hip ng vi nhau.
X l: Khng nn dng ng thi cc thuc trn. Nu vic dng ng thi
khng trnh c, th theo di cht ch ngi bnh v tc dng ph.

Thuc chn beta
Phn tch: Thiu mu cc b ngoi bin th hin bng lnh chi, c th c
hoi th ngoi bin khi dng ng thi thuc chn beta vi alcaloid nm ca g.
X l: Theo di ngi bnh v cc du hiu thiu mu cc b ngoi bin.
iu chnh liu ca alcaloid nm ca g v ngng thuc chn beta nu cn.
509
MEXILETIN
Thuc chng lon nhp thuc nhm Ib ca Vaughan - Williams,
c tc dng n nh mng v tc dng gy t
CC THUC TRONG NHM

MEXILETIN nang 200 mg
Ritalmex nang 200 mg
CH KHI CH NH THUC

Thi k mang thai: Trng hp nghi mang thai v trong 3 thng u ca thai k.
Suy tim: Chng ch nh khi suy tim nng.
Suy gan: Do chuyn ho thuc gan.
Suy thn: Nguy c tch lu.
Trng hp khc: Trng hp bloc nh - tht, nhp tim chm v lon nhp chm.
Thn trng: mc 2
Suy tim: Nguy c bin i dn truyn.
TNG TC THUC

Benzamid hoc dn cht
Phn tch: Nguy c xut hin lon nhp tht, c bit l xon nh do hip
ng tc dng in sinh l. Tng tc dc lc hc.
X l: Khng k n phi hp ny. Nn thay i thuc.

Lidocain hoc cht tng t
Phn tch: Lidocain c di dng dng ti ch lm thuc gy t v di
dng tim dng ch yu trong chuyn khoa tim. y l tng tc dc lc, phi
hp hai thuc chng lon nhp cng nhm Ib Vaughan-Williams.
X l: Nn trnh phi hp hai thuc chng lon nhp cng mt lc, tr khi
ngi bnh nm trong mt c s chuyn khoa c s theo di thng xuyn.
Propafenon
Phn tch: Nng mexiletin huyt tng c th tng, lm tng nguy c
tc dng ph. C ch: Propafenon c th c ch chuyn ho ca mexiletin.
510
X l: Theo di nng ca mexiletin trong huyt tng v nhn xt p

ng lm sng khi thm hoc ngng propafenon. Nu c hai thuc u bt u
cng lc, d liu dn dn ca c hai thuc.

Amiodaron; quinidin hoc dn cht; thuc chn beta
.
Phn tch: Nguy c xut hin xon nh. Ko di khong QT in tm
X l: Phi hp phi theo di c bit (in tm ). Ni chung, phi trnh

phi hp cc thuc chng lon nhp nhm 1 ca Vaughan-Williams, do ko di
k hn dn truyn tim.
Barbituric; phenytoin; primidon hoc dn cht; rifampicin
Phn tch: Gim hm lng mexiletin trong huyt tng do cm ng
enzym chuyn ho mexiletin gan.
X l: iu chnh liu ca mexiletin tu theo lm sng v in tm .
Disopyramid
Phn tch: Cc phi hp vi nhng thuc chng lon nhp thuc cc nhm
khc trong phn loi Vaughan-Williams cn phi tng cng theo di (in tm
) nht l vi disopyramid.
X l: Phi hp cc thuc chng lon nhp vi nhau cn c trnh
chuyn khoa k c trong khoa tim v c phng tin theo di (khoa hi sc
tim).
Quinolon
Phn tch: Nng mexiletin trong huyt tng c th tng, dn n tng
tc dng v tng phn ng ph. C ch: Cc khng sinh quinolon c th c ch
chuyn ho ca mexiletin gan (cytochrom P450 A2).
X l: Theo di p ng lm sng ca ngi bnh vi mexiletin khi bt
u hoc ngng quinolon. iu chnh liu ca mexiletin nu cn.
Tacrin
Phn tch: Nguy c nhp tim chm qu mc, do cng hp cc tc dng gy
nhp tim chm.
X l: Theo di lm sng u n.
Phn tch: Nng theophylin trong huyt thanh c th tng, dn n
tng tc dng dc l v tng c tnh. C ch: Chuyn ho gan ca
theophylin qua xc tc ca cytochrom P450 b c ch bi mexiletin.
X l: Theo di nng theophylin trong huyt tng v iu chnh liu
cho ph hp.
511
Thuc acid ho nc tiu

Phn tch: Acid ho nc tiu c th lm tng nhanh o thi mexiletin
thn v gim hiu lc ca mexiletin.
X l: Nu cn phi hp hai thuc, nn theo di cc tc dng lm sng v
iu chnh liu ca mexiletin.
Thuc kim ho nc tiu
Phn tch: Kim ho nc tiu c th lm gim o thi mexiletin thn.
Theo ti liu, tng tc ny cho thy c nhng bin i trong ngha lm sng
ca phi hp.
X l: Nu cn phi hp hai thuc, nn theo di cc tc dng lm sng v
iu chnh liu ca mexiletin.
MIANSERIN
Thuc hng thn chng trm cm, khng thuc nhm c ch MAO,
khng thuc nhm imipramin
CC THUC TRONG NHM

MIANSERIN vin nn 10 mg
Athymil vin nn 10 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Suy gan
Hng cm

Tr em - tr cn b: Tr em di 15 tui, v thiu d liu.
Thi k mang thai: Cha xc nh c tnh khng gy c hi khi iu tr bng
mianserin cho ngi mang thai, nhng cha thy c bng chng v tc dng gy qui
thai sc vt.
Cn theo di: mc 1
n ung, ru: Khng nn dng ung c ru trong khi iu tr.
Tiu ng: Theo di glucose mu ngi tiu ng khng n nh.
512
git.
ng kinh: Mianserin c th lm h ngng gy ng kinh cng vi nguy c co

TNG TC THUC

Phn tch: Cc thuc c ch MAO chn s ging ho ca cc
catecholamin. Chng c tnh cht cng giao cm v c th gy tai bin tng
huyt p khi chng c phi hp vi cc thuc c tc dng khu cc amin
tng huyt p.
X l: Phi hp chng ch nh ny i hi phi c mt khong cch thi
gian 3 ngy gia khi ngng dng cc thuc c ch MAO v khi bt u iu tr
bng mianserin.
Phn tch: Tng tc dc lc. Ngoi tng tc dng an thn, c i khng
khu th th adrenergic, do gim tc dng chng tng huyt p.
X l: Tnh n nguy c tht bi iu tr, thay i chin lc iu tr.
Ru
tc dng an thn. Mt vi tc dng tm thn vn ng c th c ghi nhn vi
mt s thuc, nht l trong tun u iu tr. Tng tc dc lc.
X l: Tt nht, khng nn dng thuc ny, v bc s k n khng ki m
sot c ngi bnh ung ru. Nguy c an thn nguy him nht l vi ngi
li xe v ngi vn hnh my mc. Khuyn ngi bnh khng ung ru, khng
dng cc ch phm c ru.

amphetamin.
X l: Lu tng tc dc lc ny xc nh mc tiu iu tr chnh.
Khuyn ngi bnh gp li thy thuc nu thy kt qu iu tr khng n nh.
Baclofen; primidon hoc dn cht; thuc ch vn morphin
hp. Ch n gim tnh to ngi li xe v ngi vn hnh my mc.
Khuyn khng ung ru, khng dng cc ch phm c ru.
513
Barbituric; benzodiazepin; dextropropoxyphen; fluoxetin; khng histamin

khng H1 an thn; methyldopa; oxaflozan; phenothiazin; thuc c ch h thn
kinh trung ng cc loi; viloxazin
X l: Phi lu tng tc ny iu chnh liu ca hai thuc. Ch
n gim tnh to ngi li xe v ngi vn hnh my mc. Khuyn khng
ung ru, khng dng cc ch phm c ru.
Fluvoxamin; medifoxamin; paroxetin
X l: Lu n tng tc ny iu chnh liu ca hai thuc. Ch
n gim tnh to ngi li xe v ngi vn hnh my mc. Khuyn khng
ung ru, khng dng cc ch phm c ru.
Procarbazin
Phn tch: Tc dng hip ng c ch h thn kinh trung ng.
X l: Phi lu s tng an thn bun ng trong v sau khi iu tr, c
bit ngi li xe v ngi vn hnh my mc.
liu.
X l: Nu cn phi hp hai thuc, lu nguy c ny khi gy m v chn
Thuc gy m cc loi; thuc gy m bay hi cha halogen

X l: Khuyn ngi bnh phi can thip ngoi khoa, thng bo cho ngi
gy m v thuc mnh ang dng.
MIFEPRISTON
Thuc chng thai nghn, khng progestogen
CC THUC TRONG NHM

MIFEPRISTON vin nn 200 mg
Mifegyne vin nn 200 mg
CH KHI CH NH THUC
514
Chng ch nh: mc 4
Tiu ng; suy gan; suy thn: Tnh n cc tc dng khng mong mun.
Thi k mang thai: Mang thai khng c xc nhn bng sinh hc, mang thai
hn 50 ngy mt kinh, nghi c thai ngoi d con.
Trng hp khc: Qu mn cm vi thuc, suy thng thn, ri lon cm mu,
suy dinh dng.

Tng huyt p/suy tim: Trong trng hp phi hp vi nhng cht tng t
prostaglandin, nhng trng thi ny l chng ch nh.
TNG TC THUC

Barbituric; carbamazepin; phenytoin; primidon; rifampicin
Phn tch: Nguy c gim hiu qu ca phng php v l do tng chuyn
ho ca mifepriston do cm ng enzym.
X l: Trc ht phi nh rng cm ng enzym l mt hin tng chm
xut hin (3 tun) v chm bin i. C th phi tnh n vic tng liu.
Indometacin; pyrazol; salicylic; thuc chng vim khng steroid
Phn tch: Nguy c gim hiu qu ca phng php.
X l: Ngng iu tr bng thuc chng vim khng steroid 24 gi trc
khi dng mifepriston.
MODAFINIL
Thuc kch thch tm thn adrenergic alpha 1 no, c ch nh dng
trong cn ng thong qua c km hoc khng km cn t ngt mt trng lc
v chng ng nhiu t pht c xc nh bng my ghi a k
CC THUC TRONG NHM

MODAFINIL vin nn 100 mg
Modiodal vin nn 100 mg
CH KHI CH NH THUC
515
Chng ch nh: mc 4
Ch cc vn ng vin th thao trnh cao, bit dc ny cha mt hot
cht c th gy phn ng dng tnh vi cc th nghim khi kim tra chng doping.
Chng lo u thi qu.

Thi k cho con b: V l thuc mi cn thiu cc nghin cu chuyn bit, nn
cn trnh k n thuc ny cho ngi cho con b.
Thi k mang thai: Mc du thuc khng thy c tc dng gy qui thai sc
vt, cn thn trng trnh k n thuc mi ny cho ngi ang mang thai, nht l
thi k u (tr trng hp tuyt i cn thit).
Thn trng: mc 2
Tng huyt p: Theo di huyt p ng mch khi ngi bnh c bit b tng
huyt p.
Cn theo di: mc 1
Suy gan: ngi suy gan nng, ch n s chuyn ho ca thuc, khuyn nn
chia cc liu thnh hai ln dng.
TNG TC THUC

Phn tch: Modafinil l thuc mi, c coi c tim nng cm ng enzym.
Vi tim nng ny, thuc c th cm ng chuyn ho mnh cc thuc nga thai
estroprogestogen, c bit loi liu thp.
X l: Chng ch nh phi hp ny. Thay i phng php nga thai, v
iu tr modafinil l mt iu tr di hn.
516
MOLSIDOMIN
Thuc chng au tht ngc thuc h cc sydnonimin, gin mch,
chng kt tp tiu cu
CC THUC TRONG NHM

MOLSIDOMIN vin nn 2 mg; 4 mg
Corvasal vin nn 2 mg; 4 mg
CH KHI CH NH THUC

Trng hp khc: H huyt p r vi tnh trng sc.
Cn thn trng: mc 2
Suy gan: Tng dn liu lng.
MUROMONAB CD3
Khng th n dng i vi khng nguyn T3 ca lympho bo T ngi
CC THUC TRONG NHM

MUROMONAB ng tim 5 mg/ 5 mL
Orthoclone OKT ng tim 5 mg/ 5 mL
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b - thi k mang thai: Tnh khng c hi cha c chng
minh vi thuc ny.
Suy tim: Suy tim mt b.
Trng hp khc: Qu mn vi thuc, tin s co git.
ng dch nhy v nguy c ph phi do thuc gy nn
NAFTIDROFURYL
517
Thuc gin tiu ng mch hng c
CC THUC TRONG NHM

NAFTIDROFURIL vin nn 200mg; nang 100 mg; ng tim 200 mg
Devatran nang 200 mg
Di-Actane nang 200 mg
Naftilux nang 200 mg
Praxilene nang 100 mg
Praxilene vin nn 200 mg
CH KHI CH NH THUC

Thi k cho con b/thi k mang thai: Nn thn trng khi dng cc thuc gin
mch hng c ny.
Cn theo di: mc 1
Bloc nh - tht.
NATRI VALPROAT HOC DN CHT

Thuc chng ng kinh khng barbituric,
tc dng khu cc cht dn truyn thn kinh (GABA)
CC THUC TRONG NHM

ACID VALPROIC nang 200 mg; ng tim 400 mg
Convulex nang 200 mg
Depakine ng tim 400 mg
NATRI VALPROAT vin nn bao phim 500 mg; siro 5,764 %; vin nn khng tan
trong d dy 200 mg; 500 mg; dung dch ung 200 mg/mL
Depakine chrono vin nn bao phim 500 mg
Depakine dung dch ung 200 mg/mL
Depakine siro 5,764 %
Depakine vin nn khng tan trong d dy 200 mg; 500 mg
VALPROMID vin nn bao tan rut 30 mg
Depamide vin nn bao tan rut 30 mg
518
CH KHI CH NH THUC
Chng ch nh: mc 4
Cc trng hp khc: Qu mn vi thuc. Vim gan cp hoc mn. Tin s gia
nh c vim gan.

Thi k cho con b: Natri valproat qua c sa m. Trnh cho con b.
Thi k mang thai: D tt bm sinh hay gp hn con m m b ng kinh,
nhng rt kh xc nh iu ny l do bnh hoc do thuc chng ng kinh gy ra.
Valproat c th gy tt nt t sng v nhng d tt ch ng ng thn kinh, nhng
nguy c gy qui thai ny kh thp v c th kim sot c khi pht hin tr c lc
sinh. Theo di ng mu tr mi sinh.
Suy gan: Acid valproic c th gy tn hi nng n gan, km theo mt, gim
mnh nng fibrinogen trong mu, c th do to ra mt cht chuyn ho c vi gan
(acid 5 - hydroxyhexanoic).
Cn theo di: mc 1
Suy thn: o thi valproat ch yu qua thn. V vy phi ch ti s tng nng
thuc trong huyt thanh, v t phi gim liu lng.
TNG TC THUC

Quinin v cc cht tng t
Phn tch: Gim na i valproat, km theo nguy c co git c m t
vi mefloquin (Lariam)
X l: Chng ch nh phi hp ny. Thay i chin lc iu tr.

Carbamazepin
Phn tch: Gim na i ca valproat do tc dng cm ng enzym ca
carbamazepin v tng cht chuyn ho c hot tnh ca carbamazepin (10, 11 epoxid) do tc dng c ch enzym ca natri valproat ( y c hai t ng tc
dc ng v chuyn ho).
X l: Vic theo di nng ca hai thuc trong huyt tng gy kh cho
k n v mc tiu chnh l t cn bng. Lp mt k hoch dng thuc u
n, v hiu chnh liu lng lc bt u, trong khi iu tr v sau khi ng ng
iu tr mt trong hai thuc. Cn trnh phi hp carbamazepin vi cht
valpromid (Depamide) v cn theo di khi phi hp carbamazepin vi valproat
(Depakine).
519
Cholestyramin
Phn tch: Cholestyramin phi hp vi acid valproic s lm gim nng
acid valproic trong huyt thanh, ko theo gim tc dng iu tr, do nh hng
n s hp thu cht ny ng tiu ho.
X l: Dng acid valproic t nht 3 gi trc khi hoc 3 gi sau khi dng
cholestyramin. Theo di p ng vi thuc v da vo , hiu chnh liu dng.
Lamotrigin
Phn tch: Khi phi hp lamotrigin vi acid valproic, th nng acid
valproic trong huyt thanh s gim, cn nng lamotrigin v c tnh ca n
li tng, c th do chuyn ho ca lamotrigin b c ch.
X l: Bnh nhn dng kt hp hai thuc ng kinh ni chung, hay c th
lamotrigin vi acid valproic phi c theo di cn thn khi ang dng mt
thuc v dng thm, hoc ngng dng, hoc thay i liu dng thuc th hai.
Hiu chnh liu lng khi cn.
Tacrin
X l: Nu cn, phi tng cng theo di gan, trnh nhng phi hp gy
nguy c vi ngi bnh cao tui.
Phn tch: Ngoi tc dng c ch h thn kinh trung ng, y cn c
phi hp acid folic vi mt thuc c tc dng khng folat (do c ch dihydrofolat
reductase).
X l: Kim tra huyt v khi cn, cho dng acid folinic, c bit
nhng ngi bnh dng liu cao cc khng folat khc hay nhng ng i
bnh c iu tr trong thi gian di. nhng ngi bnh ny, nn b sung
thm acid folinic. Cc tng tc ny khng thy ni trong y vn.
Amineptin; carmustin hoc dn cht; citalopram; dantrolene; estrogen hoc
thuc nga thai estroprogestogen; fluoro-5-uracil; fluoxetin; fluvoxamin;
griseofulvin; isoniazid hoc thuc tng t; methotrexat; paroxetin; progabid;
rifampicin; thuc chng nm dn xut imidazol
Phn tch: Phi hp cc thuc c tim nng c vi gan (cng cc tc
dng ph).
nng gan (ASAT, ALAT, phosphatase kim, bilirubin) hoc hon dng mt trong
hai thuc. Xc nh chc chn ngi bnh khng thng xuyn ung ru v
khng c tin s vim gan virus. Cc triu chng lm sng chnh khng c
hiu: bun nn, st, vng da. Nu thy ng thi pht ban ngoi da, ng a v
hch to, th ngh n nguyn nhn do thuc. Cn c kt qu th sinh hc, cn
phn bit vim gan tiu t bo khng hi phc vi vim gan mt h i ph c
c sau khi ngng thuc.
520

Phn tch: Natri valproat v dn cht lm tng nng barbituric trong
huyt tng. C th do c ch enzym v do lm gim d ho barbituric. Tng tc
dc ng hc v chuyn ho thuc. V lm sng, tng nng barbituric trong
huyt tng th hin tng cc tc dng ph (tc dng an thn).
X l: Cn phi theo di lm sng trong 15 ngy iu tr u tin cng vi
nh lng nng barbituric trong huyt tng khi cn, v hiu chnh liu
lng thch hp khi thy du hiu an thn u tin. Khuyn ngi bnh khng
ung ru v khng dng cc ch phm c ru. Khuyn ngi bnh gp li
bc s, nu thy mt mi, ng g, an thn nh lng thuc trong huyt
tng v hiu chnh liu lng barbituric cho thch hp.
Benzamid; butyrophenon; phenothiazin; thuc an thn kinh cc loi
Phn tch: Ngoi tc dng c ch h thn kinh trung ng thm vo, natri
valproat v cc dn cht cn lm tng nng cc thuc k trn trong huyt
tng, c th do c ch enzym v gim d ho chng.
X l: Nu cn phi hp thuc, phi hiu chnh liu lng cc cht k trn
theo hng gim liu lng. Cn ch ti gim tnh to ngi li xe v ngi
ng my. Khuyn ngi bnh khng ung ru, v khng c t dng thuc
hoc cc ch phm c cha ru.
Ciclosporin
Phn tch: Tng nng ciclosporin trong huyt thanh do valproat c ch
mt s isoenzym ca cytochrom P450.
X l: Nu cn phi hp, phi theo di cht ch nng ciclosporin trong
huyt thanh v hiu chnh liu lng khi bt u v c khi kt thc iu tr bng
natri valproat. Cn lu l c nhng bin ng ln gia cc c th v nng
ciclosporin trong mu, do phi theo di u n.
Didanosin
Phn tch: Hip ng cc tc dng ph: tng nguy c xut hin vim tu
do thuc.
X l: Theo di lm sng, v nu cn, trc nhng cn au ng tiu
ho, phi theo di sinh hc chc nng tuyn tu (nng amylase trong mu v
trong nc tiu).
Diltiazem
Phn tch: Diltiazem l cht c ch mt s isoenzym ca cytochrom P 450;
c th lm tng nng valproat trong huyt thanh v tng c tnh ca thuc
phi hp.
X l: V tng tc dc ng hc ny, phi theo di st sao nng
thuc, c phm vi iu tr hp trong huyt thanh.
521
Heparin
Phn tch: Natri valproat c th gy gim tiu cu v h nng
prothrombin trong mu v gim kt tp tiu cu. Nh vy, c th gy chy mu
nhng ngi bnh dng thuc chng ng mu ung, heparin hay thuc tan
huyt khi.
X l: Khi phi hp thuc, tu theo thuc chng ng mu dng, phi
tng cng theo di s lng tiu cu, test th ng mu ton phn, thi gian
Howell, thi gian chy mu.
Phn tch: Mc tiu ch yu l iu tr ung th tuyn thn. Interleukin
cng t ra c vi gan. Nn y l s phi hp hai thuc c tim nng c vi
gan.
X l: Liu php ny ch c thc hin c s chuyn khoa. Dng
interleukin i hi theo di lin tc. Trong trng hp ny, mi iu phi ph
thuc vo th trng ngi bnh. Khi phi hp hai thuc c vi gan, phi theo
di cht ch chc nng gan (ASAT, ALAT, phosphatase kim, bilirubin) hoc
nu c th, hon dng mt trong hai th thuc.
Macrolid
Phn tch: Phi hp hai thuc c tim nng c vi gan. Erythromycin c
th th hin nh mt cht c ch enzym, c th c ch chuyn ho acid
valproic v dn n ng c.
nng gan (ASAT, ALAT, phosphatase kim, bilirubin) hoc nu c th, hon
dng mt trong hai thuc. Kim tra chc chn ngi bnh khng thng xuyn
khng c hiu: bun nn, st, vng da. Nu thy ng thi pht ban ngoi
da, nga v hch to, th c th nguyn nhn do thuc. Cn c kt qu xt
nghim sinh hc, cn phn bit r nguy c xut hin vim gan tiu t bo
Mercaptopurin
Phn tch: Hai thuc u c vi gan, nn c nguy c hip ng c tnh
vi gan. Thng thng natri valproat gy vim gan tiu t bo khng hi phc,
do c tnh cht nghim trng, tri li, mercaptopurin i khi gy vim gan
mt, hi phc c sau khi ngng iu tr, nhng c th gy t vong nu
khng ngng iu tr. Nhng du hiu lm sng bo trc bao gm: suy
nhc, chn n, r, ng g, nn, au bng (v xut hi n l i cc c n ng
kinh).
X l: Theo di cht ch chc nng gan (hng tun). Cc xt nghim kinh
in u bao gm nhng xt nghim phn nh tng hp protein (ch yu
t l prothrombin, t l fibrinogen, cc yu t ng mu) bilirubin, transaminase,
phosphatase kim.
522
Phenytoin
Phn tch: Tng tc dc ng hc. C th xy ra nhiu hin tng:
nguy c qu liu phenytoin (ri lon tiu ho, rung git nhn cu, mt iu ho,
lon vn ngn, hn m, h huyt p...), do natri valproat y phenytoin khi lin
kt vi protein huyt tng (tng tc dc ng hc v phn b thuc); gim
nng natri valproat trong huyt tng do tc dng cm ng enzym ca
phenytoin (tng tc dc ng hc v chuyn ho thuc); gim thanh lc
phenytoin bi natri valproat, do gim chuyn ho phenytoin. y l phi hp hai
cht khng folat.
X l: Theo di lm sng v huyt hc (c th c thiu mu nguyn hng
cu khng l) v hiu chnh liu lng phenytoin theo nng trong huyt
tng, c bit ch tr em ng kinh.
Pyrimethamin; trimethoprim; zidovudin
Phn tch: Nguy c tng c tnh vi mu do c ch ty xng do hip
ng tc dng trn dihydrofolat reductase, c th dn n thiu mu nguyn
hng cu khng l.
X l: Nu cn phi hp thuc, phi dng mi thuc vi liu thp hn v
theo di cht ch huyt . Phi hp ny dnh cho cc thy thuc chuyn khoa
v cc phc iu tr thng c n nh r rng. C th b sung thm acid
folinic.
Ru
Phn tch: Tng c ch h thn kinh trung ng, ko theo tng tc dng
X l: Tnh ti nguy c ny hiu chnh liu lng hai thuc. Cn ngh
ti gim tnh to ngi li xe v ngi vn hnh my. Khuyn khng ung
ru v khng dng cc ch phm c ru.
Salicylat
Phn tch: Hnh nh do nhiu c ch tc dng: hip ng cc tc dng
chng kt tp tiu cu km nguy c chy mu; nguy c tim tng chy mu
ng tiu ho ngi bnh dng cc salicylat tng ln khi dng natri valproat;
cc salicylat y natri valproat khi nhng lin kt vi protein huyt tng
(tng tc dc ng hc v phn b thuc) km theo gim chuyn ho v o
thi natri valproat. Kt qu l tng dng natri valproat t do, km theo nguy c
qu liu (hn m, gim trng lc c, gim phn x, co ng t, gi m tnh t
ng trong h hp).
X l: Theo di nng natri valproat trong huyt tng; theo di lm
sng. Hiu chnh liu lng. Khuyn ngi bnh gp li thy thuc khi thy bt
k cm gic au no ng tiu ho (do k n cc salicylat). Khuyn ngi
bnh ang dng natri valproat khng t dng salicylat (thay bng
paracetamol).
523
Thuc chng ng kinh khng phi barbituric

Phn tch: Tng tc dng c ch h thn kinh trung ng, lm tng cc
tc dng an thn. Ngoi ra, nhn thy c nhng bin ng v nng thuc
trong huyt tng, c th tng hoc gim.
X l: Tnh ti nguy c ny hiu chnh liu lng hai thuc, nu cn
phi phi hp. Cn ngh n gim tnh tnh to ngi li xe v ngi vn hnh
my. Khuyn ngi bnh khng ung ru v khng dng cc ch phm c
ru. Nu cn, theo di nng thuc chng ng kinh trong huyt thanh.
Phn tch: Thuc chng trm cm ba vng h thp ngng gy ng
kinh, do c nguy c gy cc cn co git nhng ngi bnh dng thuc
chng ng kinh ny (natri valproat).
X l: Lu nguy c ny, v khi cn hiu chnh liu lng.
Phn tch: Thuc khng acid lm gim hp thu qua ng tiu ho v lm
gim tc dng ca thuc phi hp.
X l: Cn c mt khong thi gian t 1 n 2 gi k t lc dng thuc
khng acid n lc dng thuc kia. Nh l cc thuc khng acid thng c
dng 1 gi 30 pht sau khi n, v n l ngun gc tng tit dch v.
Thuc tan huyt khi
Phn tch: Natri valproat c th gy gim tiu cu, gim nng
prothrombin trong mu, gim kt tp tiu cu. Do c th gy chy mu
ngi bnh ang dng thuc chng ng mu ung, heparin hoc thuc tan
huyt khi.
X l: Khi phi hp thuc, tu theo loi thuc chng ng mu dng,
cn tng cng theo di s lng tiu cu, test th ng mu ton phn, thi
gian Howell, thi gian chy mu, t l prothrombin, t l chun quc t (INR).
Phn tch: Natri valproat c th gy gim tiu cu, h prothrombin mu v
gim kt tp tiu cu. Do natri valproat c th gy chy mu nhng ngi
bnh dng cc thuc chng ng mu ng ung, heparin hay cc thuc lm
tan huyt khi.
X l: Khi phi hp v tu loi thuc chng ng mu dng, tng
cng theo di s lng tiu cu, test th ng mu ton phn, thi gian
Howell, thi gian chy mu, t l prothrombin v t l chun quc t.
Verapamil
Phn tch: Verapamil l cht c ch mt s cytochrom P450, c th lm
tng nng thuc phi hp trong huyt thanh v nhim c.
X l: V tng tc dc ng hc ny, cn theo di cht ch nng
thuc c phm vi iu tr hp trong huyt thanh.
524

Phn tch: i khng tc dng. Tng tnh hung hn ngi nghin
amphetamin.
X l: Phi lu tng tc dc lc ny khi xc nh mc tiu iu tr ch
yu. Khuyn ngi bnh n gp bc s khi thy kt qu iu tr khng
n nh.
Oxaflozan
tc dng an thn Tng tc dc lc.
X l: Tnh ti tng tc ny hiu chnh liu lng c hai thuc. Phi
ngh n gim tnh to ngi li xe v ngi ng my. Khuyn khng ung
ru v khng dng cc ch phm c ru.
Phn tch: Tng tc dng c ch h thn kinh trung ng, gy tng tc
X l: Khuyn ngi bnh sp qua phu thut thng bo cho bc s gy
m nhng thuc m mnh dng.
NELFINAVIR
Khng protease dng trong iu tr AIDS
CC THUC TRONG NHM

NELFINAVIR vin nn 250 mg
Viracept vin nn 250 mg
CH KHI CH NH THUC
Chng ch nh; mc 4
V l thuc mi, cn theo di cc din bin trong khi s dng pht hi n cc
chng ch nh nu c.
Qu mn vi thuc.
TNG TC THUC
525

Amiodaron
Phn tch: Nng amiodaron trong huyt thanh c th tng, lm tng
nguy c c tnh ca thuc ny. C ch do nelfinavir (v c th c cc cht c
ch protease khc nh ritonavir, indinavir...) c ch chuyn ho ca amiodaron
(khng qua isoenzym 3A4 ca cytochrom P450).
X l: Chng ch nh nelfidavir cho bnh nhn ang dng amiodaron.
Ngh n thay th thuc.
Alcaloid nm ca g
Phn tch: Nguy c ng c alcaloid nm ca g c th tng (th d co
tht mch ngoi vi, thiu mu cc b cc u chi). C ch do nelfinavir (v mt
s cht c ch protease) c th nh hng n chuyn ho ca alcaloid nm
ca g gan (CYP3A4).
X l: Chng ch nh dng ng thi nelfinavir v alcaloid nm ca g.
Benzodiazepin
Phn tch: Nelfinavir c i lc mnh vi isoenzym 3A 4 ca cytochrom P450.
Do lm gim chuyn ho cc thuc c chuyn ho ch yu bi isoenzym
ny (hin tng cnh tranh) v lm tng nng ca chng trong huyt tng
v tng c tnh ca chng. Nguy c an thn ko di v c ch h hp su
(c m t vi midazolam, triazolam). Tng tc dc ng hc v chuyn
ho thuc.
X l: Khng k n phi hp ny. Cn phi thay th thuc.
Cisaprid; thuc khng histamin H1 khng an thn
Phn tch: Nelfinavir c i lc mnh vi isoenzym 3A4 ca cytochrom P450.
Do lm gim chuyn ho cc thuc c chuyn ho ch yu bi isoenzym
ny (hin tng cnh tranh) v lm tng nng ca chng trong huyt tng
v tng c tnh ca chng. Tng c tnh tim, km vi khong QT ko di, v
c th xut hin xon nh. Tng tc dc ng hc v chuyn ho thuc.
X l: Khng k n phi hp ny. Cn phi thay thuc khc.
Fentanyl
Phn tch: Nng fentanyl trong huyt tng c th tng v na i ca
thuc ko di, lm tng nguy c tc dng ph (th d c ch h hp). C ch do
chuyn ho ca fentanyl qua xc tc ca (CYP 3A4) b c ch thnh rut v
gan.
X l: Theo di cht ch chc nng h hp trong khi dng fentanyl v mt
thi gian di hn bnh thng sau khi ngng fentanyl ngi bnh ang dng
nelfinavir hoc mt cht c ch protease khc.
526
Sildenafil
Phn tch: Nng sildenafil trong huyt tng c th tng, dn n h
huyt p nghim trng c tim nng gy t vong. C ch do chuyn ho ca
sildenafil qua xc tc ca (CYP3A4) b c ch.
X l: Dng sildenafil rt thn trng v gim liu bnh nhn ang dng
cc thuc c ch protease.

Cc thuc chng nm dn xut imidazol
Phn tch: Nng cc cht c ch protease nh nelfinavir, ritonavir v.v...
trong huyt tng c th tng, lm tng nguy c c tnh. C ch do cc thuc
chng nm imidazol c ch chuyn ho ca cc cht c ch protease. Mt s
c ch khc cng c th tham gia.
X l: Cn xem xt gim liu ca nelfinavir hoc cht c ch protease
khc. Theo di ngi bnh v c tnh ca cht c ch protease v iu chnh
liu ca thuc ny nu cn thit.
Phn tch: Gim din tch di ng cong (AUC) ca thuc
estroprogestogen, c ch cha r. Nguy c mang thai.
X l: xut mt phng php nga thai khc.
Methadon
Phn tch: Tc dng dc l ca methadon c th gim. Ngi bnh ang
iu tr duy tr bng methadon c th c cc triu chng cai opiat. C ch do
chuyn ho ca methadon gan c th tng.
X l: Theo di cht ch ngi bnh ang dng methadon v cc triu
chng cai khi bt u dng cc cht c ch protease. Nu cn, nn tng li u
ca methadon. Khi ngng thuc c ch protease, nng methadon c th
tng, nn cn phi gim liu ca methadon.
Rifabutin
Phn tch: Rifabutin, mt cht cm ng enzym CYP3A4 gan, lm tng
chuyn ho ca nelfinavir, do lm gim nng ca dng c hot tnh ca
nelfinavir trong huyt tng. Song song, c s tng din tch di ng cong
(AUC) ca rifabutin, v tng nng nh ca thuc ny, dn n gim hi u
qu iu tr ca nelfinavir v tng tc dng c ca rifabutin (au c, au khp,
gim bch cu trung tnh).
X l: Gim liu ca rifabutin xung mt na.
Thuc nga thai ung
Phn tch: Hiu lc ca thuc nga thai ung c th b mt, dn n th
thai ngoi mun. C th do tng chuyn ho ca thuc nga thai gan.
527
X l: Ngi ph n cn c thng tin v s tng nguy c tht bi ca

thuc nga thai ung. Nn dng mt phng php nga thai khng c hormon.
Indinavir c th dng thay th cho nelfinavir.
528
NHA TRAO I CATION

Polyme ca styren sulfonat, di dng mui calci, natri, kali, nhm hay amni
CC THUC TRONG NHM

CALCI POLYSTYREN SULFONAT
Kayexalate thuc bt ung
CH KHI CH NH THUC
Trng hp: Kali mu cao hn hoc bng 5 mmol/lt.
NICORANDIL
Tc nhn gin mch, hot ho m knh kali,
dng trong iu tr d phng cn au tht ngc
CC THUC TRONG NHM

NICORANDIL vin nn 10 mg; 20 mg
Adancor vin nn 10 mg; 20 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai: Do thn trng, v thiu d liu trong y vn v mt thuc mi.
Suy tim: Trng hp suy tht tri, vi p lc lm y yu.
Trng hp khc: H huyt p, sc do tim v c ng vi thuc ny.
Cn thn trng: mc 2
mi.
Thi k cho con b: Do thn trng, v thiu d liu trong y vn v mt thuc

TNG TC THUC

Diltiazem
ng.
529
X l: Theo di huyt p trong khi phi hp. Tu theo thuc, huyt p c

th h nhiu hay t. iu chnh liu ca mt trong hai thuc nu cn. Xy dng
k hoch dng thuc u n. Tng cng theo di ngi bnh cao tui
(nguy c ng), v khuyn chuyn dn dn t t th nm hoc ngi sang t th
ng. Khuyn ngi bnh gp li bc s iu chnh li liu, nu thy chng
mt khi mi dng thuc.
Ru; bepridil; clonidin hoc thuc tng t; dihydropyridin;
furosemid hoc thuc tng t; guanethidin hoc thuc tng t;
methyldopa; nitrat chng au tht ngc; thuc chng trm cm ba vng
hoc thuc tng t; thuc gin mch chng tng huyt p; thuc li tiu
gi kali; thuc li tiu thi kali; thuc c ch enzym chuyn; verapamil
Phn tch: Phi hp vi mi thuc c tnh cht chng tng huyt p c th
lm tng nguy c h huyt p i khi dn ti sc.
X l: Theo di huyt p trong khi iu tr v khi ngng mt trong hai li u
trnh, c bit ch ngi bnh cao tui.
NICOTIN
Cc thuc dng b thi quen nghin ht thuc l
CC THUC TRONG NHM

NICOTIN cao dn 35 mg; 52,5 mg
Nicotinell TTS 20 cao dn 35 mg
Nicotinell TTS 30 cao dn 52,5 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: Nicotin qua c sa m.
Thi k mang thai: Nicotin dn n nhim acid, gim oxy huyt v tng kh
carbonic trong mu qu ba ca thai k. Cn c bin php ng a thai i km v i i u
tr.
Trng hp khc: Qu mn vi thuc, nhi mu c tim giai on cp, au
tht ngc khng n nh, lon nhp tim nng v tai bin mch mu no mi mc, bnh
da c th cn tr vic s dng cc thuc dn ngoi da.

Tr em: Tr em c bit nhy cm vi cc tc dng khng mong mun ca
nicotin, ngay c vi liu thp.
530
Suy tim: Do gii phng catecholamin t vng ty tuyn thng thn.
Thn trng: mc 2
Tiu ng; tng huyt p; cng tuyn gip: Do gii phng catecholamin t ty
thng thn.
Suy thn; suy gan: Tng tc dng khng mong mun.
Lot d dy: Lot d dy tin trin l mt chng ch nh.
Trng hp khc: au tht ngc n nh, suy mch no, cc bnh ng mch
ngoi vi tc nghn.
TNG TC THUC

Cafein; dextropropoxyphen; theophylin hoc dn cht
Phn tch: Nicotin gy cm ng enzym; do , nicotin c th lm tng
chuyn ho ca mt s thuc v dn n gim tc dng iu tr.
X l: Nn cnh gic vi nhng thuc c phm vi iu tr hp trong khi
iu tr thay th nicotin v xem li liu lng trong v sau khi iu tr. Nn nh
rng cm ng enzym l mt hin tng ch xut hin sau khong vi ngy, nh
vy, ngc vi s c ch enzym l mt hin tng tc th.
Thuc chn beta
Phn tch: Nicotin gy cm ng enzym, do , nicotin c th lm tng
X l: Nn cnh gic vi cc thuc c phm vi iu tr hp trong khi iu
tr thay th nicotin v xem li liu lng trong v sau iu tr; y hin tng
ch c ghi nhn vi propranolol (Avlocardyl, Hemipralon, Ratiopharm). Nn
nh rng cm ng enzym l mt hin tng ch xut hin sau khong vi ngy,
nh vy ngc vi s c ch enzym l mt hin tng tc th.
Thuc ch vn morphin
Phn tch: Nicotin gy cm ng enzym, do nicotin c th lm tng
X l: Nn cnh gic vi nhng thuc c phm vi iu tr hp trong khi
iu tr thay th nicotin v nn xem li liu lng trong v sau iu tr; y,
hin tng c ghi nhn vi pentazocin (Fortal). Nn nh rng cm ng
enzym l mt hin tng ch xut hin sau khong vi ngy, nh vy ngc vi
s c ch l mt hin tng tc th.
NILUTAMID
531
Thuc khng androgen khng steroid khng c tc dng hormon hoc khng
hormon, c dng trong iu tr ung th tuyn tin lit
CC THUC TRONG NHM

NILUTAMID vin nn 50 mg
Anandron vin nn 50 mg
CH KHI CH NH THUC

Suy gan: Do chuyn ho mnh gan, nn chng ch nh dng thuc ny khi suy
gan nng: nguy c xut hin vim gan tiu t bo hoc hn hp.
Thn trng: mc 2
Suy h hp - hen: Bt c kh th no m nng ln, phi lo xut hin bnh vim
phi k, cn phi ngng iu tr.
Trng hp khc: Nilutamid c ch h thn kinh trung ng. Ch n ngi
li xe v ngi vn hnh my v khi phi hp vi cc thuc c ch h thn kinh trung
ng khc.
TNG TC THUC

Benzodiazepin
Phn tch: C th do nilutamid c ch enzym chuyn ho thuc gan nn
c nguy c ko di v tng tc dng v c tnh ca mt s benzodiazepin.
X l: Nguy c tng ng g c m t vi mt s benzodiazepin nh
diazepam (Valium), alprazolam (Xanax), dikali clorazepat (Tranxene, Noctran),
flurazepam, nitrazepam (Mogadon), triazolam (Halcion) hoc chlordiazepoxyd
(Librax). Nn chn mt benzodiazepin khng chuyn ho bi cc enzym gan
hoc iu chnh liu ca cc benzodiazepin khi bt u, lc ang v khi ng ng
iu tr nilutamid. Cnh bo cho ngi bnh v nguy c tng tc dng.
Phenytoin
Phn tch: Nguy c tng nng phenytoin trong mu, c l do cc tnh
cht c ch enzym ca nilutamid.
X l: Tng cng theo di lm sng v sinh hc, iu chnh liu ca
phenytoin tu theo cc kt qu.
Thuc chn beta
Phn tch: C l do tnh cht c ch enzym ca nilutamid vi mt s thuc
chn beta, c nguy c tng tc dng ca thuc chn beta.
532
X l: Mt s trng hp nhp tim chm v h huyt p c m t vi

mt s thuc chn beta nh acebutolol (Sectral), alprenolol, betaxolol (Kerlone),
labetalol (Trandate), metoprolol (Lopressor, Seloken, Logroton), oxprenolol
(Trasicor, Trasipressol, Trasitensine), propranolol (Avlocardyl, Hemipralon),
timolol (Timacor, Moducren...). Thay i chin lc iu tr, hoc iu chnh liu
ca thuc chn beta lc bt u, khi ang v sau iu tr bng nilutamid. Cc
iu ny cn c s xc nhn khi m tng tc ny khng c ngha nhi u
trong lm sng. Nn nh rng cc thuc chn beta nh mt cng c tc dng
ton thn.
Phn tch: Nguy c qu liu theophylin, c l do nilutamid c tnh cht c
ch enzym chuyn ho thuc.
X l: Theo di lm sng v sinh hc (nh lng cc nng theophylin
trong huyt thanh). iu chnh liu tu theo cc kt qu lm sng v/hoc sinh
hc. Cc du hiu lm sng v ng c theophylin ch yu l bun nn, nhp
tim nhanh, nhc u, nn v nguy c co git.
Phn tch: Tng tc dng ca cc khng vitamin K c l do gim chuyn
ho ca chng.
X l: iu chnh liu lng ty theo kt qu INR (t l chun quc t) v
TP (t l prothrombin) lc bt u, khi ang v khi ngng iu tr bng nilutamid.
Nhc ngi bnh khng c ngng iu tr t ngt.
NIRIDAZOL
Thuc tng hp chng bnh sn mng
CC THUC TRONG NHM

NIRIDAZOL vin nn 100 mg; 500 mg
Ambilhar vin nn 100 mg; 500 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Suy gan: Suy gan lm chm d ho niridazol, gy tng nng trong mu, to
thun li cho xut hin cc ri lon thn kinh tm thn (kch ng, hoang t ng, o
gic, kch thch tm thn, co git dng ng kinh).
533

Thi k mang thai: V c tnh ton thn, niridazol c coi c tim nng gy
nguy him cho phi.
Trng hp khc: Tng p lc tnh mch ca, k c ngi bnh sn mng,
trm cm, l ln, co git.
Cn theo di: mc 1
Thiu ht G6DP: Xut hin thiu mu tan mu ngi thiu ht G6DP.
TNG TC THUC

Tacrin
X l: Nu cn, tng cng theo di gan. Trnh cc phi hp c nguy c
ngi bnh cao tui.

Azathioprin; carmustin hoc dn cht; dantrolen; doxorubicin hoc dn
cht; griseofulvin; isoniazid hoc thuc tng t; mercaptopurin; methotrexat;
methyldopa; progabid; rifampicin; thuc chng nm dn xut imidazol; vng
Phn tch: Phi hp hai thuc cng c c tnh vi gan. Cng c c c
thn kinh ca niridazol. Nguy c xut hin co git, ri lon tm thn v c vi
gan khi phi hp thuc.
X l: Khi phi hp hai thuc c vi gan, theo di cht ch chc nng
gan (ASAT, ALAT, phosphatase kim, bilirubin) hoc hon mt trong hai liu
php. Xc minh l ngi bnh khng ung ru thng xuyn v khng c tin
s vim gan virus. Cc triu chng lm sng chnh khng c hiu: bun nn,
st, vng da... Nu thy ng thi ban da, nga v hch to th hng v bnh
cn do thuc. Cn c kt qu cc xt nghim sinh hc, phn bit r nguy c
xut hin vim gan tiu t bo c tnh khng phc hi vi vim gan mt hi
phc c khi ngng iu tr.
Phn tch: Mc tiu chnh l iu tr ung th biu m dng tuyn ca thn.
Interleukin cng c vi gan. Nh vy l phi hp hai thuc c tim nng c
vi gan.
X l: iu tr ny ch c th tin hnh c s chuyn khoa. Dng
interleukin cn phi theo di thng xuyn. Trng hp ny nn cn nhc tu
theo tnh trng chung ca ngi bnh. Khi phi hp hai thuc c vi gan, theo
di cht ch chc nng gan (ASAT, ALAT, phosphatase kim, bilirubin) hoc
hon mt trong hai liu php nu c th.
534
Paracetamol
Phn tch: Paracetamol dng di ngy vi liu cao trn 6g/ngy (theo cn
nng) c th c vi gan (vim gan tiu t bo). Khi phi hp vi mt thu c
khc c vi gan, nguy c c vi gan tng ln.
X l: Khi phi hp hai thuc c vi gan, theo di cht ch chc nng
gan (ASAT, ALAT, phosphatase kim, bilirubin) hoc hon mt trong hai liu
php, nu c th. Xc minh l ngi bnh khng ung ru thng xuyn, v
khng c tin s vim gan virus. Cc triu chng lm sng chnh khng c
hiu: bun nn, st, vng da. Nu thy ng thi ban da, nga, v hch to th
hng v bnh cn do thuc. Cn c kt qu cc th nghim sinh hc, phn
bit r nguy c xut hin vim gan tiu t bo c tnh khng phc hi v vim
gan mt hi phc c khi ngng iu tr.
NITROFURAN
Thuc st khun ng tit niu v rut
CC THUC TRONG NHM

NITRO FURANTOIN vin nn 100 mg
Novo furan vin nn 100 mg
NIFUROXAZID nang 200 mg; hn dch 4 mg/100 mL
Ercefuryl nang 200 mg; hn dch 4 mg/100 mL
Entero-Caps nang 200 mg
NIFURZID hn dch ung 0,8 g/100 mL; nang 150 mg
Ricridene hn dch ung 0,8 g/100 mL
Ricridene nang 150 mg
CH KHI CH NH THUC

Suy thn: Nitrofuran c o thi di dng cn hot tnh do lc qua cu thn
v bi tit ng thn. ngi suy thn, hm lng nitrofuran trong huyt thanh tng,
dn n tng nguy c c tnh thn kinh gy vim nhiu dy thn kinh c th dn n
t vong, nu khng ngng iu tr.
Cn theo di: mc 2
n ung-Ru: Furazolidon v nifuratel c ch enzym alcol dehydrogenase, nn
khi ung ru dn n tch t acetaldehyd, gy tc dng antabuse (gin mch, nn, ra
m hi ).
TNG TC THUC
535

Probenecid
Phn tch: Probenecid c ch o thi nitrofuran thn, dn n tng cc
nng trong huyt thanh, ko di na i o thi v gim cc nng trong
nc tiu, do tng hiu qu ca nitrofuran.
X l: S dng probenecid lm chm o thi ca nhiu thuc c th
v c dng lm gim mt s liu lng. Cn rt cnh gic v nhng
nguy c tim n v tng c tnh ca thuc phi hp. y, gim nng
trong nc tiu c th dn n tht bi iu tr.

Ru
Phn tch: Tc dng antabuse (kiu disulfiram) cng thm vi nguy c c
vi gan: nng bt thng acetaldehyd tch t trong cc m (c ch enzym),
dn n mt s du hiu lm sng nh: cn bng vn mch, gin mch nhiu,
nhp tim nhanh, st cao, bun nn, nn, ban da, i khi h huyt p v tru
mch. Nhng triu chng ny nng hay nh tu theo lng ru ung.
X l: Trong khi iu tr vi thuc, nn trnh ung ru do tc dng
antabuse. Khuyn khng dng cc ch phm c ru.

Didanosin
Phn tch: Hip ng cc tc dng khng mong mun: tng nguy c xut
hin vim tu do thuc gy nn.
X l: Theo di lm sng v nu cn, khi c du hiu au bng, theo di
sinh hc chc nng tu (amylase mu, amylase nc tiu).
Phn tch: Thuc khng acid lm gim hp thu ng tiu ho v lm
X l: Cn ung hai thuc cch nhau t 1 n 2 gi. Cn nhc li l cc
thuc khng acid thng c ung 1 gi 30 pht sau ba n v n ung l
ngun gc tng tit dch v.
NITROIMIDAZOL HOC DN CHT

Khng sinh tng hp chng vi khun k kh, chng k sinh trng
536
CC THUC TRONG NHM

METRONIDAZOL
Flagyl vin bao phim 250 mg
Klion-Metro 250-VinaKion vin nn 250mg
Flagyl; Klion; Irizele inf. Metronidazol Inf l 100mg; dung dch tim truyn
500mg:
Dng vin t m o:
Gynalfin (metronidazol 250mg + chlorquinaldol)
Megyna (metronidazol 200mg + chloramphenicol + nystatin)
Neo-Tergynan (metronidazol 500mg + neomycin + nystatin)
Vin nn metronidazol 125mg + spiramycin 750.000 IU:
Daphazyl; Dorogyne; Gylmycin; Hadozyl; Naphacogyl; Novogyl Pologyl;
Razogyl; Rodogyl; Rovazol; Rodazol; Rotaforte; Sansvigyl (vi dn cht
acetylspiramycin); Vidorygyl; Vinphazin.
ORNIDAZOL
Avrazor vin nn 500mg
Tiberal vin nn 500mg; ng tim 125mg/1mL; 500mg/3mL; 1g/6mL
SECNIDAZOL
Flagentyl vin nn 500mg
Seczol DS v Tagera Forte
Fas-3 Kit v Gynekit - phi hp secnidazol 1g vi fluconazol v
azithromycin
TINIDAZOL
Fasigyne; Meko-Tigyl; Midazol; Tinida v Tinifil: vin nn 500mg
Sindazol dung dch tim truyn l 500mg/100ml
Dorokit v Pylobact (phi hp zinidazol vi clarithromycin + omeprazol)
Pylokit (phi hp zinidazol vi clarithromycin + lansoprazol)
537
CH KHI CH NH THUC
n ung - ru: Nguy c tc dng antabuse trong trng hp ung ru.
Thi k cho con b: Cc nitroimidazol qua c sa m.
Thi k mang thai: Trnh dng v thiu d liu, tr trng hp cn thit.
Trng hp khc: Lon to mu, d thng cng thc mu, mt iu ho hoc
bnh vim dy thn kinh ngoi bin l nhng chng ch nh ca loi thuc ny. Cn
trnh khi qu mn vi thuc.
TNG TC THUC

Ru
Phn tch: Tc dng antabuse c m t vi cc nitroimidazol nh
metronidazol (Flagyl), secnidazol (Flagentyl), ornidazol (Tiberal), tinidazol
(Fasigyne). Antabuse (hoc disulfid tetraethylthiouram hoc disulfiram) nh
hng n c ch ca ru: mt lng bt thng acetaldehyd tch t trong
cc m (c ch enzym), dn n mt s du hiu lm sng nh: cn bng vn
mch, gin mch nhiu, nhp tim nhanh, st cao, bun nn, nn, ban da, i khi
h huyt p v tru mch. Nhng triu chng nng hay nh tu theo lng
ru ung vo.
X l: Trong khi iu tr vi thuc, nn trnh ung ru v tc dng
antabuse. Khuyn khng dng cc ch phm c ru.
Disulfiram
Phn tch: Nguy c tnh trng l ln, c th do c ch enzym aldehyd
dehydrogenase hoc cc enzym khc (nh vy gn ging tc dng antabuse).
X l: V mc nng ca cc tc dng khng mong mun, chn mt liu
php khc.

Barbituric
Phn tch: iu tr bng metronidazol b tht bi. Tng tc xy ra chm.
C ch do barbituric gy cm ng chuyn ho metronidazol, nn lm
gim nng huyt tng v o thi nhanh metronidazol. Tng tc dc
ng hc.
X l: Theo di hiu qu iu tr metronidazol ngi bnh dng
barbituric ng thi. Nu cn, tng liu metronidazol. Mt cch khc, c th
dng liu ban u metronidazol cao hn cho ngi ang dng barbituric.
538
Carbamazepin
Phn tch: Nng trong huyt thanh ca carbamazepin c th tng, lm
tng tc dng dc l v c tnh ca carbamazepin. Tng tc xy ra chm.
C ch c th do c ch chuyn ho carbamazepin.
X l: Theo di p ng lm sng khi bt u hoc ngng metronidazol.
Gim st nng huyt thanh ca carbamazepin c th c ch. iu chnh liu
carbamazepin nu cn.
Phn tch: Tc dng dc l ca hydantoin gan c th b metronidazol
c ch.
X l: Khng cn phi c nhng thn trng c bit. Gim st nng
trong huyt tng ca hydantoin v iu chnh liu cho ph hp.
Phn tch: Mc tiu chnh l iu tr ung th biu m dng tuyn ca thn.
Interleukin cng c vi gan. Nh vy c s phi hp hai thuc c tim nng
c vi gan.
X l: Cch iu tr ny ch c th thc hin c s chuyn khoa. Dng
interleukin cn c s theo di thng xuyn. Trong trng hp ny nn cn
nhc ton din tu theo tnh trng chung ca ngi bnh. Khi phi hp hai
thuc c vi gan, hoc cn theo di cht ch chc nng gan (ASAT, ALAT,
phosphatase kim, bilirubin), hoc hon mt trong hai liu php, nu c th.
Phn tch: Cimetidin c ch enzym oxydase gan (cytochrom P450) chu
trch nhim chuyn ho mt s thuc. Hn na, n lm gim lu lng mu
gan. V vy, nng mt s thuc trong huyt tng tng ln (nguy c qu
liu); nhng cng v c ch mt vi chuyn ho, nn cimetidin chn mt s c
ch kh c. C l cimetidin c ch chuyn ho cc nitroimidazol, do nguy
c qu liu.
X l: Nn cn nhc tng tc ny tu theo dng bo ch dng. Bng
ng ung, phi iu chnh liu ca metronidazol (v do ging nhau, iu ny
cng c gi tr vi cc nitroimidazol khc), hoc chn mt thuc khng H2 khc t
c ch enzym hn.
Phn tch: Tng tc dng ca cc khng vitamin K do c ch enzym.
Nitroimidazol l mt thuc c ch enzym nn chn s bin i sinh hc ca
thuc khng vitamin K. Tng tc c m t vi warfarin (Coumadine).
X l: Nu cn phi hp, theo di t l prothrombin v/hoc t l chun
quc t lc bt u, trong v sau khi iu tr bng nitroimidazol. iu chnh liu.
539

Fluoro - 5 - uracil
Phn tch: Tng c tnh ca fluoro - 5 - uracil do gim thanh lc.
X l: Phi hp dng trong c s bnh vin, vi s tng cng theo di
lm sng v huyt hc i vi nguy c nhim c do fluoro-5-uracil.
NITROXOLIN
Thuc st khun ng tit niu, dn cht oxyquinolein c tc dng km khun
trn cc vi khun Gram dng, Gram m v cc Candida
CC THUC TRONG NHM

NITROXOLIN vin nn bao100 mg
Nibiol vin nn bao100 mg
CH KHI CH NH THUC
Cn theo di: mc 1
Suy gan: Gim liu, tu theo mc tn thng gan.
Suy thn: Gim liu, tu theo thanh lc creatinin.
OCTREOTD HOC THUC TNG T

Octapeptid tng hp c tc dng ging somatostatin t nhin
CC THUC TRONG NHM

OCTREOTID dung dch tim 0,1 mg/mL; 0,5 mg/mL; 0,05 mg/mL; bt pha dung
dch tim 10 mg; 20 mg ; 30 mg
Sandostatin dung dch tim 0,1 mg/mL; 0,5 mg/mL; 0,05 mg/mL
Sandostatin LAR bt pha dung dch tim10 mg; 20 mg; 30 mg
SOMATOSTATIN l bt ng kh hon 2 mg
Modustatine l bt ng kh hon 2 mg
CH KHI CH NH THUC
540
Chng ch nh: mc 4
Qu mn vi thuc.

Thi k cho con b - thi k mang thai: Do thn trng, v thiu d liu.
Tr em -tr cn b: Cha c nghin cu.
Thn trng: mc 2
Tiu ng: Gim nhu cu insulin.
liu.
Suy gan- suy thn: Kim tra cc chc nng ca cc c quan ny iu chnh
Trng hp khc: Khi u. Ch n ngi qu mn vi thuc ny.
TNG TC THUC

Biguanid
Phn tch: U tit glucagon c iu tr bng octreotid. Dng cc thuc
chng tiu ng trong khi ang iu tr bng octreotid c th to thun li cho
gim hoc tng glucose mu.
X l: Lu n cch s dng octreotid v cc ch nh, vic iu tr
thng tin hnh c s chuyn khoa, bt buc phi theo di sinh hc u n
v c mc tiu.
Ciclosporin
Phn tch: Nguy c tt nng ciclosporin trong huyt thanh dn n p
ng c ch min dch khng y v nguy c tht bi iu tr. C ch cha
r rng, c l l sandostatin c th lm gim s hp thu ciclosporin rut.
X l: Lu l phi hp ny c thng tin y t liu; nu cn
phi hp, phi theo di cht ch ciclosporin mu v iu chnh liu lc bt u,
khi ang v sau khi ngng iu tr bng octreotid.
Glucagon; sulfamid h glucose mu
Phn tch: S dng glucagon hoc thuc chng tiu ng trong khi iu
tr bng octreotid c th to thun li cho gim hoc tng glucose mu.
X l: Lu n cch s dng octreotid v cc ch nh, vic iu tr
thng tin hnh c s chuyn khoa. ngi tiu ng ang iu tr, phi
theo di cn thn glucose mu v iu chnh liu.
541
Insulin
Phn tch: ngi tiu ng ph thuc insulin, nhu cu v insulin c th
gim t 30 n 50%.
X l: Lu n hu qu ca tng tc xc nh liu. Bo cho ngi
bnh tng cng t theo di v t iu chnh nhu cu insulin cho c nhn.
ngi khng c tiu ng, theo di glucose mu.
OMEPRAZOL
Thuc chng lot, c ch c hiu bm proton, tc dng t bo thnh d dy.
Omeprazol l mt dn cht ca benzimidazol v c th c ch hot ng
ca cytochrom P450
CC THUC TRONG NHM

OMEPRAZOL nang 20 mg; vin nn 20 mg
Belifax nang 20 mg
Lokit nang 20 mg
Lomac vin nn 20 mg
Losec bt pha tim 40mg/l
Losec Mups vin nn 20mg
Meprasac vin nn 20mg
Mepraz nang 20mg
Ocid nang 20mg
Odasol nang 20mg
Olit 20 nang 20mg
Ome 20 nang 20mg
Omeral nang 20mg
Omenat nang 20mg
Omepar nang 20mg
Omeprazole nang 20mg
Omez nang 20mg
Omicap nang 20mg
Omizac nang 20mg
OMP vin nn 20mg
542
Omzol nang 20mg

Probitor nang 20mg
Protoloc 20 nang 20mg
Pylobact nang 20mg (phi hp vi clarithromycin v tinidazol)
Romesec nang 20mg
Stomex nang 20mg
Zerocid nang 20mg
CH KHI CH NH THUC

Thi k cho con b: V thiu cc nghin cu v s bi tit qua sa m.
Thn trng: mc 2
Tr em: V thiu d liu.
Cn theo di: mc 1
Suy gan: Lu n cc d liu dc ng hc, nn theo di chc nng gan
trong iu tr di ngy.
TNG TC THUC

Pentagastrin
Phn tch: Cc cht c ch bm proton c th i khng tc dng dc l
ca pentagastrin.
X l: Dng pentagastrin v dng thuc c ch bm proton phi cch xa
nhau 96 gi.

Benzodiazepin
Phn tch: Omeprazol c ch mt s cytochrom P450, nn lm chm
chuyn ho mt s benzodiazepin, lm tng nng ca chng trong huyt
thanh v trong trng hp ny d gy tc dng khng mong mun do qu liu.
X l: Tng tc ch c th xy ra vi cc benzodiazepin c chuyn ho
qua cytochrom P450 (loi chlordiazepoxyd, diazepam, flurazepam, triazolam...)
bng cch c ch chuyn ho ca chng, lm cho cc tc dng gii lo v an thn
tng ln. Cn gim liu hoc thay i cht c ch bm proton cc ngi bnh
ny.
543
Macrolid
Phn tch: pH d dy tng do omeprazol gp phn ci thin tnh bn vng
ca clarithromycin, lm tng nng trong m v d dy ca macrolid ny v
cht chuyn ho c hot tnh ca n. Tng tc dc ng hc.
X l: Tng tc c th c ngha lm sng tt, nhng cn cn phi xc
nhn thm.
Phenytoin
Phn tch: Omeprazol c ch mt s cytochrom P450, nn lm chm
chuyn ho phenytoin, lm tng nng ca chng trong huyt thanh v d c
nguy c nhim c phenytoin do qu liu. Tng tc dc ng hc v chuyn
ho thuc.
X l: Cnh gic v lm sng v nu cn, th nn theo di nng
phenytoin trong mu v iu chnh liu lc bt u, lc ang v sau khi iu tr
vi omeprazol (vic iu tr thng ko di t 4 n 6 tun) hoc thay i thuc
c ch bm proton nhng ngi bnh ny.
Tacrolimus
Phn tch: Omeprazol c ch mt s cytochrom P450, nn c ch chuyn
ho ca tacrolimus v lm tng nng trong huyt tng. Tng tc dc
X l: Nn gim liu tacrolimus v theo di chc nng thn qua vic o
creatinin mu. Vic theo di nng tacrolimus trong huyt tng c thc
hin trong khi iu tr v sau khi ngng dng tacrolimus.
Phn tch: Omeprazol b gim hp thu ng tiu ho bi thuc khng
acid, dn n gim tc dng dc l ca omeprazol.
X l: Cn ung hai thuc cch nhau t nht t 1 n 2 gi. Nn nh rng
cc cht khng acid thng c ung 1 gi 30 pht sau ba n, v n ung l
Phn tch: Omeprazol c ch mt s cytochrom P450 c th dn n chm
chuyn ho thuc ung chng ng mu, gy tng nng trong huyt thanh
v trong trng hp ny, d c nguy c chy mu do qu liu.
X l: Theo di t l prothrombin hoc t l chun quc t (INR) v iu
chnh liu lc bt u, khi ang v sau khi iu tr bng omeprazol (iu tr
thng ko di t 4 n 6 tun) hoc thay i thuc c ch bm proton
nhng ngi bnh ny.
544
OXAFLOZAN
Chng trm cm, gii lo, tc dng serotoninergic
CC THUC TRONG NHM

OXAFLOZAN dung dch ung 2%
Conflictan dung dch ung 2%
CH KHI CH NH THUC

Thi k cho con b: Trnh dng oxaflozan trong thi k cho con b, v thiu d
liu chnh xc
Thi k mang thai: Trnh dng oxaflozan khi mang thai, mc du cha chng
minh c tc dng gy qui thai no.
Suy thn: Chng ch nh dng oxaflozan khi suy thn do thuc o thi qua
thn l ch yu v do thiu cc thng s chnh xc v dc ng hc.
Thn trng: mc 2
n ung; ru: Khng nn dng ung c ru khi iu tr bng oxaflozan,
mc du c th ch phm oxaflozan ung c cha ru. Cn thn vi tc dng ging
disulfiram vi mt s ch phm do c cha ru.
TNG TC THUC

Thuc c ch monoamin oxydase (IMAO) khng chn lc
Phn tch: Tc dng hip ng ln hot tnh c ch h thn kinh trung
ng. Oxaflozan l cht chng trm cm serotoninergic. Phi hp vi cc cht
c ch monoamin oxydase c nguy c gy ra hi chng serotonin (kch ng, l
ln, run ry, cng , mch nhanh, m hi, rng mnh)
X l: Khng phi hp. i chin lc iu tr. Ch 15 ngy sau khi ngng
iu tr bng thuc c ch monoamin oxydase mi cho dng oxaflozan.

Phn tch: Gim tc dng chng tng huyt p, do oxaflozan c ch ti
thu nhn guanethidin dy thn kinh, lm kh t cn bng huyt p.
X l: Chn mt thuc chng tng huyt p khc. Nn trnh phi hp.
Ru
tc dng an thn bun ng. Vi mt s ch phm, nht l trong tun i u tr
545
u tin, c th thy mt s tc dng v tm thn-vn ng. Tng tc d c

lc.
X l: Khng nn dng thuc ny khi ngi k n khng kim sot c
vic ung ru ca ngi bnh. Nguy c bun ng l nguy him vi ngi li
xe v ngi vn hnh my. Khuyn khng ung ru v khng t dng thuc
hoc ch phm cha ru.

Amineptin; clozapin; paroxetin; procarbazin
X l: Lu nguy c ny iu chnh liu ca hai thuc. Ch n
gim tnh to ngi li xe v ngi vn hnh my. Khuyn khng ung ru
Disulfiram
ung.
Phn tch: Tc dng disulfiram do c ru trong ch phm oxaflozan
X l: Trnh ru khi dng disulfiram. D chng ngi bnh dng cc

thuc cha ru. Khng phi hp chng vi disulfiram, v cc tc dng khng
mong mun c th xut hin (tng tc ru disulfiram).
Thuc gy m cc loi (ngoi barbituric); thuc gy m bay h i ch a
halogen
cc tc dng an thn bun ng. Tng tc dc lc.
X l: Khuyn ngi bnh chun b phu thut, bo cho ngi gy m
bit cc loi thuc dng.

amphetamin.
Khuyn ngi bnh gp li bc s nu thy iu tr c v khng n nh.
Baclofen; carbamazepin; dextropropoxyphen; natri valproat hoc dn xut;
phenytoin; primidon hoc dn xut; reserpin; thuc an thn kinh cc loi; thuc
ch vn morphin; thuc khng histamin khng H1 an thn; viloxazin
cc tc dng an thn bun ng. Tng tc dc lc.
546
X l: Lu nguy c ny iu chnh liu ca hai thuc nu cn phi

hp. Ch n gim tnh to ngi li xe v ngi iu khin my. Khuyn
khng ung ru v khng t dng thuc hoc ch phm cha ru.
Barbituric; benzodiazepin; benzamid; butyrophenon; carbamat hoc thuc
tng t; gluthetimid hoc thuc tng t; methyldopa; mianserin; thuc chng
ng kinh khng barbituric; thuc chng trm cm ba vng hoc thuc tng t;
thuc c ch h thn kinh trung ng cc loi
gim tnh to nhng ngi li xe v ngi vn hnh my. Khuyn khng ung
thm ru v khng t dng thuc hoc ch phm c ru.
tc dng an thn bun ng. Tng tc dc lc. Nn nh l, liu thng
dng, rilmenidin khng lm tng tc dng c ch h thn kinh trung ng ca
cc ch phm oxaflozan.
thm ru v khng t dng thuc hoc ch phm c ru.
Dn cht phenothiazin
tc dng an thn bun ng, c m t vi mt s phenothiazin an thn.
Tng tc dc lc.
X l: Lu nguy c ny hiu chnh liu dng ca hai ch phm, nu
cn phi hp. Ch n gim tnh to nhng ngi li xe v ngi vn hnh
my. Khuyn khng ung thm ru v khng t dng thuc hoc ch phm
c ru.
Methadon
Phn tch: Tng tc dng c ch h thn kinh trung ng, km vi an
thn bun ng mnh, c bit c hi cc ngi li xe v ngi vn hnh my.
X l: Lu n tc dng tng bun ng cho li khuyn thch hp
(trnh li xe hoc vn hnh my).
X l: Nu cn phi hp, lu nguy c ny khi gy m v hiu chnh liu
dng.
547
OXITRIPTAN
Tin cht ca serotonin, c dng trong mt s git rung c sau
thiu oxy m ca Lance v Adams
CC THUC TRONG NHM

OXITRIPTAN nang 100 mg
Levotonine nang 100 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Trng hp khc: Trong cc trng hp u carcinoid rut non.

thn.
Suy thn: Tu theo thanh lc creatinin, cn nh gi mc tn thng ca
Cn theo di: mc 1
Thi k cho con b/mang thai: Do thn trng, cha c d liu v thuc mi.
Suy tim: Lu n cc tnh cht v tim mch ca ch phm.
TNG TC THUC

Phn tch: Oxitriptan l tin cht ca serotonin (amin co mch); do tnh
cht dc l ca ch phm ny, nn trnh phi hp.
X l: Nn trnh phi hp; thay i chin lc iu tr, v c nguy c ri
lon huyt p trm trng.
OXYTOCIN
Cc cht tng hp tng t oxytocin t nhin ca thy sau tuyn yn
CC THUC TRONG NHM

OXYTOCIN dung dch tim 5 IU/mL
548
Oxytocin dung dch tim 5 IU/mL

CH KHI CH NH THUC

Tng trng lc t cung, t cung e do d v, khuynh hng d nghn mch
nc i. Cc kh c hc, nhau tin o, nhim c thai nghn. Qu mn vi
oxytocin.
TNG TC THUC

Prostaglandin trong ph khoa
Phn tch: Tng tc dng ca oxytocin do prostaglandin v ngc li, cng
vi s tng mnh tn s v cng co t cung.
X l: Phi theo di lm sng rt chnh xc.
549
PAPAVERIN HOC DN CHT

Gin mch ngoi vi, loi chng co tht
CC THUC TRONG NHM

PAPAVERIN vin nn 40 mg; ng tim 0,02 g/1mL
Paverid ng tim 0,02 g/1mL
ALVERIN (hoc dipropyline)
Bi-Spas vin nn 40 mg
Dospamin vin nn 40 mg
Eftispasmin vin nn 40 mg
Non-Spas vin nn 40 mg
Spasdipyrin vin nn 40 mg
Spasma vin nn 40 mg
Spasmavrine vin nn 40 mg
Spasmebi vin nn 40 mg
Spasmapyrin vin nn 40 mg
Spasmapharin vin nn 40 mg
Spasverin vin nn 40 mg
Spasvina vin nn 40 mg
Traverin vin nn 40 mg
Vacoverin vin nn 40 mg
DROTAVERIN vin nn 40 mg; dung dch tim 40 mg/2mL
Nospa vin nn 40 mg
Nospa dung dch tim 40 mg/2mL
Nos-Bra vin nn 40 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Tng p sut ni s v ri lon dn truyn trong tim

Thi k mang thai: Thiu cc d liu.
Parkinson: Lu cc tc dng khng mong mun ca cc ch phm.
550
Cn theo di: mc 1
Suy gan: Mt vi trng hp vim gan hi phc c khi ngng thuc c
m t khi iu tr di ngy bng papaverin.
TNG TC THUC
Levodopa
Phn tch: Papaverin c th chn cc th th dopamin, do c ch tc
dng chng Parkinson ca levodopa (tin cht ca dopamin).
X l: Cn trnh phi hp, chn cch iu tr khc.
Thuc c ch monoamin oxydase typ B
dng ca levodopa, gii thch cho vic k n cng vi thuc ny. Cc t ng
tc nh vy cng ging nh ca levodopa v xin xem h ny. Papaverin c
th chn cc th th dopamin, do c ch tc dng chng Parkinson ca
levodopa (tin cht ca dopamin).
X l: Cn trnh phi hp; chn cch iu tr khc.

Nitrat chng au tht ngc
Phn tch: Phi hp vi mi thuc c tnh cht chng tng huyt p c th
lm tng nguy c h huyt p, c th dn ti sc.
X l: Theo di huyt p trong iu tr v khi ngng mt trong hai thuc.
Lu c bit ngi bnh cao tui.
PARACETAMOL
Gim au, h st
CC THUC TRONG NHM

PARACETAMOL vin nn 325 mg; 500 mg; vin n 80 mg; 150 mg; 300 mg; bt
si 150 mg; l 1g, tn khc: Acetaminophen.
Acetaphen ng tim 300 mg/2ml
551
Actadol vin nn 500 mg

Anadol vin nn 325 mg
Biogesic vin nn 500 mg
Dafalgan cm pha dung dch ung 150 mg
Dafalgan vin t 150 mg; 300 mg
Decolgen Ace vin nn 500 mg
Dolodon vin nn 500 mg
Dopalgan vin nn v nang 500 mg
Efferalgan bt si 150 mg
Efferalgan vin n 80 mg; 150 mg; 300 mg
Efferalgan vin si 500 mg
Mexcold vin nn di 500 mg
Panadol vin nn di, vin si 500 mg
Pro- dafalgan l 1g
Perfalgan l 100 ml tim truyn 10mg/mL
Tatanol vin nn di, vin si 500 mg
Tydol vin nn 650 mg
CH KHI CH NH THUC

Suy gan: Paracetamol c th dn n hoi t trung tm tiu thy gan do c tnh
ca mt trong cc cht chuyn ho ca n to thnh gan v bnh thng b kh hot
tnh do cng hp vi glutathion. Trong trng hp suy gan, kh nng kh hot tnh c
th km hiu lc.
Thn trng: mc 2
Trng hp khc: Vim gan virus. Trnh s dng trong trng hp bit l
qu mn vi ch phm ny.
Cn theo di: mc 1
Suy thn: V nguyn tc, cn theo di chc nng thn trong trng hp iu tr
ko di, mc du cha chng minh c c tnh vi thn trong iu kin s d ng
bnh thng.
TNG TC THUC

Tacrin
552
X l: Nu cn, tng cng theo di gan (transaminase); trnh cc phi

hp c nguy c ngi bnh cao tui.
Zidovudin
Phn tch: Nguy c gim bch cu v c vi gan.
X l: X l thay th bng aspirin v/ hay ibuprofen. Nu cn phi hp,
phi theo di cng thc mu v ch s gan u n.

Barbituric
Phn tch: ngi bnh dng barbituric u n, c th tng chuyn ho
ca paracetamol gan do cm ng enzym, c th ko theo gim hot tnh. Nh
vy, cng c th tng c tnh vi gan ngi nghin ru hay ngi bnh
iu tr u n bng barbituric.
X l: Theo di lm sng cc ngi bnh c nguy c ny. Nu cn, theo
di sinh hc cc ngi bnh bun nn.
Carmustin hoc dn cht; doxorubicin hoc dn cht; isoniazid hoc
thuc tng t; mercaptopurin; methotrexat; niridazol; rifampicin; thuc chng
nm dn xut imidazol; vng
Phn tch: Paracetamol ung di ngy vi liu trn 6g/ngy (theo th
trng) s gy c vi gan (vim gan th tiu t bo). Khi phi hp vi mt thuc
c vi gan khc, nguy c c vi gan tng hn.
X l: Khi phi hp hai thuc c vi gan, cn phi theo di cn thn
chc nng gan (ASAT, ALAT, phosphatase kim, bilirubin) hoc hon nu c
th, mt trong hai thuc . Xc minh ngi bnh khng dng ru thng
khng c hiu: bun nn, st, vng da... Nu c phi hp ban da, ng a v
hch to, c nhiu kh nng l do thuc. Phn bit r, cn c vo cc kt qu
th sinh hc, nguy c xut hin vim gan tiu t bo khng phc hi vi vim
gan mt phc hi c khi ngng thuc.
Dantrolen
Phn tch: y l phi hp gia hai thuc c kh nng c vi gan, nht
l khi paracetamol c dng ko di v trn 4 - 5g/ngy.
X l: Khi phi hp hai thuc c vi gan, hoc phi theo di cht ch
chc nng gan (ASAT, ALAT, phosphatase kim, bilirubin), hoc hon nu c
th, mt trong hai thuc. Xc minh l ngi bnh khng ung ru thng
xuyn v khng c tin s vim gan do virus. Cc du hiu lm sng chnh
khng c hiu: bun nn, st, vng da... Nu c phi hp ban da, ng a v
hch to, c nhiu kh nng l do thuc. Phn bit r, cn c theo cc kt qu
th sinh hc, nguy c xut hin vim gan tiu t bo khng phc hi vi vim
gan mt phc hi c khi ngng thuc.
553
Phn tch: Mc tiu chnh l iu tr bnh ung th biu m thn dng
tuyn. Interleukin cng c vi gan. Nh vy, l phi hp ca hai thuc c
kh nng c vi gan.
X l: y l mt tr liu ch c th tin hnh trong mt c s chuyn
khoa. Interleukin cn s theo di lin tc. Trong trng hp ny, cn cn nhc
theo tnh trng chung ca ngi bnh. Khi phi hp hai thuc c vi gan, hoc
l phi theo di cht chc nng gan (ASAT, ALAT, phosphatase kim, bilirubin)
hoc hon nu c th, mt trong hai thuc.
Phn tch: Tim nng gy c vi gan ca paracetamol c th tng khi
dng ng thi vi hydantoin lu di. Tc dng iu tr ca paracetamol c th
b gim khi phi hp vi hydantoin. Tng tc xy ra chm. C ch do
hydantoin c th gy cm ng cytochrom P 450 gan lm tng chuyn ho
paracetamol thnh cc cht chuyn ho c cho gan.
X l: Nguy c nhim c gan ln nht khi paracetamol dng ko di hoc
qu liu, km theo dng hydantoin u n. Khi dng liu iu tr thng thng,
paracetamol v hydantoin khng cn phi iu chnh liu hoc gim st c
bit.
Lamotrigin
Phn tch: Nng trong huyt thanh ca lamotrigin c th b gim, lm
gim tc dng iu tr. Tng tc xy ra chm. C ch cha r.
X l: Tng tc t c kh nng xy ra nu ch dng mt hoc vi liu
paracetamol. Nhng nu dng ko di, v khi nghi ng c tng tc, cn phi
iu chnh liu lamotrigin. Quan st p ng lm sng ca ngi bnh v iu
chnh liu lamotrigin theo .
Ru
Phn tch: Tng to cc cht chuyn ho c vi gan ca paracetamol v
cm ng enzym cytochrom P450 do ru, nu ngi bnh nghin ru.
X l: Trnh ko di iu tr bng paracetamol cho ngi bnh nghin
ru. Gim cc liu thuc gim au v nu cn, dng mt thuc gim au
khc.
Thuc ung chng ng mu
Phn tch: Paracetamol c th lm tng tc dng chng huyt khi ca
thuc ung chng ng mu, ph thuc vo liu dng. Nu dng liu thp (<6
vin loi 325 mg/tun), th khng c nh hng v lm sng. Tng tc xy ra
chm. C ch cha r.
X l: Hn ch dng paracetamol v gim st cc thng s ng mu
nhiu ln hn (th d 1-2 ln/tun) khi bt u hoc ngng paracetamol, c
bit khi dng paracetamol > 2275 mg/tun. iu chnh liu thuc ung chng
ng mu khi cn.
554
PAROXETIN
Thuc chng trm cm serotoninergic thun tu
CC THUC TRONG NHM

PAROXETIN vin nn 20 mg
Deroxat vin nn 20 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Tr em: Chng ch nh tr di 15 tui, do thiu nghin cu.
Qu mn vi thuc.

Thi k cho con b/mang thai: Cha c c liu.
Thn trng: mc 2
Suy gan: Lu n nguy c tng cc enzym gan.
TNG TC THUC

Sibutramin
Phn tch: Vic kt hp sibutramin vi cc thuc c ch ti thu hi
serotonin (nh paroxetin) lm tng nguy c xut hin hi chng serotonin, bao
gm cc triu chng v kch thch h thn kinh trung ng, yu ui trong vn
ng, rung git c, thc suy gim. C ch l do tc dng serotoninergic ca
hai thuc hip ng vi nhau.
X l: Trnh dng kt hp thuc ny. Nu khng th trnh c, theo di
s xut hin cc du hiu tc dng ph bnh nhn, c bit s xut hin hi
chng serotonin.
Sumatriptan
Phn tch: Tng tc dc lc do hip ng cc tc dng serotoninergic,
c th dn n tng huyt p v co tht ng mch vnh.
X l: Trnh phi hp. Nu cn phi hp, tn trng thi hn 1 tun t lc
ngng thuc chng trm cm n khi dng sumatriptan.
555
Thuc cng giao cm

Phn tch: Khi kt hp vi cc thuc c ch ti thu hi serotonin (nh
paroxetin), tnh nhy cm vi cc thuc cng giao cm tng, lm tng nguy c
xut hin hi chng serotonin. C ch cha r.
X l: Nu hai thuc ny bt buc phi dng ng thi, theo di s xut
hin nhng du hiu v triu chng v thn kinh trung ng. Hiu chnh liu
nu cn.
Thuc c ch monoamin oxydase khng chn lc
Phn tch: Tng ti thu nhn serotonin, c th ci thin p ng iu tr,
nhng sau , cng tng mnh c tnh (h nhit, co git...).
X l: Tn trng thi hn t nht 2 tun k t lc ngng thuc c ch
monoamin oxydase n khi dng thuc chng trm cm serotoninergic. Khi
ngng iu tr bng thuc chng trm cm serotoninergic, ch 1 tun l (vi
fluoxetin, cn thi hn 5 tun) mi dng thuc c ch monoamin oxydase.
Phn tch: Xy ra hi chng serotonin khi phi hp mt hot cht
serotoninergic v mt thuc c ch monoamin oxydase. Bng ngoi suy, phi
hp mt thuc chng trm cm tc ng thng qua serotonin thun tu vi
mt thuc c ch monoamin oxydase, k c c hiu, c nguy c
dn n l ln, kch ng, st cao, co git, co mch ngoi vi v tng huy t p
nng.
X l: Ch 2 tun k t lc ngng dng thuc c ch monoamin oxydase
B n khi bt u iu tr bng thuc chng trm cm serotoninergic v t nht
1 tun, t lc ngng thuc chng trm cm n lc bt u dng thuc c ch
monoamin oxydase.

Benzodiazepin
Ciproheptadin
Phn tch: Ciproheptadin lm gim tc dng dc l ca paroxetin ni
ring v cc thuc c ch ti nhp serotonin ni chung khi dng kt hp. C ch
l paroxetin c hot tnh serotoninergic, cn ciproheptadin li l cht i khng
vi serotonin. Tng tc th hin th th.
X l: Nu hiu qu chng trm cm gim i, xt vic ngng dng
ciproheptadin.
556
Cyclosporin
Phn tch: Paroxetin ni ring v cc thuc c ch ti thu nhn serotonin
ni chung lm tng nng cyclosporin trong mu, km theo tng c tnh ca
n. C ch c th do c c ch s chuyn ho cyclosporin thng qua cytochrom
P450 3A4.
X l: Theo di nng cyclosporin trong mu ton phn khi bt u dng
v khi ngng dng thuc c ch ti thu nhn serotonin. Hiu chnh liu
cyclosporin nu cn.
Thuc c ch monoamin oxydase typ A (IMAO-A)
Phn tch: Qu liu serotonin, do hip ng cc tc dng dc l ca cc
thuc. C th xut hin hi chng serotonin, mc nng nh khc nhau,
nhng c th dn ti t vong.
X l: Hi chng serotonin c cc biu hin khc nhau vi cc triu chng
v tm thn (l ln, kch ng, thm ch hn m...), v vn ng (git rung c,
run ry, tng hot ng, cng ...), v thn kinh thc vt (h hay tng huyt
p, nhp tim nhanh, rt run, m hi...), v tiu ho (tiu chy...). Cn trnh
phi hp.

Baclofen; barbituric; benzamid; buspiron; carbamat hoc thuc tng t;
carbamazepin; dn cht phenothiazin; mianserin; oxaflozan; primidon hoc dn
xut; thuc an thn kinh cc loi khc; thuc chng ng kinh khng barbituric;
thuc chng trm cm ba vng hoc thuc tng t; thuc c ch thn kinh trung
ng cc loi khc
Phn tch: Tc dng hip ng trong c ch h thn kinh trung ng. Ch
, khi cha ngoi tr, ngi li xe v ngi vn hnh my. Nn nh l
rilmenidin, liu thng dng, khng lm tng cc tc dng c ch h thn kinh
trung ng ca cc thuc .
X l: Lu nguy c ny hiu chnh liu ca hai thuc, nu cn phi
hp. Ch n gim tnh to ngi li xe v ngi vn hnh my. Khuyn
khng ung ru v khng t dng thuc hoc cc ch phm c ru.
Lithi
Phn tch: Hip ng cc tc dng khng mong mun: tng c tnh vi
thn kinh ca cc mui lithi, km vi nguy c xut hin hi chng serotonin
557
(kch ng, run ry, cng , h hay tng huyt p, nhp tim nhanh, m hi,
rng mnh,...).
X l: Theo di lm sng u n, nu cn phi hp. Nu cn, hiu chnh
liu dng trong khi v sau khi iu tr bng thuc chng trm cm v theo di t
l lithi trong huyt thanh.
Phn tch: Phi hp cc thuc c th c vi gan (cng hp cc tc dng
khng mong mun).
X l: Khi phi hp hai thuc c vi gan, hoc theo di cht ch chc
nng gan (ASAT, ALAT, phosphatase kim, bilirubin) hoc hon, nu c th,
mt trong hai cch tr liu. Xc minh l ngi bnh khng ung ru u n v
khng c tin s vim gan do virus. Cc triu chng lm sng chnh khng c
hiu: bun nn, st, vng da,... Nu c s phi hp ban da, nga v hch to,
bo hiu kh nng bnh do thuc. Phn bit r, theo cc kt qu th nghi m
mt phc hi c khi ngng dng thuc.
Phenytoin
tc dng an thn bun ng. Ngoi ra, gim t l paroxetin trong huyt tng c
th lm thay i p ng iu tr.
X l: Lu cc nguy c ny hiu chnh liu dng hai thuc, nu cn
phi hp. Ch n gim tnh to ngi li xe v ngi vn hnh my.
Khuyn khng ung ru v khng t dng thuc hoc cc ch phm c
ru.
Ru
X l: Ch n gim tnh to ngi li xe v ngi vn hnh my.
Khuyn khng ung thm ru v khng t dng thuc hoc ch phm cha
ru.
Phn tch: Do lin kt mnh vi protein huyt tng, thuc phi hp c
th th ch cc khng vitamin K, c bit l acenocoumarol (Sintrom). Nguy c
chy mu.
X l: Theo di t l prothrombin hay t l chun ha quc t -INR v hiu
chnh liu thuc ung chng ng mu khi bt u, khi ang iu tr v trong 8
ngy sau khi ngng paroxetin.

Dextropropoxyphen; interferon alpha ti t hp; thuc ch vn morphin;
thuc khng histamin khng H1 an thn;
558

X l: Lu nguy c ny hiu chnh liu hai thuc. Ch n gi m
tnh to ngi li xe v ngi vn hnh my. Khuyn khng ung ru v
Methadon
Phn tch: Gia tng tc dng c ch h thn kinh trung ng, km an thn
mnh gy bun ng, c hi c bit cho nhng ngi li xe v vn hnh my.
X l: Cn trnh li xe v vn hnh my mc. Thng bo cho ngi xung
quanh bit mi nguy him ny.
PENICILAMIN HOC THUC TNG T

Tc nhn to phc vi cc cation ho tr hai, cng c dng trong iu tr
vim a khp dng thp v c mt nhm thiol trong cu trc
CC THUC TRONG NHM

PENICILLAMIN vin nn 250 mg
Cuprenil vin nn 250 mg
Trolovol vin nn 250 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: Thiu cc d liu.
Thi k mang thai: Nguy c d dng xng. Trong trng hp m b bnh
Wilson, ngi k n phi cn nhc tng quan nguy c/li ch.

Cc bnh mu: Nguy c gim bch cu, gim tiu cu, mt bch cu ht.
Suy thn: Nguy c tn thng thn nng thm
Nhc c: Tng cc triu chng nhc c.
Trng hp khc: Lupus ban . Cc bnh vim da nng. Qu mn vi mt
trong cc thnh phn ca ch phm. Tin s tai bin nng vi cc thiol.
TNG TC THUC
559

Aminosid tim hoc dng ti ch; foscarnet
Phn tch: Tng nguy c c vi thn, do phi hp hai thuc c tim nng
c vi thn. Cng hp tc dng khng mong mun.
X l: Nhng phi hp ny thng thy, nht l trong bnh vin; mc du
cch dng aminosid liu duy nht hng ngy hn ch c c vi tai v c
vi thn, nhng khi cn phi hp, nn hiu chnh liu aminosid theo thanh
lc creatinin (cng thc Cockroft v Gault). Theo di c bit khi dng ngi
bnh cao tui.
Vng
Phn tch: Tng cc nguy c c vi thn, cc ri lon v huyt hc v ban
da.
X l: Cn nhc k tng quan li ch/nguy c, theo bi cnh sinh l bnh
hc; theo di phi hp c s chuyn khoa, nu khng trnh c.

Amphotericin B
Phn tch: Phi hp amphotericin B tim vi cc cht c vi ty i hi
phi rt thn trng. Nguy c thiu mu v cc ri lon khc v huyt hc.
X l: Nu cn phi hp, nn theo di cn thn cng thc mu v, nu
cn, th tin hnh gim liu.
Azathioprin; cisplatin hoc dn xut; cyclophosphamid hoc thuc tng
t; doxorubicin hoc dn xut; fluoro 5 uracil; melphalan; mercaptopurin;
methotrexat; thuc chng ung th cc loi khc
Phn tch: Nguy c tng c tnh vi mu, do c ch tu xng, do cc
tc dng cng hp, c th dn n mt bch cu ht.
X l: Nu c th, trnh phi hp. Nu cn phi hp, nn dng cc liu
thp cho mi thuc v theo di cn thn cng thc mu. Phi hp ny do cc
chuyn gia thc hin v thng cc phc iu tr c thit lp tt.
tc dng cng hp, c th dn n bt sn tu.
X l: Nu cn phi hp, nn dng liu thp cho mi thuc v theo di
cn thn cng thc mu.
Clozapin
tc dng hip ng, c th dn n mt bch cu ht. Ch dng n c
clozapin, cng c th mt bch cu ht nng, thm ch t vong ( c tnh min
dch).
560
X l: Nu cn phi hp, nn dng cc liu thp cho mi thuc. Khng

th d on s xut hin mt bch cu ht khi dng clozapin. Vic theo di cn
thn huyt , thng lm khi dng mt thuc km t bo, vn c gi tr . Tuy
vy, ngi bnh phi c thng bo nu thy hi st, vim hng v lot ming
th phi ngng iu tr bng clozapin.
Dactinomycin; dn cht pyrazol; pentostatin; trimethoprim; vincristin hoc
thuc tng t
Phn tch: Dng ng thi hai thuc c ch tu xng c th dn n cc
ri lon huyt hc nng, tu theo di thi gian tr liu. Cng cn theo di
chc nng thn.
X l: Phi hp ny cn theo di u n v huyt hc v thn.
Dn cht phenicol
Phn tch: Nguy c c vi mu, do c ch tu xng, do tc dng cng
hp, c th dn n bt sn tu. Ch dng n c dn cht phenicol cng c
th b mt bch cu ht nng, thm ch t vong (c tnh min dch).
X l: Nu cn phi hp, nn dng nhng liu thp cho mi thuc. Khng
th d on s xut hin mt bch cu ht khi dng cc dn cht phenicol.
Vic theo di cn thn huyt , thng lm vi vic dng mt thuc km
t bo, vn c gi tr. Tuy vy, ngi bnh phi c thng bo l nu thy hi
st, au hng v lot trong ming th phi ngng iu tr bng thuc phenicol.
Digoxin
Phn tch: Penicilamin lm gim nng digoxin trong huyt thanh, nn c
th lm gim tc dng dc l ca n. C ch cha r.
X l: Theo di nng digoxin trong huyt thanh. Nu thy p ng lm
sng gim, cn nng cao liu digoxin ln.
Phn tch: Interleukin ch c dng c s chuyn khoa. Nguy c cng
hp cc tc dng c vi thn v c ch tu xng ca hai thuc.
X l: Tr liu bng interleukin ch c tin hnh trong c s chuyn
khoa, do mc nghim trng ca ch nh. Cn nhc cc tng tc t ng i
theo tnh trng chung ca ngi bnh. Nu khng th hon mt trong hai loi
thuc, theo di cn thn v thng xuyn ion , thanh lc creatinin v cng
thc mu.
Khng acid ung hoc than hot
Phn tch: Gim hp thu penicilamin v bi cc khng acid (ti 66%).
X l: Cn thit ung hai thuc cch nhau t nht 2 gi. Thuc khng acid
thng phi cho ung sau khi n 1 gi 30 pht, v thc n l ngun gc tng tit
dch v.
561
Pyridoxin
Phn tch: Nguy c thiu mu hay vim thn kinh ngoi bin khi dng
penicilin ko di do i khng hay do tng o thi pyridoxin (trong c th).
X l: Khi iu tr penicilin ko di, c th cn dng pyridoxin trong qu
trnh iu tr tu theo s xut hin cc triu chng.
St
Phn tch: Gim hp thu penicilamin do st (ti 35%). Ung thuc cch xa
nhau (2 gi). Phi theo di.
X l: Tng tc cn lu v khuyn ngi bnh ung hai thuc cch xa
nhau t nht 2 gi.
PENICILIN
Cc khng sinh dit khun (h beta lactam)
CC THUC TRONG NHM

AMOXICILLIN nang 250mg; 500 mg; bt pha tim l 1g; bt pha siro 250 mg;
500mg; 25mg/mL; vin nn 125 mg; hn dch 125 mg/5 mL; gi 250 mg
Amodex bt pha tim l 1g; bt pha siro 250 mg; 500mg
Amolin bt pha siro 25 mg/mL
Amox nang 250 v 500mg
Amoxycilin nang 250 mg; 500 mg
Cc bit dc: Amoxilin phi hp vi Kali Clavulamat: Augmentin, Amorsiklav,
Moxiclav v.v
Clamoxyl gi 250 mg; bt pha dch treo ung 250mg/5mL
Helicocin bt pha siro 250 mg/5mL
Hiconcil nang 500 mg
Lykamox nang 250 v 500mg
Maxmox vin nn 125 mg; hn dch 125 mg/5 mL
Ospamox nang 250mg; 500 mg
AMPICILLIN l 1g; nang 250 mg; 500 mg; vin nn 250 mg; hn dch ung
125mg/ 5mL; bt pha siro 250 mg/5mL; 500 mg/5mL
Ampicillin bt pha tim l 1g
Ampicillin hn dch ung 125 mg/5mL
Ampicillin nang 250 mg; 500 mg; vin nn 250 mg
562
Ampicillin Panpharma bt pha tim l 1g

Ampicillin Sedapharm bt pha tim l 1g
Rosampline vin nang 500 mg
Standacillin bt pha tim l 1 g
Standacilline nang 250 mg; 500 mg
Totapen l 1g; bt pha siro 250 mg/5mL; 500 mg/5mL
BENZATHIN BENZYL PENICILLIN l 1,2 MIU; 2,4 MIU
Extencilline bt pha tim 2,4 MIU/l
Penicilline G benzathine bt pha tim 1,2 MIU/l
BENZYL PENICILLIN l 500.000 n v; 1.000.000 n v
Benzyl penicillin l 1.000.000 n v
Benzyl penicillin l 500.000 n v
CLOXACILLIN nang 250 mg; 500 mg
Apo-Cloxi nang 250 v 500 mg
Cloxacillin nang 250 mg
Cloxil nang 250 mg
Klox nang 250 mg; 500 mg
Lykaklox nang 250 v 500 mg
Novo- Cloxin nang 250 mg
IMIPENEM l 250 mg v 500 mg
Tienam l 250 mg v 500 mg
OXACILLIN nang 500 mg
Bristopen nang 500 mg
Clopencil nang 500 mg
PHENOXYMETHYL PENICILLIN vin nn 400.000 IU; 1.000.000 IU; 250mg;
500mg
Mekopen vin nn 1.000.000 IU
Ospen vin nn 1.000.000 IU
Ospen vin nn 250 mg; 500 mg
Penicillin V vin nn 400.000 IU
Penicillin V vin nn 1.000.000 IU
SULBACTAM
Genertam bt pha tim 250 mg + 500 mg ampicilin
Karazon-S bt pha tim 1 g + 1 g cefoperazon
563
SULTAMICILLIN TOSYLATE bt pha hn dch ung 250 mg/5mL; vin nn 375

mg
Dodacin vin bao phim 375 mg
Unasyn bt pha hn dch ung 250 mg/5mL
Unasyn vin nn 375 mg
TICARCILLIN V ACID CLAVULANIC l 1,6 g; 3,2 g
Timentin bt pha tim l 1,6 g; 3,2 g
Timentin chai dch truyn 3,2 g
CH KHI CH NH THUC
Chng ch nh: mc 4
Nguy c d ng cho vi cc cephalosporin v cc penicilin.
Cn theo di: mc 1
n ung-ru: Nc hoa qu hay ung chua, nu c dng nhiu (250mL)
c th lm hng cc penicilin khng bn mi trng acid.
Thi k cho con b: Cc penicilin qua c sa m v c th lm tr ang b
mn cm.
dng.
Thi k mang thai: Cc penicilin vt qua hng ro nhau thai. Thn trng khi s
Suy thn: Cc penicilin c o thi di dng c hot tnh qua nc tiu v

mt; suy thn ko theo tng nng trong huyt thanh, km vi nguy c tng c vi
thn kinh (l ln, co git, git rung c) v cc phn ng qu mn (my ay, ph, hch
to).
TNG TC THUC

Probenecid
Phn tch: Probenecid c ch s o thi tch cc cc penicilin qua thn.
S phi hp ny c th c dng gim liu penicilin.
X l: Vic dng probenecid lm chm s o thi ca nhiu loi
thuc, c th v c dng gim liu lng mt s thuc. l trng
hp ca cc penicilin, phi hp ny c dng trong iu tr nhm t nng
penicilin trong mu cao v ko di. Cn rt cnh gic v cc nguy c tim n
v s tng c tnh ca thuc phi hp. Nghin cu bi cnh bnh l.

Phn tch: Nguy c quan trng v pht ban da, c bit l vi cc penicilin
nhm A (ampicilin). Nguy c ny quan trng nhng ngi b thng phong. Tuy
564
nhin, khng xc nh c alopurinol hay tng acid uric mu l nguyn nhn

ca tc dng ny.
X l: Cn trnh phi hp ny. Nn hng v mt loi khng sinh khc,
c hot ph tng t, ty theo mm bnh c xem xt.
H phenicol
Phn tch: Tc dng dit khun ca cc phenicol c th i khng vi tc
dng dit khun ca h thuc c phi hp ny. Tc dng sau biu hin trn
cc vi khun giai on pht trin theo hm s m. S i khng ny c th
gy tn hi trong iu tr vim mng no m cn phi can thip nhanh v mnh.
X l: Cn tnh n nguy c ny tu theo bi cnh sinh l bnh hc. S
phi hp c th c thc hin tu theo cc thuc v cc mm bnh lin i
(quan tm n cc nng ti thiu c ch-MIC).
565
Macrolid
Phn tch: Tc dng km khun ca cc macrolid c th i khng vi tc
dng dit khun ca cc penicilin. Tc dng sau biu hin trn cc vi khun
giai on pht trin theo hm s m. S i khng ny c th gy tn hi trong
iu tr vim mng no m cn phi can thip nhanh v mnh.
X l: Nn tnh n nguy c ny ty theo bi cnh sinh l bnh hc. S
phi hp c th c thc hin, ty theo cc thuc v cc mm bnh lin i
(quan tm n cc nng ti thiu c ch - MIC).
Methotrexat
Phn tch: Nng trong huyt thanh ca methotrexat c th tng, lm
tng nguy c nhim c. Tng tc xy ra chm. C ch c th do c ch cnh
tranh bi tit methotrexat qua ng thn.
X l: Gim st nhim c methotrexat v nh lng nng
methotrexat 2 ln/tun ngi bnh t nht trong 2 tun u. Liu lng v thi
gian dng leucovorin h tr c th phi tng ln. Nu cn phi dng mt
khng sinh ph rng, ceftazidim c th t c tng tc hn.
Sulfamid khng khun
Phn tch: Tc dng km khun ca cc sulfamid khng khun c th i
khng vi tc dng dit khun ca cc penicilin. Tc dng ca cc penicilin biu
hin trn cc vi khun giai on pht trin to mng vi khun theo hm s m.
S i khng ny c th c hi trong iu tr vim mng no m cn phi can
thip nhanh v mnh.
X l: Tnh n nguy c ny theo bi cnh sinh l bnh hc, s phi hp
c th c thc hin tu theo cc thuc v cc mm bnh lin i (quan tm
n cc nng ti thiu c ch-MIC).
Synergistin
Phn tch: Tc dng km khun ca cc synergistin c th i khng tc
dng dit khun ca cc penicilin. Tc dng ca cc penicilin biu hin trn cc
vi khun giai on pht trin mng vi khun theo hm s m. S i khng
ny c th c hi trong iu tr bnh vim mng no m cn phi can thip
nhanh v mnh.
X l: Tnh n nguy c theo bi cnh sinh l bnh hc, s phi hp c
th c thc hin tu theo cc thuc v cc mm bnh lin quan (quan tm
n cc nng ti thiu c ch-MIC).
Tetracyclin
Phn tch: Tc dng km khun ca cc tetracyclin c th i khng vi
tc dng dit khun ca cc penicilin. Tc dng ca cc penicilin biu hin trn
cc vi khun giai on pht trin mng t bo vi khun theo hm s m. S
i khng ny c th c hi trong iu tr vim mng no m cn can thi p
nhanh v mnh.
566
X l: Tnh n nguy c ny trong bi cnh sinh l bnh, s phi hp c

th c thc hin tu theo cc thuc v cc mm bnh lin i (quan tm n
cc nng ti thiu c ch-MIC).

Aminoglycosid
Phn tch: Tnh hip ng ca cc khng sinh ny c bit r. Tuy
vy, mt s penicilin tim (th d ampicilin, penicilin G, mezlocilin, piperacilin,
ticarcilin...) c th lm mt tc dng ca mt s aminoglycosid (th d amikacin,
gentamicin, netilmicin, tobramycin...). C ch cha r.
X l: Khng c trn ln cc aminoglycosid tim vi cc penicilin tim
vo trong cng mt dung dch. In vivo, penicilin lm aminoglycosid mt tc dng
c v lin quan n gim chc nng thn. Cn gim st nng aminoglycosid
v chc nng thn. iu chnh liu khi cn.
Cholestyramin
Phn tch: Gim hp thu cc penicilin qua ng tiu ho.
X l: Nu hai thuc c k n ng thi, khuyn ung penicilin trc 2
gi hay sau 4 gi, k t lc ung cholestyramin.
Phn tch: iu tr khng sinh lm gim h vi khun ng rut, c th
lm gim ti hp thu cc steroid trong chu trnh rut - gan. Nguy c tht thng
gim hot tnh estroprogestogen. Khng c yu t tin on.
X l: Nguy c ny cn cn nhc theo thi gian iu tr v cc tn hi gy
ra cho h vi khun ng rut. Tuy vy, vn cn bit ngi ph n c b tiu
chy trong khi ang dng ng thi cc estroprogestogen khng?
Thuc chn beta (atenolol)
Phn tch: Tc dng chng tng huyt p v chng au tht ngc ca
atenolol c th b gim khi phi hp vi ampicilin. Tng tc xy ra nhanh. C
ch sinh kh dng ca atenolol c th b gim do km hp thu ng tiu ho
bi ampicilin.
X l: Nu nghi c tng tc, cn nhc tng liu atenolol v gim st
huyt p cht ch. C th cho ampicilin chia thnh nhiu liu nh, tri ra.
Phn tch: Thuc khng acid lm gim hp thu qua ng tiu ho dn
n gim tc dng ca thuc c phi hp.
X l: Cn ung hai thuc cch nhau t nht 2 gi. Cn nhc li l cc
khng acid thng ung 1 gi 30 pht sau ba n v thc n l ngun gc tng
tit dch v.
567
PENTAGASTRIN
Cht tng t gastrin v cu trc, dng lm thuc chn on
trong thm d chc nng tit dch v
CC THUC TRONG NHM

PENTAGASTRIN ng tim 0,5 g
Peptavlon ng tim 0,5 g
CH KHI CH NH THUC

Thi k cho con b/mang thai: V thn trng, do khng c cc d liu trong y
vn v thuc ny.
Lot d dy - t trng - vim d dy: Ngoi tr cc hon cnh rt c bit v
c s bnh vin, chng ch nh nghim ngt thuc ny trong cc lot thng hay chy
mu d dy - t trng mi xy ra.
Qu mn cm vi thuc.
TNG TC THUC

Lansoprazol; omeprazol
Phn tch: Cc cht c ch bm proton c th i khng vi tc dng
dc l ca pentagastrin.
X l: Sau khi dng pentagastrin t nht 96 gi mi c dng thuc c
ch bm proton.
Thuc chng lot khng H2 kiu cimetidin; thuc chng lot khng H2 kiu
ranitidin
Phn tch: Kh nng i khng gia tc dng dc l ca pentagastrin v
ca thuc khng H2.
X l: Khuyn ngi bnh ung sau khi dng pentagastrin t nht 24 gi
mi c dng thuc khng H2.
Phn tch: Kh nng gim hp thu pentagastrin v gim tc dng ca
thuc.
X l: Khuyn ngi bnh ung 2 thuc cch nhau t nht 4 gi.
568
PENTAMIDIN
Thuc dit trypanosom ngoi tr Trypanosoma cruzi, cng tc dng vi
Leishmania, Blastomyces dermatis v Pneumocystis carinii
(bnh phi ngi bnh suy gim min dch)
CC THUC TRONG NHM

PENTAMIDIN thuc bt lm kh dung 300 mg
Pentacarinat thuc bt lm kh dung 300 mg
CH KHI CH NH THUC

Thi k mang thai: Cn trnh do thn trng, khng c c liu ph n v do
thy chm ct ho th.
Suy h hp; hen: Nguy c co tht ph qun vi dng thuc kh dung. ngi
hen, xem xt vic dng trc mt thuc gin ph qun.
Cn theo di: mc 1
Tiu ng: Tng cng theo di khi tiu ng.
Tng huyt p: Tng cng theo di khi ri lon huyt p.
Suy gan: Tng cng theo di khi suy gan.
Suy thn: Cn theo di chc nng thn.
TNG TC THUC

Benzamid
Phn tch: Trong nhm benzamid, ch c sultoprid (Barnetil ) c th c
nguy c. Mi thuc gim lc co c (gy nhp tim chm) c th dn n gia tng
nguy c ri lon nhp tht, nht l cc cn xon nh, do cc tnh cht i n sinh l ca sultoprid thm vo.
X l: Chng ch nh v phi cm phi hp ny.
569
Bretylium; vincamin
Phn tch: Gia tng nguy c xon nh do cng hp tc dng in - sinh l
hc. Gim kali mu, nhp tim chm v khong QT di c sn (ch nhn thy
trn in tm ) l cc yu t thun li cho xut hin xon nh. Xon nh l
mt dng nhp tht c bit, c th xut hin tng cn rt ngn (vi giy, mt
thu: cm gic ngt nhng khng mt tri gic).
X l: Chng ch nh v khng c k n phi hp c nguy c cht
ngi ny.
Macrolid
Phn tch: Tng nguy c xon nh bi tc dng cng hp ch c m
t vi erythromycin tim tnh mch. H kali mu, nhp tim chm v kho ng QT
di (trn in tm ) l cc yu t thun l i cho xut hi n xo n nh. Xo n
nh l mt dng nhp tht c bit, c th xut hi n t ng c n r t ng n (vi
giy, mt thu: cm gic ngt nhng khng mt tri gic). Trong h macrolid, ch
c erythromycin, c bit l dng tim tnh mch, c th dn n cc r i lo n
nhp tim (ko di khong QT, ngoi tm thu tht, xon nh, blc nh tht).
X l: Chng ch nh v khng c k n phi hp ny, v c kh nng
gy t vong. Ngay c khi dng mt mnh, erythromycin tim tnh mch cng c
th dn n ri lon nhp tim. Khng nn tim c liu ngay mt lc, m nn
truyn tnh mch lin tc hay ngt on, thi gian ca mi ln truyn t nht
phi 60 pht.
Sparfloxacin
Phn tch: Gia tng nguy c xon nh. Xon nh l mt dng nhp tht
c bit, c th xut hin tng cn rt ngn (vi giy, mt thu: cm gic ng t
nhng khng mt tri gic), i khi, tin trin thnh rung tht cht ngi.
X l: Nn trnh phi hp thuc. Nn chn mt fluoroquinolon khc hoc
mt thuc khc phi hp ty theo mc tiu iu tr. Nu phi hp ny tuyt i
cn, bt buc phi theo di lm sng v in tm .
Phn tch: Tng tc ch c m t vi astemizol (Hismanal ), mt
thuc khng histamin H1 c coi l khng an thn: tng nguy c xut hin xon
nh. Xon nh l mt dng nhp tht c bit, c th xut hin tng cn rt
ngn (vi giy, mt thu: cm gic ngt m khng mt tri gic), i khi, tin trin
thnh rung tht, cht ngi.
X l: Chng ch nh phi hp ny. Nn chn mt khng histamin khng
an thn khc khng to xon nh( cetirizin, loratadin).

Amiodaron; bepridil; corticoid khong; furosemid hoc thuc tng t;
glucocorticoid; halofantrin; tetracosactid; thuc nhun trng kch thch
Phn tch: Nguy c xut hin xon nh khi phi hp thuc. H kali mu,
nhp tim chm v khong QT di (trn in tm ) l cc yu t thun li cho
570
xut hin xon nh. Xon nh l mt nhp tht c bit, c th xut hin thnh
tng cn rt ngn (vi giy, mt thu: cm gic ngt nhng khng mt tri gic),
i khi tin trin thnh rung tht.
X l: Cn trnh phi hp ny. Dng cc thuc khng dn n xon nh.
Nu cn phi hp, nn theo di lin tc (monitoring) khong QT v tin hnh
theo di kali mu. Ch cc du hiu lm sng c th bo tr c h kali mu
nh: mt mi, yu c, co cng c.
Amphotericin B
Phn tch: Nguy c xut hin xon nh khi phi hp vi amphotericin B
bng ng tim. H kali mu, nhp tim chm v khong QT di c sn (ch
thy trn in tm ) l cc yu t thun li cho s xut hin xon nh. Xon
nh l mt dng nhp tht c bit, c th xut hin cn rt ngn (vi giy, mt
thu: cm gic ngt nhng khng mt tri gic). Phi hp amphotericin B tim vi
cc cht c vi tu khc i hi phi rt thn trng. Nguy c thiu mu hay
cc ri lon khc v huyt hc.
X l: Cn trnh phi hp. Dng cc thuc khng dn n xon nh. Nu
cn phi hp, nn b tr theo di lin tc (monitoring) khong QT v tin hnh
theo di kali mu. Ch cc du hiu lm sng c th bo tr c h kali mu
nh mt mi, yu c, co cng c.
Disopyramid; quinidin hoc dn cht
Phn tch: Nguy c xut hin xon nh khi phi hp thuc, do hip ng
tc dng in - sinh l. H kali mu, nhp tim chm, khong QT di (trn i n
tm ) l cc yu t thun li cho xut hin xon nh. Xon nh l mt loi
nhp tht c bit, c th xut hin tng cn rt ngn (vi giy, mt thu: cm
gic ngt nhng khng mt tri gic).
theo di u n kali mu. Ch cc du hiu lm sng c th bo tr c h
kali mu, nh mt mi, yu c, co cng c.
Sotalol
Phn tch: Nguy c xut hin xon nh khi phi hp hai thuc, c to
thun li bi h kali mu. H kali mu, nhp tim chm, mt khong QT di (trn
in tm ) l cc yu t to d dng cho xut hin xon nh. Xon nh l
mt loi nhp tht c bit, c th xut hin tng cn rt ngn (vi giy, mt
thu: cm gic ngt nhng khng mt tri gic).
theo di u n kali mu. Ch cc du hiu lm sng c th bo tr c h
kali mu nh mt mi, yu c, co cng c.
Phn tch: Nguy c xut hin xon nh khi phi hp hai thuc. H kali
mu, nhp tim chm, khong QT di (trn in tm ) l cc yu t thun l i
571
cho xut hin xon nh. Xon nh l mt loi nhp tht c bit, c th xut
hin tng cn rt ngn (vi giy, mt thu: cm gic ngt nhng khng mt tri
gic), tin trin i khi thnh rung tht cht ngi.
theo di u n kali mu. Ch cc triu chng lm sng c th bo trc h
kali mu nh: mt mi, yu c, co cng c.
Zalcitabin
Phn tch: thy mt trng hp t vong, do vim gan ti cp, vi
pentamidin tim tnh mch khi ang dng zalcitabin.
X l: Nu iu tr vim phi do Pneumocystis carinii bng pentamidin
tim tnh mch, phi ngng iu tr bng zalcitabin.

Didanosin
Phn tch: Tng nguy c xut hin vim ty do hip ng tc dng khng
mong mun. Tng tc dc lc hc.
X l: Cn theo di lm sng u n v nh lng amylase mu
(amylase l enzym c ngun gc t ty hay nc bt, xc tc phn gii tinh bt
thnh maltose).
Foscarnet
Phn tch: Nguy c h calci mu nng.
X l: Theo di cn thn ion v thanh lc creatinin. Khng dng
foscarnet vi pentamidin tim tnh mch. Theo di calci mu v b sung calci
theo nhu cu.
Phn tch: Interleukin ch c th c dng c s chuyn khoa. Nguy c
hip ng tc dng c vi thn ca hai thuc.
X l: Vic iu tr bng interleukin ch c th tin hnh c s chuyn
khoa, do tnh cht quan trng ca ch nh. Tng tc cn c cn nhc theo
th trng chung ca ngi bnh. Nu khng th hon mt trong hai thuc, theo
di cn thn ion v thanh lc creatinin.
Zidovudin
Phn tch: Gia tng nng zidovudin trong huyt tng do gim chuyn
ho cht ny.
X l: Gim liu zidovudin. Theo di tc dng khng mong mun lin quan
n zidovudin (theo di huyt hc v lm sng).
572
PENTOSTATIN
Cht c ch adenosin desaminase (ADA), enzym chuyn ho cc purin.
c dng trong bnh bch cu t bo tc ngi ln
CC THUC TRONG NHM

PENTOSTATIN l bt ng kh tim 10 mg
Nipent l bt ng kh tim 10 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: Mc du khng c mt nghin cu no c tin hnh, tc
dng khng mong mun tim n dn n chng ch nh trong thi k cho con b.
Thi k mang thai: Thuc ny c tc dng sinh qui thai chut cng v chut
nht. Mc du khng c mt c liu no ngi mang thai, cn trnh dng do cc tnh
cht sinh l bnh hc ca n. Cn c bin php nga thai ph n tui sinh
trong thi gian iu tr.
Qu mn vi ch phm.

Tr em: Khng c c liu.
Suy thn: Cc du hiu c vi thn km theo tng creatinin mu (thng l
phc hi) c m t.
Nhim khun ang tin trin.
Thn trng: mc 2
Suy gan: Do tc dng khng mong mun c m t vi thuc ny.
TNG TC THUC

Vaccin sng gim c lc
Phn tch: Nguy c pht trin nhim khun tng ng vi vaccin do
pentostatin gy suy gim min dch.
X l: Dng hai thuc cch nhau t 3 thng ti 1 nm v tu theo mc
suy gim min dch.
573

Alopurinol hoc dn cht; colchicin hoc dn cht; probenecid
Phn tch: Pentostatin c th lm tng acid uric mu. Cn phi hiu chnh
liu ca thuc cha thng phong kim sot tng acid uric mu.
X l: Nn dng alopurinol (c ch tng hp acid uric) hn l cc thuc
o thi acid uric do nguy c acid uric c th gy bnh thn.
Azathioprin; carmustin hoc dn cht; cisplatin hoc dn cht; clozapin;
dactinomycin; fluoro - 5 - uracil; interferon alpha ti t hp; melphalan;
mercaptopurin; procarbazin; thuc chng ung th cc loi
Phn tch: Dng cng lc hai thuc c ch tu xng c th dn n cc
ri lon huyt hc nng tu theo thi gian iu tr.
X l: Phi hp cn c theo di u n v huyt hc.
Cyclophosphamid hoc thuc tng t; doxorubicin hoc dn cht;
levamisol; thiotepa; vincristin hoc thuc tng t
Phn tch: Nguy c tng c tnh vi mu, do c ch tu xng, do tc
dng hip ng, c th dn n mt bch cu ht.
X l: Trnh phi hp nu c th. Nu cn phi hp, nn dng liu thp
cho mi thuc v theo di cn thn cng thc mu. S phi hp ny lin quan
n cc chuyn gia v cc phc iu tr thng c xc lp sn.
Phn tch: Phi hp hai thuc gy c ch tu xng.
X l: Interleukin ch c dng trong c s chuyn khoa, do mc trm
trng v bnh l. Tng tc phi cn nhc v mi chc nng ca c th phi
c theo di lin tc. D sao, vic theo di huyt l bt buc.
Phn tch: Dng cng lc hai thuc gy c ch tu xng c th dn n
cc ri lon huyt hc nng theo thi gian iu tr. Cng cn theo di chc nng
thn.
X l: Phi hp cn c theo di u n v huyt hc v v thn.
PENTOXYFYLIN
Dn cht ca xanthin. Thuc gin mch chng thiu mu cc b,
c dng trong chng tp tnh cch hi
574
CC THUC TRONG NHM

PENTOXYFYLLIN vin nn 400 mg; ng tim 100 mg; 300 mg
Torental L P vin nn 400 mg
Torental ng tim 100 mg; 300 mg
CH KHI CH NH THUC

Thi k mang thai: Do thn trng, khng nn dng.
Qu mn.

Suy mch vnh: giai on nhi mu c tim cp, khng nn dng dng thuc
tim.
Cn theo di: mc 1
Thi k cho con b: Do thn trng, thiu cc c liu chnh xc.
Suy thn: Gim liu dng khi suy thn nng.
Huyt p thp.
TNG TC THUC

H pyrazol; h salicylat; thuc chng vim khng steroid
Phn tch: Do pentoxyphilin c kh nng gy chy mu, nn phi hp vi
mi thuc c tnh cht chng kt tp tiu cu hay chng ng mu u lm tng
nguy c chy mu. Nguy c ny tng ln do tc dng xm hi ca cc thuc
chng vim khng steroid ln nim mc d dy (xut huyt ng tiu ho).
X l: Nu cn phi hp, phi theo di bng cc th nghim ng mu
thch hp (thi gian Howell v thi gian cephalin kaolin) trong v sau tr liu. Nu
c th, tm mt gii php iu tr khc cc ngi bnh c tin s lot d dy.
Thuc tan huyt khi
Phn tch: Phi hp vi mi thuc c tnh cht chng kt tp tiu cu hay
chng ng lm tng nguy c chy mu.
X l: Thuc tan huyt khi thng do thy thuc chuyn khoa ch nh.
Nu khng trnh c phi hp ny, cn theo di cc xt nghim ng mu
thch hp (thi gian Howell v thi gian cephalin kaolin). Nu c th, nn tm mt
gii php iu tr khc.
Ticlopidin
Phn tch: Phi hp vi mi thuc c tnh cht chng kt tp tiu cu
hoc chng ng mu u lm tng nguy c chy mu.
575
X l: Nu cn thc hin phi hp thuc ny, phi theo di thng qua cc

th nghim v ng mu thch hp (thi gian Howell, thi gian cephalin kaolin)
trong v sau khi iu tr bng ticlopidin. Nu c th, nn tm mt gii php i u
tr khc.

Phn tch: Tng nguy c chy mu.
X l: Theo di ch yu thi gian chy mu nu s phi hp ny phi ko
di. Hi ngi bnh v cc tin s lot d dy. Ch ngi bnh cao tui.
Phn tch: Tng nguy c chy mu (cha r c ch).
X l: Tng cng theo di u n thi gian Quick v/ hoc t l chun
quc t, c bit l vo lc u, trong khi hay lc ngng s phi hp ny. Hiu
chnh liu theo cc kt qu sinh hc.

Dextran
Phn tch: Dextran l cht c ch tiu cu. Vi cc thuc c cc tnh cht
chng ng mu v chng kt tp tiu cu, nguy c chy mu phi c trnh
hay c kim sot cht ch.
X l: Nn trnh phi hp cc thuc ny vi nhau do kh khn v theo di
vic gim ng mu nh mong mun v nguy c chy mu tim n.
PHENAZON
Thuc gim au h st, cn gi l antipyrin
CC THUC TRONG NHM

PHENAZON
Otipax dung dch nh tai phi hp vi lidocain
TNG TC THUC
576

Phn tch: Tc dng ca khng vitamin K b gim v antipyrin l mt cht
cm ng enzym tim nng lm tng chuyn ho v thanh lc, c bit vi
warfarin, nh vy gim tc dng ca thuc chng ng mu.
X l: Antipyrin (phenazon) c mt trong mt s bit dc c k n
hay t dng v lun lun di dng thuc phi hp gim au v h st. Khi
dng phi hp vi thuc ung chng ng mu, phi gim st t l chun quc
t (INR) hoc t l protrombin v nu cn iu chnh liu lc bt u, trong khi
v sau khi iu tr bng thuc c cha antipyrin. Khuyn ngi bnh ung thuc
chng ng mu (nht l warfarin), khng dng ch phm c antipyrin.
577
PHENICOL
Khng sinh dit khun, u bng l cloramphenicol
CC THUC TRONG NHM

CLORAMPHENICOL vin nn 100 mg; 250 mg; 500 mg; nang 100 mg; 250 mg; 500
mg
Cloraxin vin nn 125 mg; 250 mg
Chlorocid vin nn 250 mg; 500 mg
Cloraxin thuc nh mt 0,4%
Leucomycine vin nn 500mg
Lykacetin-S bt pha tim 1g/l
Cloromycetin vin nn 250mg
Tifocin nang, vin bao 250mg
THIAMPHENICOL vin nn 125 mg; thuc tim 250 mg
Thiophenicol vin nn 125 mg
Thiophenicol thuc tim 750 mg
CHNG CH NH V THN TRNG KHI S DNG
Chng ch nh: mc 4
Tin s suy tu, qu mn vi ch phm.

Thi k cho con b: Cc phenicol qua c sa m, vi nguy c hi chng
xm cho tr b m.
Tr em/ mang thai: Thuc phenicol khng gy qui thai, nhng c th thy ng
c vi cloramphenicol vo cui thai k v vi cloramphenicol v thiamphenicol tr s
sinh di 6 thng. Nguy c quan trng hn vi cloramphenicol (hi chng xm: nn,
chn n, phn mu xanh, gim trng lc, h nhit, thm ch t vong).
Bnh mu: Do tc dng c ch ty xng.
Suy thn: Ngi suy thn c nguy c d b suy tu, nhng nu gim liu
cloramphenicol th c th mt tc dng. Chng ch nh trong trng hp suy thn
nng.
Thn trng: mc 2
Suy gan: Do chuyn ho gan.
TNG TC THUC
578

Aminosid tim hoc dng ti ch; aminosid ung; h penicilin; lincosamid
Phn tch: Tc dng km khun ca cc phenicol c th i khng vi tc
dng dit khun ca thuc phi hp. Tc dng dit khun th hin trn cc vi
khun giai on pht trin theo hm s m. S i khng ny c th tc hi
trong iu tr vim mng no m ta cn can thip nhanh v mnh.
X l: Phi ch n nguy c ny trong bi cnh sinh l bnh hc, s
phi hp c th thc hin tu theo cc thuc v cc mm gy bnh (tnh n
cc nng ti thiu c ch- MIC).
Phenytoin
Phn tch: c ch chuyn ho phenytoin gan bi cloramphenicol. Thm
na, chuyn ho cloramphenicol s tng ln do phenytoin, dn n gim hot
lc ca n.
X l: Nng phenytoin tng ng k (2 n 4 ln nng ban u) vi
ngy sau khi cho dng cloramphenicol. Nn trnh phi hp.
Ru
Phn tch: Tc dng ging disulfiram cng thm nguy c c vi gan: mt
t l bt thng acetaldehyd tch t trong cc m (c ch enzym), ko theo mt
s du hiu lm sng nh: cn bng vn mch, gin mch quan trng, nhp tim
nhanh, st cao, bun nn, nn, ban da, i khi h huyt p v tru mch. Cc
triu chng ny t nhiu quan trng tu theo lng ru ung vo.
X l: Trong khi iu tr vi thuc, nn trnh ung ru v cc ch phm
hoc thuc c cha ru, do tc dng ging disulfiram.
St
Phn tch: Gim p ng v huyt hc (tht bi iu tr dng phi hp st
v/hay vitamin B12) vi cc mui st do tc ng ca cc phenicol trong to
hng cu. Cn nhc li tc dng c ch tu xng ca cloramphenicol.
X l: Thay hay ngng khng sinh trong khi iu tr thiu mu vi mui st.
Synergistin
Phn tch: Tc dng km khun ca synergistin c th i khng vi tc
dng dit khun ca cc thuc phenicol. Tc dng dit khun biu hin trn cc
vi khun giai on pht trin theo hm s m. S i khng ny c th c hi
trong iu tr vim mng no m ta cn phi can thip nhanh v mnh.
X l: Lu n nguy c ny trong bi cnh sinh l bnh hc, s phi
hp c th thc hin tu theo cc thuc v cc mm bnh lin quan (tnh n
cc nng ti thiu c ch -MIC).
579

Phn tch: Tng tc c m t vi dicoumarol, acenocoumarol, v tc
dng chng ng mu tng ln c th l do c ch enzym.
X l: Theo di t l chun ha quc t -INR v t l prothrombin v nu
cn hiu chnh liu dng lc bt u, ang dng v sau tr liu bng
cloramphenicol.
Zalcitabin
Phn tch: C th xut hin bnh l thn kinh ngoi vi.

Amphotericin B
Phn tch: Phi hp amphotericin B tim vi cc thuc c vi tu khc
i hi phi rt thn trng. Nguy c thiu mu hay cc ri lon khc v huyt
hc.
X l: Khi cn phi hp, nn theo di cn thn huyt v nu cn th
tin hnh gim liu.
580

cyclophosphamid hoc thuc tng t; dactinomycin; doxorubicin hoc dn
cht; fluoro 5 uracil; ganciclovir; interferon alpha ti t hp; levamisol;
melphalan; mercaptopurin; methotrexat; penicilamin hoc thuc tng t;
procarbazin; thuc chng ung th cc loi; thiotepa; vincristin hoc thuc tng
t
Phn tch: Nguy c tng c tnh vi mu do c ch tu xng, do tc
dng cng hp, c th dn n mt bch cu ht. Ch dng n c cc thuc
phenicol cng c th b mt bch cu ht nng, thm ch t vong (c tnh min
dch).
X l: Nu cn phi hp, nn dng cc liu thp cho mi thuc. Khng th
d on s xut hin mt bch cu ht khi dng cc thuc phenicol. Vic theo
di cn thn huyt , c thc hin bnh thng khi s dng mt cht km t
bo, vn c gi tr. Tuy nhin, ngi bnh phi c bo trc l hi st, vim
hng v lot ming th phi ngng tr liu bng cc thuc phenicol.
Barbiturat
Phn tch: Tc dng ca cloramphenicol c th b gim (nng huyt
thanh gim). Trong khi , tc dng barbiturat c th tng. Tc dng ko di vi
ngy sau khi ngng barbiturat. Tng tc xy ra chm. C ch: chuyn ho
cloramphenicol tng v chuyn ho barbiturat gim.
X l: C th phi tng liu cloramphenicol. Gim st nng khng sinh
trong huyt tng v iu chnh liu. Nu c biu hin nhim c barbiturat,
phi gim liu thuc ny.
Clozapin
dng cng hp, c th dn n mt bch cu ht. Ch dng n c clozapin
cng c th b mt bch cu ht nng, thm ch t vong (c tnh min dch).
X l: Trnh phi hp. Nu cn phi hp, nn dng cc liu thp cho mi
thuc. Khng th d on s xut hin mt bch cu ht khi dng clozapin.
Vic theo di cn thn huyt , thc hin bnh thng khi s dng mt cht
km t bo, vn cn gi tr. Tuy nhin, ngi bnh phi c bo trc l nu
hi st, vim hng v lot ming th phi ngng thuc ngay.
Didanosin
Phn tch: Vin nn didanosin c cha mt khng acid: nguy c gim hp
thu thuc phenicol qua ng tiu ho tu theo vic tng pH d dy.
Phn tch: Nguy c lm nng thm nhng bin i cc dng t bo mu
(suy tu).
X l: Khi phi hp, cn theo di huyt ngi bnh c nguy c.
581
Rifampin
Phn tch: Nng trong huyt thanh ca cloramphenicol gim dn, lm
gim tc dng khng khun. Cc tc dng ny c th ko di vi ngy sau khi
ngng rifampin. Tng tc xy ra chm. C ch: chuyn ho cloramphenicol
tng do rifampin gy cm ng cc enzym gan.
X l: C th phi tng liu cloramphenicol trong khi phi hp vi rifampin,
nu cha t c kt qu iu tr mong mun.
Phn tch: Tng tc c xc lp r rng vi tolbutamid v
clorpropamid. Tc dng chng tiu ng tng ln, c l do cloramphenicol c
ch chuyn ho gan. Ngi bnh t nhiu nhy cm vi s phi hp ny v
cc h qu u t nhiu quan trng.
X l: C nguy c h glucose mu v c nhng khc bit gia cc c
nhn, nn ngi k n phi theo di glucose mu. Bo cho ngi bnh tng
cng t theo di.
Zidovudin
Phn tch: Phi hp zidovudin vi cc thuc c vi tu khc i hi phi
rt thn trng. Nguy c thiu mu hay cc ri lon khc v huyt hc.
X l: Khi cn phi hp, nn theo di cn thn huyt v nu cn th
phi gim liu.
PHENOTHIAZIN
Thuc hng tm thn ch yu l an thn kinh m mt s
c tnh cht khng H1 r (nh promethazin, oxomemazin...)
CC THUC TRONG NHM

CLOPROMAZIN vin nn 25 mg; 100 mg; siro 5 mg/mL; thuc n 25 mg; 50 mg;
ng tim 25 mg; 50 mg
Aminazin vin bao 25 mg
Largactil vin nn 25 mg; 100 mg
Largactil thuc tim 25 mg
FLUPHENAZIN vin nn 1 mg; 2,5 mg; 5mg; 25 mg; ng tim 2,5 mg/1mL; thuc
ung git dung dch 4 %
Modecate thuc tim 25 mg
Moditen vin nn 25 mg
582
Moditen Action PR thuc tim 25 mg

LEVOMEPROMAZIN vin nn 2 mg; 25 mg; 100 mg
Nozinan thuc tim 25 mg
Nozinan vin nn 100 mg
Tiserein vin nn, bao 25 mg; dung dch tim 25 mg/mL
MEQUITAZIN vin nn 5 mgl; siro
Primalan vin nn 5 mg; 10 mg
METOPIMAZIN ng tim 10 mg
Vogalene ng tim 10 mg
NIAPRAZIN siro 3 mg/mL
Nopron siro 3 mg/mL
OXOMEMAZIN vin nn 10mg; siro 0,1%
Toplexil nang 1,65 mg (phi hp vi guaifenesin, paracetamol)
PROMETHAZIN vin nn 15 mg; 25 mg; siro 5 mg/2mL; ng tim 50 mg/mL
Phenergan vin nn 25 mg; siro 0,1%; kem bi da 2%
Prothazine vin nn 25 mg; siro 0,1%; kem bi da 2%
Pipolphen vin nn 25 mg; ng tim 50mg/2mL
PROPERICIAZIN nang; vin nn
Neuleptil vin nn 25 mg
PIPOTHIAZIN vin nn 10 mg; thuc tim 10 mg/mL
Piportil vin nn 10 mg
Piportil thuc tim 10 mg/mL
THIOPROPERAZIN vin 10 mg; dung dch ung
Majeptil vin nn 10 mg
Majeptil dung dch ung
THIORIDAZIN vin bao 10 mg; 50 mg; 100 mg
Melleril vin bao 10 mg; 50 mg; 100 mg
TRIPLUPERAZIN vin nn 10 mg; 100 mg; dung dch ung.
Terfluzine vin nn 10 mg; 100 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Bnh tng nhn p: Cc phenothiazin c c tnh cao v i m t c th t o ra
nhng cht ng ng ng trn gic m c, c thu tinh th , t n th ng vng m c v
583
gim th lc. Ngoi ra, tc d ng li t ph giao c m c th d n n gin ng t v i

nguy c cn tng nhn p c p ng i c b m ch t d m c.
Ph i tuyn tin lit/ u tuyn tin lit: Cc phenothiazin v c bit
clorpromazin c cc tnh cht lit ph giao cm, nguyn nhn ca cc ri lon tiu tin
v nc tiu.
Bnh Parkinson: Cc phenothiazin, nht l i vi cc loi thuc tc dng
mnh, c tc dng khng dopamin, nn l nguyn nhn thng gy ra hi chng ngoi
thp gi Parkinson (tng ng v tng trng lc c) c th khng hi phc c.

Thi k cho con b: Cc phenothiazin qua c sa m v c nguy c
dn n an thn bun ng cc tr cn b. Ngoi ra, thuc cn lm tng tit sa.
Bnh mu: Nn theo di u n v nhn khoa v huyt hc trong trng hp
iu tr ko di; chng ch nh khi c tin s mt bch cu ht.
Ri lon chuyn ho porphyrin: Mt s phenothiazin (levopromazin, pipotiazin,
thioproperazin...) c th gy ra cc cn cp tnh ngi bnh b ri lon chuyn ho
coproporphyrin di truyn.
Thn trng: mc 2
n ung; ru: Ru lm tng tc dng an thn bun ng ca cc phenothiazin
v lm tng nguy c l ln.
Cn theo di: mc 1
Tr em: Do tc dng khng mong mun, dng liu rt thp cho tr em.
ng kinh: Cc phenothiazin c th lm gim ngng gy ng kinh v gy ra
cn ng kinh. ngi b ng kinh ang iu tr, phi hiu chnh liu dng thuc
chng co git.
Thi k mang thai: Cc phenothiazin c l khng gy qui thai, nhng vn nn
trnh trong 3 thng u ca thai k, nh mi thuc hng tm thn.
Suy tim: Cc phenothiazin c tc dng an thn, nht l thng gy ra cc tc
dng thn kinh thc vt (h huyt p th ng) v tim mch (ri lon dn truyn hay
thiu mu cc b c tim) trong suy tim.
Suy gan: Suy gan lm tng c tnh ca phenothiazin do chm kh hot tnh.
Suy thn: Suy thn lm tng c tnh ca phenothiazin do chm o thi.
Ngi cao tui: Ngi bnh cao tui d b h huyt p th ng v cc ri lon
v mt, nn liu thuc dng phi thp v tng dn.
Trng hp khc: Nn theo di u n v nhn khoa v huyt hc trong
trng hp iu tr ko di, c bit khi b st ko di hay nhim khun.
TNG TC THUC
584

Amiodaron: Sotalol
Phn tch: Tng nguy c gy lon nhp tim nng gy t vong, bao gm c
xon nh. Tng tc xy ra chm. C ch: tc dng hip ng lm ko di
khong QT.
X l: Thioridazin (mt loi phenothiazin) chng ch nh dng cho ngi
ang iu tr mt s thuc chng lon nhp nh amiodaron, bretylium,
disopyramid, procainamid, quinidin, sotalol.
Benzamid (Cisaprid)
Phn tch: Hip ng tc dng khng mong mun, biu hin qua nguy c
lm nng thm tc dng ngoi thp khi phi hp vi mt s thuc an thn kinh,
dn cht ca cc phenothiazin. Ngoi ra, cn tng nguy c ri lon nhp tht,
nht l xon nh, do cng thm tc dng in - sinh l, ch c m t v i
sultoprid (Barnetil ).
X l: Cn trnh phi hp. Thay i chin lc iu tr. Xc nh l, trong
nhm benzamid, ch c sultoprid c th lm tng nguy c xut hin xon nh.
Levodopa
Phn tch: Tng tc dc lc. Kt hp levodopa vi cc thuc an thn
kinh phenothiazin c nhng tc dng i khng dopamin c th dn n gim
tc dng ch vn dopamin ca levodopa.
X l: Chng ch nh kt hp ny, tr khi mun tm mt tc dng i
khng dc l v phi thc hin bnh vin chuyn khoa.
Quinolon (grepafloxacin, sparfloxacin)
Phn tch: Tng nguy c gy lon nhp tim nng, bao gm xon nh c
th gy t vong. C ch cha r.
X l: Chng ch nh dng sparfloxacin cho ngi ang iu tr cc thuc
ko di khong QT (th d nh phenothiazin). Tng t, cng chng ch nh
dng grepafloxacin cng vi cc thuc , tr khi c theo di tim cht ch
(ngha l ngi bnh phi nm bnh vin). Cc loi quinolon khng sinh khc,
khng ko di khong QT hoc khng chuyn ho qua isoenzym CYP 3A4, c th
dng thay th.
Thuc chn beta: pindolol, propranolol
Phn tch: Tc dng ca mt hoc c hai thuc u tng, bao gm c
nguy c lon nhp nng c th gy t vong khi dng phi hp vi thioridazin.
Tng tc xy ra chm. C ch: Clorpromazin c th c ch chuyn ho bc
u gan ca propranolol v lm tng tc dng dc l. Mt s thuc chn
beta c th c ch chuyn ho ca thioridazin.
X l: C th cn phi gim liu lng trong khi phi hp, tuy vy
thioridazin c chng ch nh dng cho ngi ang dng pindolol hoc
propranolol.
585

Phn tch: Do c ch c hiu monoamin oxydase typ B, phenothiazin ko
di tc dng ca levodopa, nh vy gii thch ti sao li c s kt hp vi
levodopa. Cc tng tc nh vy cng ging nh tng tc ca levodopa. Kt
hp levodopa vi mt s thuc c tc dng i khng dopamin c th dn n
cc tc dng i khng.
X l: Chng ch nh phi hp ny, tr khi mun tm mt i khng tc
dng dc l v phi thc hin bnh vin chuyn khoa.

Phn tch: Tng tc dng c ch h thn kinh trung ng, lm tng tc
dng an thn bun ng. Tng tc dc lc.
X l: Ch n mt tnh to ngi li xe hoc vn hnh my. Khuyn
khng nn ung ru.
Phn tch: Gim tc dng lm h huyt p do c ch ti nhp guanethidin
n-rn do cc thuc an thn kinh phenothiazin (m t vi clorpromazin).
X l: Thay i cch iu tr bng cch chn mt thuc chng tng huyt
p khc. Phi hp nn trnh.
Lithi
Phn tch: Cc tai bin c thn kinh thuc loi hi chng l ln c
thng bo cc ngi bnh c dng phi hp lithi vi thuc an thn kinh h
phenothiazin (c m t vi chlorpromazin, fluphenazin, thioridazin).
X l: Cn trnh phi hp. Thay i chin lc iu tr, tr khi ngi bnh
trong mt c s chuyn khoa m bo theo di lin tc.
Methyldopa
Phn tch: Vi cc thuc an thn kinh ni chung, c nguy c lm thay i
tc dng chng tng huyt p do chn ti nhp cc cht chuyn ho ca
methyldopa trong cc n-rn adrenergic. Nguy c gia tng h huyt p t th
ng cng c vi mi thuc an thn kinh.
X l: Trong vic tm kim s cn bng v huyt p, ngi k n phi
lu n nguy c thay i huyt p vi cc thuc an thn kinh v ch n l a
cch iu tr. Nu cn phi hp, bo cho ngi bnh bit h ung thuc
u n theo gi c nh v tng cng t theo di. Nu khng, thay i
chin lc iu tr. Khuyn ngi bnh n khm li, nu thy huyt p khng
n nh.
Ritonavir
Phn tch: Ritonavir c i lc cao vi isoenzym 3A4 cu cc cytochrom P450,
nn c nguy c quan trng v cnh tranh gia ritonavir vi cc thuc khc b
586
chuyn ho, hay nghi ng b chuyn ho bi isoenzym ny. S cnh tranh ny

gy gim chuyn ho v tng ng k nng ca chng trong huyt tng.
Nguy c h huyt p, an thn bun ng v tng tc dng ngoi thp (m t vi
thioridazin trong nhm ny). Tng tc dc ng hc v chuyn ho thuc.
X l: Theo di cht ch ngi bnh v s xut hin tc dng c v nu
cn gim liu thuc an thn kinh.
Ru
Phn tch: Tng tc dng c ch h thn kinh trung ng, lm tng tc
dng an thn bun ng. Mt s tc dng tm thn - vn ng c th thy
mt s thuc, nht l trong tun u iu tr. Tng tc dc lc.
X l: Khng nn dng thuc ny, v khng th ngn chn ngi bnh
ung ru. Nguy c bun ng c bit nguy him i vi ngi li xe hoc vn
hnh my.

Phn tch: Amantadin d lm xut hin tc dng gy l ln v o gic ca
cc thuc c tnh cht khng cholinergic ( y l tc dng khng cholinergic
ca cc thuc an thn kinh loi phenothiazin).
X l: Nu nghi ng c tng tc, do thy tc dng khng mong mun, th
hiu chnh liu dng ca cc thuc khng cholinergic khi dng phi hp vi
amantadin. Hng dn cho ngi bnh bit tc dng khng mong mun c th
xy ra.
Phn tch: Do tnh i khng dopamin ca phenothiazin, c kh nng tng
nng prolactin v i khng tc dng ca bromocriptin.
X l: Tc dng i khng ny c nguy c gy nhiu mc tiu iu tr
chnh. S phi hp cn c theo di; hoc thay th thuc phi hp. Lu l
tc dng i khng dopamin kh yu v tu thuc liu dng.
Buspiron
tc dng an thn bun ng. Vi mt s ch phm, thy mt s tc dng tm
thn vn ng, nht l trong tun iu tr u tin. Tng tc dc lc.
X l: Tt nht, khng nn phi hp hai thuc, do ngi k n khng th
kim sot c vic ung ru ca ngi bnh. Nguy c an thn bun ng
nguy him cho ngi li xe v ngi vn hnh my. Khuyn khng ung ru
v khng t dng thuc hoc ch phm cha ru.
Butyrophenon; reserpin; thuc an thn kinh cc loi
Phn tch: Cc phenothiazin c th c dng trong iu tr nh mt
thuc khng histamin hay mt thuc an thn kinh. trng hp sau, khi chng
587
c phi hp vi cc thuc an thn kinh khc, s c tc dng hip ng khng

mong mun, biu hin bng nguy c nng thm tc dng ngoi thp.
X l: Lu nguy c ny hiu chnh liu dng. Theo di lm sng.
Carbamat hoc thuc tng t; carbamazepin; thuc c ch h thn kinh
trung ng cc loi; dihydropyridin; interferon alpha ti t hp; medifoxamin;
paroxetin; phenytoin; procarbazin; thuc an thn kinh cc loi; thuc ch vn
morphin; thuc chng ng kinh khng barbituric
tc dng an thn. Tng tc dc lc. Nn nh l rilmenidin, vi liu thng
thng, khng lm tng tc dng c ch h thn kinh trung ng ca cc thuc
.
X l: Lu nguy c ny hiu chnh liu ca hai thuc nu cn phi
hp. Ch n gim tnh to ngi li xe v ngi vn hnh my. Khuyn
588
Clozapin
Phn tch: Tng cc tnh cht khng cholinergic, do cng hp tc dng
khng mong mun, nh b tiu tin, kh ming v to bn.
X l: Cn lu nhng tc dng khng mong mun ca loi thuc ny.
Nu nht thit phi phi hp, bo cho ngi bnh bit nhng tc dng khng
mong mun . Trnh dng ngi b bnh v tuyn tin lit v tng
nhn p.
Diazoxid
Phn tch: Tng tc dng tng glucose mu ca diazoxid. Cha r tc
dng ny cn ko di bao nhiu lu sau khi ngng clorpromazin. C ch cha
r. Tng tc xy ra nhanh.
X l: Diazoxid gy tng glucose mu, cn cnh gic khi phi hp hai
thuc theo mc tiu iu tr chnh mong mun. Theo di huyt p u n, nu
cn phi hp.
Phn tch: Tng cng tc dng chng tng huyt p.
X l: Cn iu chnh liu dng, lp k hoch dng thuc v nhn mnh
vi ngi bnh v s tun th. Lc u iu tr, khuyn ngi bnh o thng
xuyn huyt p cho ti khi t cn bng iu tr.
Phn tch: Ngoi tng tc dng c ch h thn kinh trung ng, th natri
valproat v cc dn cht cn lm tng nng trong huyt tng ca
phenothiazin, c l do c ch enzym v gim s d ho chng. Mt khc,
phenothiazin li c ch chuyn ho acid valproic.
X l: Nu cn phi hp, nn gim liu dng ca cc phenothiazin. Ch
n gim tnh to ngi li xe v ngi vn hnh my. Khuyn ngi bnh
khng ung ru v khng t dng thuc, hay cc ch phm c ru. Gim st
nng acid valproic trong huyt thanh. Hiu chnh liu nu cn.
Primidon hoc dn cht
tc dng an thn bun ng, iu ny ch ng vi mt s phenothiazin an thn.
Tng tc dc lc.
X l: Lu nguy c ny hiu chnh liu dng ca hai thuc, nu cn
Phn tch: Vi liu cao (100 mg/ngy), clorpromazin lm tng glucose mu
do gim gii phng insulin.
589
X l: iu chnh liu dng lc bt u, lc ang v lc ngng tr liu

bng clorpromazin. Thng bo cho ngi bnh h tng cng t theo di
trong khi iu tr bng clorpromazin.
Thuc cng giao cm alpha beta (adrenalin, noradrenalin)
Phn tch: Clorpromazin lm gim tc dng tng huyt p ca
noradrenalin. Clorpromazin i khng vi tc dng co mch ngoi bin ca
adrenalin v trong mt s trng hp lm o ngc tc dng ca adrenalin.
Tng tc xy ra nhanh. C ch: da trn quan st lm sng, c ch c th lin
quan n tnh cht i khng dc l, lm gim ton b tc dng ca adrenalin,
noradrenalin.
X l: Gim st cc du hiu sng ca ngi bnh khi phi hp cc thuc
ny. Trong trng hp cp, dng cc bin php h tr.
X l: Khuyn ngi bnh sp phi phu thut bo cho bc s gy m v
cc thuc dng.
Thuc gin mch chng tng huyt p; thuc c ch enzym chuyn dng
angiotensin
Phn tch: Tng tc dng h huyt p ca cc thuc ny. H huyt p l
tc dng khng mong mun in hnh ca cc thuc an thn kinh dn cht cu
phenothiazin.
X l: Nu cn phi hp, phi tng cng theo di huyt p trong khi iu
tr v lc ngng iu tr vi 1 trong 2 thuc. Tin hnh hiu chnh li u. Nh n
mnh v k hoch dng thuc v vic tun th. c bit thn trng khi dng
ngi bnh cao tui, phng ng do tt huyt p.
Phn tch: Thuc khng acid lm gim hp thu qua ng tiu ho, do
lm gim tc dng ca thuc c phi hp.
X l: Cn mt khong cch t nht t 1 n 2 gi gia ln ung thuc
khng acid v thuc khc. Cn nhc li l cc khng acid thng c ung
sau ba n 1 gi 30 pht v n l ngun gc tng tit dch v.
ng.
X l: Theo di huyt p trong khi phi hp hai thuc. Tu theo thuc

dng, h huyt p c th t hay nhiu. Hiu chnh liu dng ca mt hay hai
thuc. Lp mt k hoch ung thuc u n. Khuyn ngi bnh nu thy
chng mt khi bt u iu tr, nn gp li thy thuc hiu chnh liu dng
cu mt hay hai thuc. Tng cng theo di nhng ngi bnh cao tui (nguy
590
c b ng) v khuyn h khi chuyn t t th nm hay ngi sang ng phi dn

dn.
Phn tch: Cc thuc nhun trng nhy v thm thu lm gim s hp thu
v gim hot tnh ca cc thuc an thn kinh nhm phenothiazin khi ung cng.
X l: Tng tc c th trnh c nu dng cc thuc ny cch nhau t
nht 2 gi.

amphetamin.
Khuyn ngi bnh gp li bc s, nu thy iu tr khng n nh.
Baclofen
X l: Lu nguy c ny hiu chnh liu dng ca hai thuc nu cn
Khuyn khng ung ru v khng t dng thuc hoc cc ch phm c
ru.
591
Barbituric; fluoxetin; fluvoxamin; mianserin

Disopyramid; thuc chng trm cm ba vng hoc thuc tng t; thuc
khng cholinergic;
Phn tch: Tng tnh cht khng cholinergic do cng hp tc dng khng
mong mun: b tiu tin, kh ming v to bn.
X l: Cn lu nhng tc dng ph ca loi thuc ny. Nu nht thit
phi phi hp, bo cho ngi bnh v nhng tc dng ph. Trnh dng cho
ngi bnh tuyn tin lit v ngi tng nhn p.
Oxaflozan
tc dng an thn bun ng, iu ny xy ra vi mt s phenothiazin an thn.
Tng tc dc lc.
X l: Lu nguy c ny hiu chnh liu dng ca hai thuc, nu cn
Phn tch: Tng tc dc lc. Tng tc dng c ch h thn kinh trung
ng, ko theo tng tc dng an thn bun ng. Nhiu thuc khng histamin an
thn c cu trc phenothiazin.
X l: Lu nguy c ny hiu chnh liu dng ca hai thuc nu cn
Khuyn khng ung thm ru v khng t dng thuc hoc ch phm c
ru.
Thuc c ch monoamin oxydase (IMAO) khng chn lc
Phn tch: Tng tc dng an thn bun ng v h huyt p th ng, do
cng hp tc dng ca c hai thuc (ch nht ngi bnh cao tui, nhy
cm vi h huyt p th ng) v tng cc phn ng ngoi thp.
X l: Khi phi hp, cn theo di, nht l ngi bnh cao tui, ngi
li xe v vn hnh my. Khuyn khng ung ru v khng t dng thu c
hoc ch phm c ru.
PHENYTOIN
Hydantoin chng ng kinh
592
CC THUC TRONG NHM

PHENYTOIN vin nn 100mg
Di-Hydan vin nn 100mg
CH KHI CH NH THUC

Thi k cho con b: Phenytoin qua c sa m.
Thi k mang thai: Cc d tt bm sinh hay gp hn tr em c sinh ra t b
m b ng kinh v c th hoc do ng kinh, hoc do thuc chng ng kinh. Phenytoin
hnh nh l nguyn nhn ca mt s d tt (mt, vm ming, ngn tay) v gy nhng ri
lon v ng mu khi mi sinh (chy mu).
Qu mn vi nhm hydantoin.
Cn theo di: mc 1
Ngi bnh cao tui: Nguy c b nhim c, do gim chuyn ha hoc do gim
protein trong huyt tng, nn lm tng phn thuc t do.
TNG TC THUC

Diazoxid
Phn tch: ng thi gim tc dng chng ng kinh v tng glucose mu
khi phi hp hai thuc.
X l: Thay i chin lc iu tr, do kh t c mt cn bng iu tr.
Disulfiram
Phn tch: c ch chuyn ho gan dn theo tng nng phenytoin
trong huyt tng. Phi hp thuc c th dn n cc ri lon tm thn v mt
phi hp vn ng.
X l: o nng phenytoin trong huyt tng v hiu chnh liu dng,
thm ch ngng disulfiram. Nng phenytoin trung bnh c tc dng iu tr
ti u tu theo cc phng php nh lng, l t 5 n 15 mg/lt. Xc minh cc
tr s do phng th nghim a ra.
Phn tch: Tng chuyn ho cc estroprogestogen gan, do cm ng
enzym, dn n nguy c th thai.
X l: Trnh dng cc thuc nga thai liu thp v chn loi liu cao hoc
khuyn dng mt phng php nga thai khc, nu iu tr bng phenytoin ko
di. Cn nh, cm ng enzym khng bao gi l hin tng tc thi.
593
Mifepriston
Phn tch: Nguy c gim hiu qu ca phng php, do tng chuyn ho
mifepriston bi cm ng enzym.
X l: Cn nh rng cm ng enzym l mt hin tng chm xy ra (3
tun). C th xem xt tng liu dng.
Phenicol
Phn tch: Cloramphenicol c ch chuyn ho phenytoin gan. Ngoi ra,
chuyn ho ca cloramphenicol cng tng ln do phenytoin, do gim hot
tnh.
X l: Nng phenytoin tng ng k (2 n 4 ln nng ban u) vi
ngy sau khi dng cloramphenicol. Nn trnh phi hp.
Phn tch: Tng chuyn ho cc thuc nga thai progestogen gan bi
cm ng enzym, dn n nguy c th thai.
X l: Trnh dng cc thuc nga thai liu thp v nn chn cc thuc
nga thai liu cao hoc khuyn mt phng php nga thai khc, nu vic iu
tr bng cht cm ng ny ko di. Cn nh, cm ng enzym khng bao gi l
hin tng tc thi.
Pyrazol
Phn tch: Tng tc dc ng hc: tng nng phenytoin trong mu,
c l do s chuyn ho cnh tranh gan.
X l: Hiu chnh liu dng theo nng phenytoin trong huyt tng.
Ru
Phn tch: Gim nng phenytoin trong huyt tng, do cm ng enzym
ngi nghin ru. Ngi nghin ru phi c theo di cn thn (nguy c
gim tc dng chng co git ca phenytoin). Trong cn say ru cp ( ngi
khng nghin ru), nng phenytoin huyt tng li tng cao.
X l: Tt nht, khng dng phenytoin v khng th kim sot c vic
ung ru ca ngi bnh. Nguy c an thn bun ng s nguy him, nht l
cho ngi li xe v ngi vn hnh my. Khuyn khng ung ru v khng t
Saquinavir
Phn tch: Cc cht cm ng enzym lm tng chuyn ho saquinavir vi
h qu l gim nng trong huyt tng dng saquivavir c hot tnh v gim
hiu qu iu tr.
X l: Nn tm mt thuc khc thay th khi saquinavir c dng ng
thi. Nu khng th thay th, nn tng liu saquinavir khng lm gi m tc
dng khng virus.
594
Sulfamid khng khun

Phn tch: Tng tc dc ng hc: tng nng phenytoin trong huyt
tng do c ch enzym v do y phenytoin khi lin kt protein trong huyt
tng, c th dn n cc du hiu qu liu.
X l: Chn mt h thuc khc cc sulfamid; nu cn phi hp, nn qun
l cn thn liu dng ca phenytoin.
Phn tch: Cimetidin l mt cht c ch cc oxydase gan (cytochrom
P450) cn cho chuyn ho mt s thuc. Ngoi ra, thuc ny cn lm gim l u
lng mu gan. Do vy, nng trong huyt tng ca mt s thuc tng ln
(nguy c qu liu), nhng cng do c ch mt s chuyn ho, nn cimetidin
chn mt s c ch gii c. Cimetidin c ch chuyn ho ti gan ca
phenytoin, do c nguy c qu liu.
X l: Phenytoin c phm vi iu tr hp, vic c ch chuyn ho ca n
dn n cc nguy c qu liu. Nu cn, phi tng cng theo di nng trong
huyt tng, nu thy xut hin tht bi trong iu tr hoc phi thay thuc
chng lot.
Thuc cng giao cm (dopamin)
Phn tch: Cho phenytoin trong khi truyn dopamin c th gy h huyt p
nng v c kh nng lm ngng tim. Tng tc xy ra nhanh. C ch cha r.
C th do dopamin lm thiu ht catecholamin phi hp vi tc dng c ch c
tim ca phenytoin.
X l: Phi dng phenytoin ht sc thn trng i vi ngi ang truyn
dopamin. Nu phi dng phenytoin, gim st cht ch huyt p ngi bnh v
ngng ngay truyn phenytoin nu thy huyt p gim.

Phn tch: Nng phenytoin trong huyt thanh c th gim, dn n
gim tc dng dc l.
X l: Theo di nng ca phenytoin trong huyt thanh v quan st v
s gim tc dng ca phenytoin hoc tng c tnh ca thuc ny, nu acid
folic c a vo hoc rt b ra khi phc iu tr. iu chnh li u c a
phenytoin nu cn.
Acetaminophen (paracetamol)
Phn tch: Tim nng nhim c gan do paracetamol (acetaminophen) c
th tng khi phi hp vi phenytoin dng lu di. Tc dng iu tr ca
acetaminophen c th b gim khi dng ng thi vi phenytoin. Tng tc xy
ra chm. C ch: Phenytoin gy cm ng cc enzym ca microsom gan, lm
tng chuyn ho acetaminophen thnh cc cht chuyn ho c vi gan.
X l: Nguy c nhim c gan ln nht khi dng acetaminophen lu di
hoc qu liu, km theo dng phenytoin thng xuyn u n. Thng khng
595
cn iu chnh liu hoc gim st c bit khi dng acetaminophen v

phenytoin vi liu iu tr thng thng.
Acyclovir
Phn tch: Nng huyt thanh ca phenytoin c th b gim, lm gim
tc dng phenytoin. Tng tc xy ra mun. C ch cha r.
X l: Theo di ngi bnh pht hin thay i tc dng ca phenytoin
khi bt u hoc ngng iu tr acyclovir. iu chnh liu phenytoin nu cn.
Amiodaron
Phn tch: Tng nng ca phenytoin trong huyt thanh km theo triu
chng c tnh. Phenytoin c th lm gim nng ca amiodaron trong huyt
thanh. C ch: c l c s gim chuyn ho ca phenytoin v tng chuyn ho
ca amiodaron.
X l: Theo di nng thuc v quan st bnh nhn v c tnh hoc
mt tc dng iu tr khi dng phi hp ny. Cn chun b iu chnh liu
ca thuc ny hay thuc kia. V cc tc dng c th chm nhiu tun, nn cn
phi theo di di ngy.
Baclofen
X l: Lu nguy c ny iu chnh liu dng ca hai thuc, nu cn
phi hp. Ch n gim tnh to ngi li xe v ngi vn hnh
my. Khuyn khng ung ru v khng t dng thuc hoc ch phm cha
ru.
Benzodiazepin
Phn tch: Nguy c khng d on c tng hay gim nng phenytoin
trong huyt thanh.
X l: Theo di lm sng v nng phenytoin huyt thanh.
Cafein
Phn tch: Cafein c phi hp vi mt thuc gy cm ng enzym.
Trong vng 10 n 12 ngy, phenytoin gy cm ng, lm tng chuyn ho
cafein gan v lm gim hot tnh v nng cafein trong huyt tng.
X l: Nu cafein c dng trong iu tr (kch thch h hp), nn theo
di lm sng v nng trong huyt thanh. iu chnh liu dng trong khi dng
v khi ngng dng phenytoin.
Ciclosporin
Phn tch: Gim nng ciclosporin trong huyt thanh, do kch thch d
ho bi enzym.
X l: Nu cn phi hp, cn theo di k nng ciclosporin trong huyt
thanh v iu chnh liu dng lc u v lc cui iu tr bng phenytoin. Lu
596
l nng ciclosporin bin ng ln theo tng ngi bnh, nn cn phi theo

di u n.
Clozapin
Phn tch: Tng tc dc ng hc: tng chuyn ho clozapin bi cm
ng enzym, c th dn n tht bi trong iu tr bng clozapin.
X l: Nhn xt ngi bnh v p ng lm sng v iu chnh liu ca
clozapin cho ph hp.
Corticoid-khong
Phn tch: Tng d ho cc corticoid-khong bi cc thuc cm ng enzym
nh phenytoin. Cm ng enzym ch th hin sau 10 n 12 ngy t khi bt u
iu tr.
X l: Cm ng enzym khng phi l mt hin tng tc thi. Khi iu tr
cng vi thuc cm ng enzym trung hn v di hn phi tnh n nguy c
gim tc dng iu tr. iu chnh liu dng corticoid-khong khi dng v sau
khi ngng phenytoin.
Cycloserin
Phn tch: Cycloserin c kh nng c ch chuyn ho phenytoin gan.
X l: Tng tc ny cn c xc nhn. Ch theo di nng
phenytoin nu cn. Nu thy c nhng bin ng, chuyn cc nhn xt ti
Trung tm cnh gic thuc.
Didanosin
Phn tch: Vin nn didanosin c cha mt khng acid gy nguy c gim
hp thu phenytoin ng tiu ho, tu theo s gia tng pH dch v.
Dihydropyridin
Phn tch: Tng nng phenytoin trong huyt tng, vi cc du hiu
qu liu, c l do y phenytoin ra khi cc v tr gn kt protein trong huyt
tng v/hoc b c ch chuyn ho ( m t vi nifedipin).
X l: iu chnh liu phenytoin trong v khi ngng iu tr bng
dihydropyridin. Tng tc c xc lp vi nifedipin; cn c nhng nhn xt cho
cc dihydropiridin khc.
Disopyramid
Phn tch: Do cm ng enzym, nng disopyramid trong huyt thanh b
gim ti nng khng cn hiu qu do cm ng enzym.
X l: Khi cn th theo di in tm , lm sng, nng trong huyt
thanh ca disopyramid v iu chnh liu lng.
597
Ethosuximid
Phn tch: Nng trong huyt thanh ca phenytoin c th tng, lm tng
tc dng dc l v c tnh. Tng tc xy ra chm. C ch cha r. Tuy
nhin, c th ethosuximid c ch chuyn ho phenytoin gan.
X l: Gim st nng trong huyt thanh ca phenytoin v theo di
nhim c phenytoin hoc gim tc dng ngi bnh khi bt u thm hoc
ngng ethosuximid. iu chnh liu phenytoin nu cn.
Phn tch: Theo mt c ch cha hon ton sng t, phenytoin lm gim
tc dng dc l ca furosemid c th b gim ti 50%. C th c s gim hp
thu furosemid theo ng ung.
X l: Nu cn, tng liu furosemid trong v sau khi iu tr bng
phenytoin. Theo di s bi niu.
Glucocorticoid
Phn tch: S gim tc dng ca glucocorticoid c th xy ra trong vng
vi ngy sau khi bt u dng phenytoin v ti 3 tun sau khi ngng phenytoin.
Dexamethason c th lm gim nng ca phenytoin. C ch: c s tng
chuyn ho ca glucocorticoid thng qua s cm ng enzym ca phenytoin.
Dexamethason c th lm tng thanh lc ca phenytoin gan.
X l: C khi cn tng gp i (hoc hn) liu ca glucocorticoid. Liu ca
phenytoin cng c th phi tng. Nu khng trnh c phi hp ny, nn theo di
nng ca phenytoin v iu chnh liu ca thuc ny hay thuc kia.
Glycosid tr tim
Phn tch: Nng glycosid tr tim trong huyt thanh c th gim v tc
dng ca chng cng gim. C ch cha r.
X l: Nu nghi c tng tc, cn theo di nng trong huyt thanh v
theo di ngi bnh v s mt tc dng iu tr. Tng liu ca glycosid tr tim,
nu thy cn.
Hormon tuyn gip
Phn tch: Tc dng ca hormon tuyn gip c th gim. C ch c l do
phenytoin lm tng d ho ca chng (cm ng enzym).
X l: Khi iu tr di hn hormon tuyn gip cng vi phenytoin l mt
thuc cm ng enzym, phi tnh n nguy c gim hiu lc. iu tr liu dng
trong v sau khi ngng iu tr vi phenytoin.
Phn tch: Nng phenytoin trong huyt thanh c th tng, d n n
tng tc dng dc l v c tnh ca phenytoin. li u i u tr thng th ng,
c tnh ca phenytoin thng r rt nh t ng i bnh acetyl ho ch m
isoniazid. C ch: Isoniazid c ch enzym chuy n ho phenytoin microsom
gan.
598
X l: Theo di nng phenytoin trong huyt thanh v quan st ngi

bnh v c tnh ca phenytoin hoc s gim tc dng ca thuc ny nu
isoniazid c a vo hoc rt khi phc iu tr. iu chnh liu ca
phenytoin nu thy cn.
Lansoprazol
Phn tch: Tng tc dc ng hc. Cn thn trng vi cc thuc b
chuyn ho qua xc tc ca cytochrom P 450, v c nguy c gim hot tnh ca
cc thuc ny do cm ng enzym, c th dn n tht bi iu tr.
X l: Lanzoprazol l thuc tng i mi v cn thiu cc nhn xt lm
sng. y c th c tng tc v nn chuyn cc nhn xt lm sng v Trung
tm cnh gic thuc. Xem xt nguy c trong bi cnh iu tr. Nu cn, i u
chnh liu theo kt qu cc ln nh lng phenytoin, khi bt u v khi ng ng
iu tr bng lansoprazol. Theo di lm sng.
Levodopa
Phn tch: Levodopa gim tc dng. Tng tc xy ra chm. C ch cha
r.
X l: Cn thn trng khi phi hp. Nu nghi c tng tc, cn nhc thay
i cch iu tr.
Phn tch: Dng ng thi trong khoa tim hai thuc ny c th lm tng tc
dng c ch tim. Ngoi ra, phenytoin c th lm tng chuyn ho ca lidocain
gan, do lm gim nng lidocain trong huyt tng.
X l: Nu phi hp, nn nhanh chng b tr cc phng tin theo di.
Theo di nng lidocain, nu cn, hoc lm in tm nu lm sng yu
cu.
Medifoxamin; phenothiazin; procarbazin
X l: Lu nguy c ny iu chnh liu hai thuc. Ch n gi m
khng t dng thuc hoc cc ch phm cha ru.
Mexiletin
Phn tch: Gim nng mexiletin trong huyt tng, do cm ng enzym.
X l: iu chnh liu dng ca mexiletin theo lm sng v in tm .
Phn tch: Tng tc dc ng hc. Nhiu hin tng c th biu hin:
nguy c qu liu phenytoin (ri lon tiu ho, rung git nhn cu, mt iu ho,
lon vn ngn, hn m, h huyt p,...) do phenytoin b y khi protein huyt
tng do natri valproat (tng tc dc ng hc khu phn b); gim nng
natri valproat trong huyt tng do tc dng cm ng enzym ca phenytoin
599
(tng tc dc ng hc khu chuyn ho); gim thanh lc phenytoin bi

natri valproat, do gim chuyn ho. Phi hp ca hai ch phm c tnh cht
khng folic.
X l: Theo di lm sng v huyt hc (c th thiu mu nguyn hng cu
khng l) v iu chnh liu lng phenytoin ty theo nng trong huyt
tng, c bit tr em b ng kinh.
Nilutamid
Phn tch: C th do cc tnh cht c ch enzym ca nilutamid, nng
ca phenytoin c nguy c tng.
X l: Tng cng theo di lm sng v sinh hc. iu chnh liu ca
phenytoin theo cc kt qu theo di.
Omeprazol
Phn tch: Nng phenytoin trong huyt thanh c th tng, dn n tng
tc dng dc l v c tnh. C ch do omeprazol c ch chuyn ho oxy ho
ca phenytoin gan.
X l: Theo di nng ca phenytoin trong huyt thanh v quan st
ngi bnh v c tnh hoc gim tc dng ca phenytoin, nu omeprazol
c a vo hoc rt khi phc iu tr. iu chnh liu ca phenytoin, nu
cn thit.
Paroxetin
Phn tch: Nng phenytoin trong huyt thanh c th gim khi dng phi
hp vi paroxetin, do lm gim tc dng iu tr ca phenytoin. C ch cha
r.
X l: Nu nghi c tng tc, c th cn phi iu chnh liu ca
phenytoin khi bt u, khi ngng hoc khi thay i liu ca paroxetin. Theo di
p ng lm sng ca ngi bnh.
Progabid
Phn tch: C th tng nng phenytoin trong huyt tng dn n qu
liu (c thn kinh).
X l: Progabid l thuc chng ng kinh la chn hng hai, c vi gan.
Nn tnh n nguy c tht bi iu tr. iu chnh liu dng.
600
Pyrimethamin; trimethoprim
Phn tch: Nguy c tng c tnh v mu do c ch ty xng, do hip
ng tc dng ln dehydrofolat reductase, c th dn n thiu mu nguyn
hng cu khng l.
cn thn huyt . Phi hp ny dnh cho cc chuyn gia v cc phc iu
tr thng c xc nh r. C th b sung thm acid folinic.
Quinidin hoc dn cht
Phn tch: Tng chuyn ho gan, do cm ng enzym, dn n gim tc
dng ca quinidin v dn cht. iu chnh liu dng quinidin. Khi cn, phi theo
di cn thn nng quinidin trong huyt tng v cnh gic khi ngng iu tr
phenytoin.
Khuyn khng ung thm ru.
Phn tch: Tng chuyn ho gan, do cm ng enzym, ko theo gim tc
dng ca quinin v thuc tng t.
X l: iu chnh liu quinin. Theo di cn thn nng quinin trong
huyt tng v cnh gic khi ngng iu tr phenytoin. Lu nguy c ny
iu chnh liu dng ca hai thuc nu cn phi hp. Ch n gim tnh to
ngi li xe v ngi vn hnh my. Khuyn khng ung ru do tc dng c
ch h thn kinh trung ng ca mt trong hai thuc. Nu ngi bnh t dng
thuc, t dc ca cc thuc phi khng cha ru.
Rifampicin
Phn tch: Nng ca phenytoin trong huyt thanh c th gim, dn n
gim tc dng dc l ca phenytoin. C ch do rifampicin lm tng chuyn ho
ca phenytoin microsom gan.
X l: Khi cn, phi theo di cn thn nng phenytoin trong huyt
tng v cnh gic lc ngng iu tr rifampicin. iu chnh liu dng phenytoin
theo kt qu nh lng trong huyt tng.
Salicylat
Phn tch: Salicylat c th y phenytoin khi cc lin kt vi protein huyt
tng, v nh vy, lm tng nng trong huyt tng ca thuc chng ng
kinh.
X l: nhng ngi ng kinh, cn phi t c nng hiu qu ca
phenytoin. iu chnh liu dng theo nng phenytoin trong mu. Khuyn
ngi bnh tun th y lnh v dng thuc v theo di trong iu tr.
601
Sucralfat
Phn tch: Tc dng chng co git ca phenytoin c th gim. C ch do
c s gim hp thu phenytoin khi c mt sucralfat.
X l: Dng hai thuc cch nhau 2 gi. Thuc khng acid nn ung sau
ba n, v n lm tng tit acid.
Phn tch: Sulfamid y phenytoin ra khi cc lin kt vi protein huyt
tng v/hay c ch d ho, ko theo tng na i v tng nng phenytoin
trong huyt thanh.
X l: Cn iu chnh liu ca phenytoin trong v sau khi iu tr bng
sulfasalazin.
602
Tacrolimus
Phn tch: Nng ca tacrolimus trong huyt thanh c th gim do
phenytoin, cn nng ca phenytoin trong huyt thanh c th tng do
tacrolimus. C ch do phenytoin c th lm tng chuyn ho ca tacrolimus
(cytochrom P450 3A4).
X l: Theo di nng tacrolimus v phenytoin trong huyt thanh. Theo
di p ng lm sng ca ngi bnh trong khi dng cc thuc ny cng vi
nhau. Nu cn, iu chnh liu.
Tetracosactid
Phn tch: Tng d ho adrenocorticoid bi cc thuc cm ng enzym (nh
phenytoin). Cm ng enzym ch biu hin t 10 n 12 ngy sau khi khi u
iu tr.
cng vi mt thuc cm ng enzym trung v di hn, phi tnh n nguy c
gim tc dng iu tr ca tetracosactid. iu chnh liu lng tetracosactid
trong iu tr v sau khi ngng phenytoin (thuc cm ng).
Tetracyclin
Phn tch: Na i ca doxycyclin gim ng k khi dng cng vi
phenytoin. C ch doxycyclin c chuyn ho bng cch lin hp gan , l
mt quy trnh c th cm ng c. Phenytoin gy cm ng s chuyn ho ny
do enzym microsom gan xc tc. Ngoi ra cn c th c s tham gia ca
chuyn dch doxycyclin ra khi cc v tr gn vo protein huyt tng.
X l: Nng ca khng sinh l rt quan trng p ng iu tr t
kt qu. Theo di cht ch p ng lm sng khi phenytoin c dng cng
vi doxycyclin. Mt s tc gi khuyn nn tng gp i liu dng hng ngy ca
doxycyclin duy tr thch hp nng thuc trong huyt tng. Tng tc ni
trn cha c xc nh vi cc tetracyclin khc, nhng cng nn thn trng.
Phn tch: C s gim hoc mt tc dng dc l ca theophylin hoc
ca phenytoin. C ch: c th phenytoin lm tng chuyn ho ca theophylin.
Ngc li, theophylin cng lm tng chuyn ho ca phenytoin.
X l: Khi thm hoc rt i mt trong hai thuc ny trong phc , th nn
theo di nng ca tng thuc trong huyt thanh v iu chnh liu cho ph
hp.
Phn tch: Phenytoin lm gim nng trong huyt tng ca itraconazol,
fluconazol v miconazol do cm ng enzym (gim hiu qu).
X l: Nguy c iu tr tht bi nu phi hp vi cht cm ng enzym ko
di t nht mi ngy. Trong trng hp ny, iu chnh liu dng v nu cn,
nh lng itraconazol hoc dn cht imidazol khc trong huyt tng.
603

Phn tch: Salicylat v acid tiaprofenic c th y phenytoin khi cc lin
kt protein trong huyt tng v nh vy lm tng nng trong huyt tng
ca thuc chng ng kinh.
X l: iu chnh liu dng tu theo nng phenytoin trong mu trong
khi v sau khi iu tr bng thuc chng vim khng steroid. Theo di cc du
hiu lm sng v c tnh ca phenytoin.
Phn tch: Dng di hn phenytoin lm tng chuyn ho thuc gy m, c
th dn n tng liu dng, km h qu c th xy ra l c cho gan v thn.
X l: Phi hp c th gp ti bnh vin. Khuyn ngi bnh bo cho
thy thuc gy m vic ung u n phenytoin. Ngi gy m phi lu n
tng tc ny.
Thuc gin c khng kh cc (atracurium, pancuronium, tubocurarin...)
Phn tch: Thuc gin c khng kh cc c th b gim thi gian tc dng
hoc b gim tc dng. Tng tc xy ra nhanh. C ch: Phenytoin lm thay i
chuyn ho ca thuc gin c pancuronium v c tc dng trc ch ni thn
kinh - c tng t nh thuc gin c khng kh cc.
X l: C th phi tng liu thuc gin c khng kh cc. Gim st hiu
qu thuc xem c b gim khng.
Phn tch: Phenytoin gy cm ng enzym, lm tng d ho thuc chng
ng mu gan. Cm ng enzym khng phi l mt hin tng tc thi, nn
phi tr liu vi cc cht cm ng t trc t nht mi ngy c biu hin
tng tc.
X l: iu chnh liu lng khi tnh n tng tc xy ra mun ny theo
cc kt qu xt nghim sinh hc INR (t l chun quc t) v TP (t l
prothrombin). Theo di thng xuyn khi bt u iu tr chng ng mu cho
ngi ang dng v khi ngng dng thuc c tnh cht cm ng enzym.
Viloxazin
Phn tch: Ba tc dng c ghi nhn: h thp ngng gy ng kinh bi
viloxazin; c ch cnh tranh s hydroxyl ho, d ho ca phenytoin b gim; tng
tc dng c ch h thn kinh trung ng, ko theo tng tc dng an thn bun
ng.
X l: Nu cn phi hp, nn iu chnh liu lng phenytoin. Gim liu
ty theo nng trong huyt tng (ty theo phng php nh lng, nng
iu tr phenytoin dao ng t 5-15mg/lt). Ch n s gim tnh to ngi
li xe v ngi vn hnh my. Khuyn khng ung ru v nu ngi bnh t
dng thuc, kim tra t dc ca cc thuc khng c c ru.
604
Vitamin nhm D
Phn tch: Khi iu tr di ngy, phenytoin l cht cm ng enzym c th
kch thch lm tng chuyn ho vitamin D, do lm gim tc dng ca vitamin
ny v gy ri lon chuyn ho calci.
X l: Lu n thi gian iu tr. Cm ng enzym khng phi l mt
hin tng tc thi, m biu hin nhiu ngy sau khi khi u iu tr. Vi
cc tr liu di hn, nn iu chnh liu dng v b sung thm vitamin D nu
cn.
Zidovudin
Phn tch: C s c ch chuyn ho ca zidovudin (lin hp glucuronic)
v s thanh lc ca n. Khi phi hp vi zidovudin, ngi ta nhn thy c s
thay i nng ca phenytoin. Theo y vn, cc nng c th thay i theo
chiu ny hay chiu khc. Tng tc ny cn c thm t liu.
X l: iu chnh liu ca zidovudin, theo di tc dng v huyt hc ca
zidovudin v theo di lm sng v hiu qu ca phenytoin (nh lng trong
huyt tng).

Alopurinol
Phn tch: Nng trong huyt thanh ca phenytoin c th tng, lm tng
c tnh. Tng tc xy ra chm. C ch: chuyn ho phenytoin c th b
c ch.
Barbituric
Phn tch: Theo trnh t thi gian dng thuc, nu dng phenobarbital
ngay trc phenytoin, c s tng nng phenytoin trong huyt tng do cnh
tranh khu chuyn ho. Nu dng phenytoin trc phenobarbital, nhng thay
i ca nng phenytoin khng d on c.
X l: Da vo trnh t thi gian dng cc thuc v tu trng hp, lu
nguy c ny iu chnh liu dng ca hai thuc, nu cn phi hp. Ch
n s gim tnh to ngi li xe v ngi vn hnh my. Khuyn khng ung
Carbamazepin
Phn tch: Phenytoin lm gim hm lng carbamazepin trong huyt
thanh. Cn tc dng ca carbamazepin trn phenytoin th thay i tht thng.
C ch: C s tng chuyn ho ca carbamazepin do cm ng enzym. Cn
carbamazepin c th lm gim sinh kh dng ca phenytoin.
X l: Theo di nng ca c hai thuc trong huyt thanh, nht l khi
bt u dng hoc khi ngng mt thuc. Thay i liu nu cn thit duy tr
hiu lc iu tr v trnh c tnh.
605
Fluoxetin
tc dng an thn bun ng. Cng tng nng phenytoin vi cc du hi qu
liu (do c ch chuyn ho).
X l: Lu cc nguy c ny iu chnh liu dng ca hai thuc trong
v sau khi iu tr bng fluoxetin, nu cn phi hp. Ch n s gim tnh to
ngi li xe v ngi vn hnh my. Khuyn khng ung ru v khng t
Khng histamin khng H1 an thn; fluvoxamin
X l: Lu nguy c ny iu chnh liu ca hai thuc. Ch n s
Mebendazol
Phn tch: Tc dng dc l ca mebendazol c th b gim. C ch cha
r.
X l: Khng cn phi thn trng c bit. Nu nghi c tng tc, c th
tng liu mebendazol trong khi phi hp vi phenytoin. nh lng nng
mebendazol trong huyt thanh v iu chnh liu (trng hp xy ra trong khi
iu tr bnh do Echinococcus multilocularis).
Methadon
Phn tch: Tng tc dng c ch h thn kinh trung ng, km vi an
thn bun ng mnh, c bit c hi cho ngi li xe v ngi vn hnh my.
X l: Ngi k n phi lu s tng tc dng bun ng ny khi k n
cc thuc vi li khuyn thch hp( trnh li xe hoc vn hnh my; bo cho
ngi xung quanh bit mi nguy him).
Methotrexat
Phn tch: Nng phenytoin trong huyt thanh c th gim, dn n mt
tc dng iu tr. C ch do gim hp thu hoc tng chuyn ho ca phenytoin.
X l: Theo di nng phenytoin trong huyt thanh v iu chnh liu
ca phenytoin cho ph hp. Dng phenytoin tim tnh mch c th c ch.
606
Metronidazol
Phn tch: Tc dng dc l ca phenytoin c th tng. C ch cha r.
Tuy nhin, chuyn ho phenytoin gan c th b metronidazol c ch.
X l: Khng cn thn trng c bit. Gim st nng trong huyt tng
ca phenytoin v iu chnh liu nu cn.
Praziquantel
Phn tch: Nng trong huyt thanh ca praziquantel c th b gim, lm
gim tc dng iu tr. C ch cha r.
X l: Theo di p ng lm sng ca ngi bnh. C th cn phi tng
liu praziquantel khi phi hp vi phenytoin. nh lng nng huyt thanh c
th gip trong iu tr.
Primidon hoc dn cht
Phn tch: Tu theo trnh t thi gian dng cc thuc; nu primidon c
dng trc so vi phenytoin, c s tng nng phenytoin trong huyt tng do
cnh tranh khu chuyn ho. Nu phenytoin c dng trc primidon, nhng
thay i ca nng phenytoin khng d on c.
X l: Da vo trnh t thi gian dng cc thuc v tu trng hp, lu
nguy c ny iu chnh liu lng ca hai thuc nu cn phi hp. Ch
n s gim tnh to ngi li xe v ngi s dng my. Khuyn khng ung
Pyridoxin
Phn tch: Nng huyt thanh ca phenytoin c th b gim, lm gim
tc dng dc l ca phenytoin. Tng tc xy ra chm. C ch cha r
X l: Gim st nng huyt thanh ca phenytoin v theo di s gim
tc dng hoc tng c tnh ca phenytoin khi bt u hoc ngng dng
pyridoxin. iu chnh liu phenytoin khi cn.
Thuc ch vn morphin; oxaflozan
hp. Ch n s gim tnh to ngi li xe v ngi vn hnh my. Khuyn
Thuc c ch HMG-CoA reductase (atorvastatin, simvastatin)
Phn tch: Nng trong huyt tng ca mt s thuc c ch HMG-CoA
reductase c th b gim, lm gim tc dng iu tr (th d tng cholesterol
mu). C ch: nghi c tng chuyn ho ca thuc c ch HMG-CoA reductase.
X l: Gim st p ng lm sng ca ngi bnh; nu nghi c tng tc,
c th cn phi thay thuc. Pravastatin c v t tng tc vi phenytoin hn v
c th dng lm thuc thay th thch hp.
607
PHOSPHO HOC PHOSPHAT

Yu t khong cht thit yu trong cu to ca m xng
v c dng lm cht chng calci niu
CC THUC TRONG NHM

Phosphat v c ng tim 0,140 mg/2mL; vin nn si 750 mg
Oligosol P ng tim 0,140 mg/2mL
Phosphore Sandoz vin nn si 750 mg
CH KHI CH NH THUC
Thn trng: mc 2
Gim calci mu
Cn theo di: mc 1
Suy thn: Trnh dng cho ngi suy thn mn.
PINAVERIUM BROMID
Thuc chng co tht hng c, khng khng cholinergic,
c tnh i khng cc knh chm ca calci
CC THUC TRONG NHM

PINAVERIUM BROMID vin nn 10 mg; 50 mg
Dicetel vin nn 10 mg; 50 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: Thuc qua c sa m, lm gim tit sa; nguy c tc
dng c kiu atropin.
Thi k mang thai: Trnh k n cho ngi mang thai, nguy c c tnh ca
atropin tr s sinh (tc rut ct su).

Tr em: Pinaverium bromid l thuc dnh cho ngi ln.
608
609
PIPERAZIN
Thuc tr giun, tc dng ln giun a v giun kim,
do chn thn kinh vn ng ca giun
CC THUC TRONG NHM

PIPERAZIN SIRO l 30 mL; 120 mL
Piperazin siro l 30 mL; 120mL
Siro piperazin
CH KHI CH NH THUC
Chng ch nh: mc 4
Suy gan: Do tc dng khng mong mun ca thuc ny.
Suy thn: Do chuyn ho ca thuc ny.
Thn trong: mc 2
ng kinh: C cc tin s co git.
TNG TC THUC

Pyrantel hoc dn cht
Phn tch: i khng dc l. Pyrantel l thuc tr giun gy kh cc chc
nng thn kinh c v lm lit giun. Piperazin cng l thuc tr giun, nhng gy
tng phn cc ca ni thn kinh c. Hai tc dng ny l i khng.
X l: Nn trnh phi hp. Thay i chin lc iu tr.
Phenothiazin (clorpromazin)
Phn tch: Piperazin c th gy co git khi phi hp vi phenothiazin. C
ch cha r
X l: Cn phi theo di cht ch ngi ang dng phenothiazin
(clorpromazin) m dng thm piperazin.
PIRIBEDIL
Thuc ch vn dopamin, dng trong cc biu hin au
do thiu mu cc b ca cc bnh ng mch
610
CC THUC TRONG NHM

PIRIBEDIL vin nn bao 50 mg; vin nn bc 20 mg; ng tim 3 mg
Trivastal vin nn bc 20 mg
Trivastal ng tim 3 mg
Trivastal retard 50 vin nn bao 50 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Tru tim mch; nhi mu c tim giai on cp.
Cn theo di: mc 1
Thi k mang thai: Do thn trng v thiu cc c liu trong y vn v thuc ny.
Tng huyt p: Mc du c nguy c h huyt p th ng, iu tr chng tng
huyt p vn phi c tip tc.
PRALIDOXIM
Ti hot ho enzym cholinesterase,
gii c cc thuc phospho hu c khng cholinesterase
CC THUC TRONG NHM

PRALIDOXIM vin nn 500 mg; dung dch tim 500 mg/20 mL; dung d ch tim
25 mg/mL
PAM vin nn 500 mg
PAM - A dung dch tim 500 mg/20 mL
Pampara dung dch tim 25 mg/mL
CH KHI CH NH THUC
Thn trng: mc 2
Thi k mang thai: Do thiu cc nghin cu lm sng y ngi mang thai,
nn thn trng khi dng pralidoxim, ch c dng khi tin lng sng cn b e da.
Suy thn: Phi gim liu dng trong trng hp suy thn.
Nhc c: iu tr bng pralidoxim c th gy cn nhc c.
611
PRAZIQUANTEL
Thuc chng k sinh trng chnh dit sn l
nh sn mng hay mt s sn l gan
CC THUC TRONG NHM

PRAZIQUANTEL vin nn 600 mg
Distocide vin nn 600 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Bnh u trng sn dy mt.

Thi k cho con b: Ngng cho con b ngy dng thuc v 72 gi tip sau.
Thi k mang thai: Khng c dng trong 3 thng u.
Cn theo di: mc 1
Trong trng hp c bnh l phi hp khc (bnh sn mng v bnh u trng
sn ln), ngi bnh phi c nhp vin trong khi iu tr v tc dng ca
praziquantel trn cc u trng sn trong no.
TNG TC THUC

Carbamazepin
iu tr tht bi. Tng tc xy ra nhanh. C ch cha r
X l: Theo di p ng lm sng. C th cn phi tng liu praziquanel
trong khi phi hp dng carbamazepin. Theo di nng trong huyt thanh ca
praziquantel c th c ch trong iu tr.
Cloroquin
Phn tch: Cloroquin lm gim sinh kh dng ca praziquantel nn lm
gim tc dng iu tr. C ch cha r
X l: C th phi tng liu praziquantel.
612
Glucocorticoid
Phn tch: Tng tc dc ng hc xc lp r vi dexamethason. Khi
phi hp vi dexamethason, nng praziquantel gim 50%.
X l: Khi iu tr ph thuc liu dng, cn lu tng tc ny iu
chnh liu dng. Tu tnh hnh, thay i corticoid v vn phi cnh gic.
Khng histamin H2 (cimetidin)
Phn tch: Nng trong huyt thanh ca praziquantel c th tng, lm
tng tc dng iu tr cng nh tng tc dng ph. Tng tc xy ra chm. C
ch: Cimetidin c th c ch chuyn ho ln u tin ca praziquantel.
X l: Theo di ngi bnh pht hi n cc tc d ng ph trong th i
gian phi hp praziquantel vi cimetidin, thu c khng histamin H 2 khc
(th d nh ranitidin) c th t tng tc h n v c th l thu c thay th thch
hp.
Phenytoin
iu tr c th b tht bi. C ch cha r
X l: Theo di p ng lm sng. C th cn phi tng liu praziquantel
trong thi gian phi hp vi phenytoin. Nng trong huyt thanh ca
praziquantel c th c ch cho iu tr.
613
PRIMIDON
Thuc chng ng kinh, t chuyn ho in vivo thnh phenobarbital
CC THUC TRONG NHM

PRIMIDON vin nn 250 mg
Sertan vin nn 250 mg
CH KHI CH NH THUC

Thi k cho con b: Cc barbituric qua c sa m, c nguy c lm tr chm
tng th trng v bun ng.
Thi k mang thai: Nguy c gy bnh chy mu tr s sinh, c th phng
bng dng vitamin K.
Suy h hp ; hen: Cc barbituric c ch cc trung tm h hp hnh no.
Ri lon chuyn ha porphyrin: ngi d mc bnh, c nguy c ri lon
chuyn ho porphyrin, do cm ng tng hp enzym ALA - synthetase, ko theo tng
tng hp cc porphyrin km vi au bng, nn, ri lon tm thn v thn kinh (lit mm
hai chi di) nht l trng hp ri lon chuyn ho porphyrin cp gin on.
Qu mn vi barbituric.
Thn trng: mc 2
n ung; ru: Ung ru t nhiu - say ru cp lm chm chuyn ho
barbituric v lm tng c tnh. Ngc li, ung ru qu nhiu v ko di (nghin ru
mn) lm tng s phn gii barbituric gan (nhn barbituric ngi nghin ru). Tuy
nhin, ru lm tng tc dng an thn thn kinh trung ng ca cc barbituric.
Suy gan: Phn ln cc barbituric c chuyn ho ti gan (tr phenobarbital t b
chuyn ho). Suy gan lm chm s kh hot tnh v tng c tnh ca chng.
Suy thn: Phenobarbital t b chuyn ho v b o thi dng c hot tnh qua
thn. Nh vy, suy thn lm tng c tnh cu barbituric ny.
Cn theo di: mc 1
Tr em: Nguy c b l thuc th cht v tm thn (nghin) vi cc phn ng
nghch thng kch thch v kch ng khi dng barbituric lm thuc ng. Phenobarbital,
cht cm ng enzym, lm tng chuyn ho v gim hiu lc ca vitamin D, nn c
nguy c gy ci xng tr em ng kinh.
Suy tim: Do tc dng gim lc co c v gim trng lc c, cc barbituric gy c
ch c tim, t quan trng liu gy ng, tr khi b suy tim.
TNG TC THUC
614

Ru
bun ng. Vi mt s ch phm ca primidon , c th thy mt s tc dng tm
thn - vn ng, nht l trong nhng tun iu tr u tin. Tng tc dc lc.
X l: Khng nn k n thuc ny v ngi k n khng th khng ch
c vic ung ru ca ngi bnh. Ch n gim tnh to ngi li xe v
ngi vn hnh my. Khuyn khng ung ru v khng t dng thuc hoc
ch phm c ru.
tc dng bun ng. Tng tc dc lc.
gim tnh to ngi li xe v ngi vn hnh my Khuyn khng ung ru
Phn tch: Tng chuyn ho cc estroprogestogen gan bi cm ng
enzym, do c nguy c th thai.
X l: Trnh dng cc thuc nga thai liu thp v chn dng thuc nga
thai liu cao v khuyn mt phng php nga thai khc nu iu tr barbituric
ko di. Cn nh, cm ng enzym khng bao gi l hin tng tc thi.
Mifepriston
Phn tch: Nguy c gim hiu qu ca mifepriston do tng chuyn ho bi
cm ng enzym.
X l: u tin phi nh s cm ng enzym l mt hin tng xy ra
chm v chm mt i. C th phi tng liu lng.
cm ng enzym, dn n nguy c th thai.
X l: Trnh dng cc thuc nga thai liu thp v chn dng thuc nga
thai liu cao hay khuyn mt phng php nga thai khc nu iu
tr primidon ko di. Cn nh, cm ng enzym khng bao gi l hin tng tc
thi.

Acid ascorbic
Phn tch: Dng ng thi cc thuc ny vi acid ascorbic lm tng bi tit
acid ascorbic.
615
X l: Nhu cu vitamin C nhng ngi bnh iu tr di hn vi

barbituric (nh ngi b ng kinh) nh vy tng ln. C th cho b sung thm.
Nn nh l vitamin C thng c t dng.
Phn tch: Khi b sung acid folic c nguy c gim nng thuc chng
ng kinh trong huyt thanh. Vic dng ng thi thuc cng vi acid folic c
th lm gim tc dng ca thuc chng co git, do tc dng i khng trn h
thn kinh trung ng.
X l: Tng cng theo di lm sng v sinh hc khi iu tr ng kinh
cc ngi bnh c dng thm acid folic. iu chnh liu dng thuc chng
ng kinh, nu cn, trong khi dng v sau khi ngng acid folic.
Baclofen; benzamid; butyrophenon; carbamat hoc thuc tng t; clozapin;
gluthetimid hoc thuc tng t; medifoxamin; paroxetin; procarbazin; reserpin;
thuc an thn kinh cc loi; thuc chng ng kinh khng barbituric; thuc c
616
Buspiron
tc dng gy bun ng khi kt hp thuc. C th thy mt s tc dng v tm
thn vn ng, nht l trong tun iu tr u tin. Tng tc dc lc.
X l: Khng nn phi hp hai thuc, bi ngi k n khng th ngn
chn c ngi bnh ung ru. Nguy c bun ng l kh nguy him ngi
li xe v ngi vn hnh my. Khuyn khng ung ru v khng t dng
Ciclosporin
Phn tch: Gim nng ciclosporin trong huyt thanh do cm ng enzym
lm tng d ho.
X l: Nu cn phi hp, phi theo di k nng ciclosporin trong huyt
thanh v iu chnh liu dng lc bt u v lc ngng iu tr bng primidon.
Lu l ciclosporin trong mu chu cc bin ng ln gia cc c th v s theo
di phi u n.
Corticoid - khong
Phn tch: Tng d ho cc corticoid - khong bi cc thuc cm ng
enzym. Cm ng enzym ch biu hin nhiu ngy sau khi bt u tr liu.
gim hiu qu iu tr. iu chnh liu lng corticoid - khong trong khi iu tr
v sau khi ngng primidon.
Phn tch: Tc dng hip ng trong c ch h thn kinh trung ng. Cn
ch , khi iu tr ngoi tr, ngi li xe v ngi vn hnh my. Cn ghi nh
l rilmenidin liu thng dng khng lm tng tc dng c ch h thn kinh
trung ng ca primidon.
X l: Lu nguy c ny iu chnh liu dng ca hai ch phm, nu
cn phi hp. Ch n gim tnh to ngi li xe v ngi vn hnh my.
Phn tch: Tng c tnh ca cyclophosphamid, do tng chuyn
cyclophosphamid thnh cht chuyn ho alkyl ho (cm ng enzym).
X l: Theo di cn thn huyt v nh gi nguy c gim bch cu
ca phi hp. Ch n thi gian iu tr cn thit xy ra tng tc ny c
th xy ra. Cm ng enzym l mt hin tng to lp dn (t nht 10 ngy).
Dihydropyridin (nifedipin, felodipin)
Phn tch: Nng trong huyt thanh ca nifedipin, felodipin b gim, c
th lm gim tc dng. Tng tc xy ra chm. C ch: tng chuyn ho
dihydropyridin do cm ng enzym.
617
X l: iu chnh liu theo p ng lm sng. C th phi tng liu

nifedipin, felodipin.
Disopyramid
Phn tch: Gim nng disopyramid trong huyt thanh, do cm ng
enzym, ti cc nng khng hiu qu.
X l: Theo di in tm , lm sng, nng thuc chng lon nhp
trong huyt thanh v iu chnh liu dng, tu theo trng hp.
618
Glucocorticoid
Phn tch: Tng d ho thuc ny bi cc thuc cm ng enzym (primidon,
barbituric). Cm ng enzym ch th hin t 10 n 12 ngy sau khi bt u iu
tr.
gim hiu qu iu tr. iu chnh liu glucocorticoid khi iu tr v sau khi
ngng primidon.
Glycosid tr tim
Phn tch: Tng chuyn ho gan bi cm ng enzym, ko theo gim
hot tnh ca digitalis chuyn ho (ngha l digitalin, khng phi digoxin).
X l: Lu nguy c ny iu chnh liu dng digitalin (digoxin thi qua
thn), nu cn phi hp. iu chnh liu dng digitalis trong v sau khi iu tr
vi barbituric.
Griseofulvin
Phn tch: Tng chuyn ho gan, bi cm ng enzym, ko theo gim
hot tnh ca griseofulvin.
X l: Lu nguy c ny iu chnh liu dng ca 2 thuc, nu cn
phi hp. Tm quan trng ca tng tc ny cn phi xc nh thm.
X l: Bo cho ngi bnh bit nguy c. Theo di huyt p trong khi phi
hp. Tu theo thuc dng, h huyt p c th t hay nhiu. iu chnh liu dng
ca mt hoc hai thuc. Lp k hoch dng thuc u n. Khuyn ngi
bnh, nu thy chng mt lc u iu tr, nn gp li thy thuc iu chnh
liu dng ca mt hay hai thuc, nu cn. Tng cng theo di ngi bnh
cao tui (nguy c b ng) v khuyn h, khi t th nm hay ngi m chuyn
sang t th ng, th phi t t.
Hormon tuyn gip; tetracosactid
Phn tch: Tng d ho ca thuc phi hp bi cc thuc cm ng enzym.
Cm ng enzym ch din ra 10 n 12 ngy sau khi bt u tr liu.
cng vi thuc cm ng enzym trung v di hn, phi tnh n nguy c gi m
hiu qu iu tr. iu chnh liu hormon gip trng trong v sau khi ngng
primidon.
Phn tch: Do cm ng enzym, mt cht chuyn ho ca isoniazid c vi
gan c hnh thnh.
619

chc nng gan (ASAT, ALAT, enzym phosphatase kim, bilirubin) hoc hon,
nu c th mt trong hai tr liu. Xc minh l ngi bnh khng ung ru
thng xuyn v khng c tin s vim gan do virus. Cc du hiu lm sng
chnh khng c hiu: bun nn, st, vng da,... Khi thy ng thi ban da,
nga v hch to th hng bnh cn do thuc. Phn bit r, theo cc kt qu
th nghim sinh hc, nguy c xut hin vim gan tiu t bo khng phc hi vi
mt vim gan mt phc hi c khi ngng tr liu.
Methotrexat
Phn tch: Tng tc dng khng mong mun ca methotrexat c th do
tng c ch dihydrofolat reductase.
X l: Lu nguy c ny do methotrexat l thuc thng c dng trong
c s chuyn khoa.
Metronidazol
Phn tch: Mt tc dng iu tr ca metronidazol. C ch: do barbituric
gy cm ng, lm tng chuyn ho metronidazol (o thi nhanh v nng
huyt thanh thp). Tng tc xy ra chm.
X l: Theo di tc dng iu tr ca metronidazol khi phi hp vi
barbituric. Nu cn, phi tng liu metronidazol cng c th dng liu cao
metronidazol ngay ban u cho ngi ang dng barbituric.
Mexiletin
Phn tch: Gim nng mexiletin trong huyt tng, do cm ng enzym.
X l: iu chnh liu dng ca mexiletin theo nhn xt lm sng v in
tm .
Phn tch: Natri valproat v cc dn cht lm tng nng primidon trong
huyt tng, c th do c ch enzym v gim d ho thuc ny. Tng tc
dc ng hc khu chuyn ho. V lm sng, s gia tng nng primidon
trong huyt tng s dn n tng tc dng khng mong mun (bun ng).
X l: Phi theo di lm sng trong 15 ngy u tr liu, km vi nh
lng nng primidon trong huyt tng v iu chnh liu dng ngay khi c
cc du hiu u tin ca tc dng bun ng. Khuyn ngi bnh gp li bc
s khi thy mt, ng g, an thn tin hnh nh lng trong huyt tng
nhm iu chnh li liu dng primidon.
Phenothiazin
tc dng bun ng, iu ny ch vi mt s phenothiazin an thn. Tng tc
dc lc.
620
X l: Lu nguy c ny iu chnh liu dng ca hai thuc nu cn

Khuyn khng ung ru v khng t dng thuc c ru.
Progabid
Phn tch: Tng tc dc ng hc lm tng chuyn ho gan do cm
ng enzym, ko theo gim hot tnh ca progabid; cng c th tng nng
trong huyt tng ca phenobarbital hay primidon.
X l: Progabid l thuc chng ng kinh la chn bc hai, c vi gan.
Nn tnh n nguy c tht bi iu tr. iu chnh liu.
Quinidin hoc dn cht
hot tnh ca quinidin (v cc dn cht); iu chnh liu. Theo di cn thn,
nng quinidin trong huyt tng v thn trng khi ngng primidon (nguy c
nhim c quinidin).
X l: Lu nguy c ny iu chnh liu dng ca hai thuc, khi cn
phi hp ny t ra cn thit. Ch n gim tnh to ngi li xe v ng i
vn hnh my. Khuyn khng ung ru v khng t dng thuc hoc ch
phm c ru.
hot tnh ca quinin (v thuc tng t).
X l: iu chnh liu lng quinin. Theo di cn thn nng quinin
trong huyt tng v thn trng khi ngng primidon (nguy c nhim c quinin).
Lu nguy c ny iu chnh liu lng ca hai thuc nu s phi hp ny
t ra cn thit. Ch n s gim tnh to ngi li xe v ngi vn hnh
my. Khuyn khng ung ru v khng t dng thuc hoc ch phm c
ru.
Succinimid
Phn tch: Khi dng kt hp vi succinimid, nng primidon v cht
chuyn ho ca n l phenobarbital trong huyt thanh gim. C ch cha r.
X l: Khi phi kt hp hai thuc ny, phi theo di nng primidon v
phenobarbital trong huyt thanh mi khi c s thay i trong liu php
succinimid (bt u iu tr, thay i liu dng, thi dng). Khi cn, phi hiu
chnh liu primidon.
Tacrolimus
Phn tch: Gim nng tacrolimus trong huyt thanh do cm ng enzym,
lm tng d ha.
X l: Nu phi hp ny cn thit, theo di k nng tacrolimus trong
huyt thanh v iu chnh liu tacrolimus lc u v lc cui tr liu bng
primidon. Lu l ciclosporin trong mu c nhng bin ng ln gia cc c th
v s theo di phi u n.
621
Tetracyclin
Phn tch: Tng d ho doxycyclin gan do cm ng enzym. Mc du vic
ny cha c xc nhn cho cc tetracyclin khc khng b o thi qua ng
nc tiu, c l vn cn phi thn trng.
X l: Tng tc ny cn nhiu ngy iu tr vic kch thch enzym c
th xy ra. C nguy c tht bi iu tr, nu khng sinh khng t cc nng
ti thiu c ch (MIC) vi khun gy bnh. Lu nguy c ny v chn mt khng
sinh khc.
Phn tch: Phi hp vi mt thuc cm ng enzym. Sau khong 10 n
12 ngy, th cht gy cm ng lm cho chuyn ho theophylin gan nhanh ln,
nn lm gim hot tnh v nng trong huyt tng ca theophylin.
X l: Theo di lm sng ngi bnh. iu chnh liu lng tu theo nng
theophylin trong mu, trong v sau khi ngng iu tr primidon.
Thuc chn beta
Phn tch: Do cm ng enzym, tng d ho gan cc thuc chn beta
(acebutolol, alprnolol, betaxolol, labetalol, metoprolol, oxprenolol, propranolol,
timolol).
X l: Gim tc dng dc l ca thuc chn beta khi iu tr cng vi
barbituric ko di trong t nht 3 tun (ch ngi b ng kinh). Nguy c mt
hot tnh dn dn ca thuc chn beta. Hi ngi bnh v hiu qu ca tr liu
(au tht ngc hay tng huyt p) v nh gi u n v mt lm sng hiu qu
iu tr, hoc chn mt thuc chn beta khng b gan chuyn ho.
Phn tch: Gim nng trong huyt tng, m t cho itraconazol, do
cm ng enzym (gim hiu qu).
X l: Nguy c tht bi iu tr, nu phi hp vi cc thuc cm ng
enzym nh primidon ko di t nht 10 ngy. Trong trng hp ny, iu chnh
liu dng v nu cn th tin hnh nh lng itraconazol trong huyt tng.
Phn tch: Cc thuc chng trm cm ba vng lm h ngng gy ng
kinh v nh vy c nguy c xut hin cc cn co git ng i bnh i u tr
bng primidon.
hp.
X l: Lu nguy c ny v iu chnh liu lng primidon tu theo trng

Phn tch: Primidon lm tng chuyn ho cc thuc gy m (gim tc
dng), lm tng thm nguy c c vi gan do cn tng liu lng cc thuc gy
m.
622
X l: Trng hp can thip ngoi khoa, khuyn ngi bnh bo cho

ngi gy m v mi th thuc dng.
Thuc lm acid ho nc tiu
Phn tch: Tng ti hp thu primidon ng thn.
X l: C s gia tng tc dng dc l ca primidon, nn cn iu chnh
liu, nu phi hp l cn thit. o pH nc tiu bng giy th bit c cn
iu chnh liu hay khng.
Phn tch: Primidon l cht cm ng enzym, lm tng tc chuyn ho
gan ca cc thuc chng ng. Cm ng enzym khng phi l mt hin
tng tc thi. Tr liu bng cc thuc cm ng enzym cn nhiu ngy
tng tc th hin.
X l: Cn lu n tng tc iu chnh liu v vic theo di sinh
hc (INR: t l chun quc t v TP: t l prothrombin) phi lm thng xuyn
hn, khi bt u tr liu bng thuc chng ng trong khi dng v sau khi ngng
iu tr primidon. Kim tra m bo c s theo di u n ny. Lu n trnh
t thi gian ca cc tr liu.
Thuc ung khng acid hoc than hot
Phn tch: Thuc khng acid lm gim hp thu primidon qua ng tiu
ho do lm gim tc dng.
X l: Cn ung hai thuc cch nhau t nht 1 n 2 gi. Nhc li l cc
khng acid thng c dng sau khi n 1 gi 30 pht v n l ngun gc tng
tit dch v.
Vitamin D
Phn tch: Vi mt tr liu di hn, cc thuc cm ng enzym c th kch
thch v gia tng d ho vitamin D, nh vy lm gim hiu lc ca vitamin D v
nh hng ti s chuyn ho calci.
X l: Ch n thi gian tr liu. Cm ng enzym ch c to lp dn
dn. Vi cc tr liu di ngy bng barbituric, nn iu chnh liu v cho b sung
vitamin D, nu cn.
Zidovudin
Phn tch: Do ngoi suy t rifampicin v rifabutin, primidon lm gim nng
zidovudin do tng chuyn ho (cm ng enzym).
X l: Nu thy gim p ng vi iu tr bng zidovudin, iu chnh liu
zidovuin.

Phn tch: Tim nng nhim c gan ca acetaminophen (paracetamol) c
th tng khi phi hp vi primidon liu cao v ko di. Tc dng iu tr ca
623
acetaminophen c th gim khi phi hp. Tng tc xy ra chm. C ch:

Barbituric c th gy cm ng enzym ca gan lm tng nhanh chuyn ho ca
acetaminophen, c th dn n nng cao bt thng cc cht c cho gan.
X l: Nguy c ln nht khi dng acetaminophen qu liu km theo dng
barbituric thng xuyn. Khi dng vi liu iu tr thng thng, khng cn phi
iu chnh liu.
Acetazolamid (thuc c ch carbonic anhydrase)
Phn tch: Phi hp c th lm thay i nng primidon trong huyt
thanh v nc tiu. Tng tc xy ra chm. C ch cha r.
X l: Nu ang dng c hai thuc primidon v acetazolamid, nng
primidon v cht chuyn ho phenobarbital c th thp hn mong i; phi nghi
l c tng tc thuc. C th ngng mt thuc hay dng hai thuc cch xa
nhau.
amphetamin.
Khuyn ngi bnh gp li bc s nu thy kt qu iu tr khng n nh.
Barbituric
X l: K n tha v ch, v xt n cc tnh cht dc l v cc ch nh
ca hai thuc ny. Nu k n phi hp, phi lu nguy c ny iu chnh
liu ca hai thuc. Ch n gim tnh to ngi li xe v ng i s dng
my. Khuyn khng ung ru v nu ngi bnh t dng thuc, kim tra
nhng thuc ny khng c cha ru.
Carbamazepin
Phn tch: Tng chuyn ho gan do cm ng enzym, ko theo gim tc
dng ca carbamazepin. iu chnh liu dng carbamazepin. Theo di cn
thn, nng carbamazepin trong huyt tng v cnh gic lc ngng
primidon.
Cloramphenicol
Phn tch: Tc dng ca cloramphenicol c th b gim (nng huyt
thanh gim), trong khi th tc dng ca barbituric c th tng. Tc dng c
th ko di vi ngy sau khi ngng barbituric. Tng tc xy ra chm. C ch:
chuyn ho ca cloramphenicol c th tng v chuyn ho barbituric c th
gim.
624
X l: C th phi tng liu cloramphenicol. Gim st nng trong huyt

tng ca khng sinh v iu chnh liu. Nu c du hiu nhim c barbituric,
phi gim liu barbituric.
Khng histamin khng H1 an thn; fluoxetin; fluvoxamin; methadon;
mianserin; oxaflozan; thuc ch vn morphin; viloxazin
X l: Lu nguy c ny iu chnh liu dng ca hai thuc nu cn
Methyldopa
Phenytoin
Phn tch: Tu thuc trnh t thi gian dng cc thuc, nu primidon c
dng trc phenytoin, c s tng nng phenytoin trong huyt tng do cnh
tranh khu chuyn ho. Nu dng phenytoin trc primidon, cc bin ng v
nng ca phenytoin khng d on c.
X l: Da vo thi im dng cc thuc v tu trng hp, lu nguy c
ny iu chnh liu dng ca hai thuc, nu cn phi hp. Ch n gim
X l: Nu cn phi hp hai thuc, lu nguy c ny khi gy m v chn
liu dng.
Phn tch: C l thuc c ch monoamin oxydase c ch chuyn ho
primidon gan v ko di tc dng c ch h thn kinh trung ng. Hin tng
c tnh tc thi.
X l: Phi lu tng bun ng trong v sau khi iu tr, c bit l
ngi li xe v ngi vn hnh my. Khuyn ngi bnh khng ung ru v
625
PROBENECID
Thuc tng acid uric niu do c ch ti hp thu urat ti ng thn
CC THUC TRONG NHM

PROBENECID vin 500 mg
Benemid vin 500 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Suy thn: Probenecid tc dng nh mt cht c ch h vn chuyn acid hu c
ng thn. Tc dng gy acid uric niu cng r khi thn cn nguyn vn v suy thn
ko theo s khng hon ton vi probenecid (cht ny cn b buc c lin quan n s
xut hin cc hi chng h thn).
Si urat, tng urat niu.
Thn trng: mc 2
Bnh thng phong: Khi tng urat niu trn 700 mg/24gi v khi c cn thng
phong th pht do bnh mu.
Bnh mu: Probenecid khng c dng trong iu tr bnh thng phong th
pht do cc bnh mu.
Si thn: Nguy c tng bnh si uric.
Cn theo di: mc 1
Thi k mang thai: Do qua c hng ro nhau - thai v xut hin trong mu
cung nhau.
Lot d dy t trng; vim d dy: Tng tc dng khng mong mun v d
dy-rut.
TNG TC THUC

Phn tch: Probenecid c ch bi tit indometacin thn. Tng tc dc
ng hc.
626
X l: Probenecid c th v c dng lm chm thi nhiu loi

thuc gim liu lng. Phi rt cnh gic v cc nguy c tim n v s tng
c tnh ca thuc phi hp. Xem xt bi cnh sinh l bnh hc c th.
Methotrexat
Phn tch: Probenecid c ch bi tit methotrexat thn. Tng tc dc
ng hc. S phi hp ny c th c dng gim liu methotrexat, nhng
c tnh ni ti ca methotrexat lm n tr nn nguy him, nu k n m
khng suy tnh.
thuc gim liu lng. Phi rt cnh gic v cc nguy c tim n v s tng
c tnh ca thuc phi hp. Xem xt bi cnh sinh l bnh hc c th.
Nitrofuran
Phn tch: Probenecid c ch thi nitrofuran thn, ko theo tng nng
trong huyt thanh, ko di thi gian bn thi v gim nng trong n c
tiu, nh vy gim hiu qu. Tng tc dc ng hc.
thuc gim liu lng. Phi rt cn thn v cc nguy c tim n v s tng
c tnh ca thuc phi hp. y, do gim nng trong nc tiu, c th
phi phng tht bi iu tr.
Penicilin
Phn tch: Probenecid c ch bi tit cc penicilin thn. S phi hp ny
c th c dng gim liu dng cc penicilin. Tng tc dc ng hc.
X l: Probenecid c th v c dng lm chm s bi tit ca
nhiu loi thuc v gim liu lng. Vi cc penicilin, s phi hp ny
c dng trong iu tr t nng penicilin trong mu c li ch v ko
di. Phi rt cnh gic v cc nguy c tim n v vic tng c tnh ca thuc
c phi hp. Xem xt bi cnh sinh l bnh hc c th.
Sulfamid chng tiu ng
Phn tch: Probenecid c ch bi tit sulfamid thn. Phi hp ny c th
c dng gim liu ca sulfamid, nhng c tnh ni ti ca sulfamid lm
cho phi hp tr nn nguy him nu k n m khng suy xt (nguy c h
glucose mu).
X l: Probenecid c th v c dng lm chm thi v gim liu
lng ca nhiu loi thuc c th v c dng gim mt s liu dng.
Phi rt cnh gic v cc nguy c tim n v s tng c tnh ca thuc phi
hp. Xem xt bi cnh sinh l bnh hc c th.
Sulfamid khng khun; sulfasalazin hoc dn cht
Phn tch: Probenecid c ch bi tit sulfamid thn. S phi hp ny c
th c dng gim liu ca sulfamid, nhng c tnh ni ti ca sulfamid lm
cho phi hp tr trn nguy him nu k n m khng suy tnh.
627
X l: Probenecid c th v c dng lm chm thi v gim liu

lng ca nhiu loi thuc. Phi rt cnh gic v cc nguy c tim n v s
tng c tnh ca thuc phi hp. Xem xt bi cnh sinh l bnh hc c th.

Salicylat
Phn tch: Cc salicylat dng u n vi liu thp hn bnh thng c
ch tc dng gy acid uric niu ca probenecid. Ngc li, probenecid c ch
salicylat bi tit acid uric qua nc tiu v c th lm gim bi xut cc salicylat
v dn n c tnh ca thuc ny.
X l: Cn trnh phi hp. i chin lc iu tr.
Zidovudin
Phn tch: Probenecid c ch s lin hp glucuronic ca zidovudin v lm
gim bi tit thn ko theo tng na i, nng trong huyt thanh v c
tnh ca zidovudin.
X l: Cn trnh phi hp.

Asparaginase
Phn tch: Asparaginase lm tng acid uric trong mu.
X l: Phi hp phi c qun l trong c s bnh vin. iu chnh
phng php iu tr chng thng phong. trnh si urat, nn chn alopurinol
thay cho cc thuc gy acid uric niu, v nhng thuc ny c th gy cc bnh
thn do acid uric.
Cephalosporin c nhn thiomethyltetrazol; cephalosporin hoc thuc
tng t
Phn tch: Tng tc dc ng hc. Gim bi tit ng thn cc
cephalosporin, ko theo tng nng cephalosporin trong huyt thanh v thi
gian bn thi ca khng sinh. C th dng s phi hp ny ko di tc dng
ca cephalosporin.
X l: Xc nh mc tiu iu tr v quan tm n tng tc ny. liu
bnh thng, vi mt s cephalosporin, c nguy c c vi thn, mc du cn
c kin khc nhau.
Phn tch: Probenecid c th lm tng nng furosemid trong huyt
thanh bng cch c ch bi tit ng thn.
X l: Do probenecid c th lm tng ti hp thu furosemid, nn nu cn
th tin hnh iu chnh liu. ngha lm sng ca tng tc ny cn c thm
nhiu thng tin hn.
628
Ganciclovir
Phn tch: Probenecid c ch bi tit ganciclovir ng thn v c nguy c
ko theo tch lu ganciclovir, do gim thanh lc thuc khng virus thn.
X l: C th dng tng tc gim liu dng ganciclovir. Nu hai thuc
c dng ng thi, nn iu chnh liu ca thuc khng virus.
Pentostatin
Phn tch: Pentostatin c th lm tng nng acid uric trong mu. iu
chnh liu dng thuc chng thng phong cn thit kim sot chng acid uric
mu cao.
X l: Nn dng alopurinol (c ch tng hp acid uric) hn l cc thuc
thi uric do c th c nguy c gy bnh thn vi acid uric.
Phn tch: Tng mnh nng trong huyt tng ca thuc chng vim
khng steroid (c m t ch yu vi ketoprofen), do gim thanh lc qua thn
v lin kt vi protein huyt tng.
X l: Nguy c tng tc dng khng mong mun ca cc thuc chng
vim. Gim liu lng ca thuc chng vim khng steroid.
Phn tch: Cc thuc ny lm tng acid uric mu v gim tc dng iu tr
chng thng phong.
X l: Nn trnh dng hai thuc ng thi, do nguy c tht bi trong iu
tr chng thng phong.
Zalcitabin
Phn tch: Tng nng zalcitabin trong huyt tng, vi tng nguy c
c tnh.
X l: Theo di cc tc dng khng mong mun lin quan ti zalcitabin v
gim liu dng, nu cn.

Acyclovir
Phn tch: Probenecid c th lm tng nng trong huyt thanh ca
acyclovir, nn lm tng tc dng iu tr v tc dng ph. Tng tc xy ra
nhanh. C ch: Probenecid c th c ch bi tit acyclovir qua ng thn.
X l: Liu lng acyclovir (v valacyclovir) c th cn phi gim nu c
biu hin nhim c acyclovir.
629
Phn tch: Probenecid c th c tc dng ko di thi gian gy m do
thiopental hoc t c kt qu gy m vi liu thp thiopental. C ch cha
r.
X l: Liu thiopental dng khi m c th gim. Tuy nhin, do thuc
ny tc dng ngn (tnh tng pht), nn khng cn c bin php c bi t no
ngoi cc thn trng thng thng khi gy m.
Phn tch: Tng thi gian tc dng ca thuc c ch enzym chuyn dng
angiotensin. Tng tc xy ra chm. C ch: Probenecid lm gim bi tit thuc
c ch enzym chuyn dng angiotensin qua thn.
X l: Nu nghi c tng tc thuc, theo di huyt p v gim liu thuc
c ch enzym chuyn dng angiotensin, nu cn.
Sulfon (dapson)
Phn tch: Tc dng dc l v c tnh ca dapson c th tng. C ch:
Probenecid c ch cnh tranh vi dapson o thi tch cc qua ng thn,
lm dapson v cht chuyn ho ca dapson b tch lu.
X l: Theo di nhim c dapson, c th phi gim liu dapson hoc
ngng probenecid.
630
PROCARBAZIN
Thuc km t bo, c tnh cht c ch monoamin oxydase (c ch MAO)
CC THUC TRONG NHM

PROCARBAZIN nang 50 mg
Natulan nang 50 mg
CH KHI CH NH THUC
Thuc ny phi do bc s chuyn khoa k n. Do , chng ch nh phi c
cn nhc tu theo tnh trng ngi bnh v phi c bc s chuyn khoa nh gi.
TNG TC THUC

Phn tch: Tng tc c th lm tng khng thng xuyn huyt p
nhng ngi bnh sau khi dng thm procarbazin l thuc c tnh cht c ch
MAO, bi mt c ch khng gii thch c.
X l: Nu phi hp ny c k n, nn cn thn v liu lng v bo
cho Trung tm cnh gic thuc v mi s bt thng.
Fluoxetin
Phn tch: Procarbazin c cc tnh cht c ch MAO. C nguy c cng
ging thuc c ch MAO: tng ti thu nhn serotonin, c th ci thin p ng
vi iu tr, nhng trong thi gian sau, cng c th lm tng c tnh nng (h
nhit, co git...).
X l: Tn trng thi hn t nht 2 tun t khi ngng thuc c ch MAO
n khi bt u iu tr bng thuc chng trm cm serotonin. Khi ngng iu
tr bng thuc chng trm cm serotonin, ch 5 tun mi c dng thuc c
ch MAO.
Fluvoxamin
Phn tch: Procarbazin c tnh cht c ch MAO. Nguy c cng ging
thuc c ch MAO: tng ti thu nhn serotonin, c th ci thin p ng vi
iu tr, nhng cng c th, trong thi gian sau, lm tng tc dng c nng (h
nhit, co git,...)
X l: Tn trng thi hn t nht 2 tun k t khi ngng thuc c ch
MAO n khi bt u iu tr bng thuc chng trm cm serotonin. Khi ngng
iu tr bng thuc chng trm cm serotonin, ch 1 tun mi dng thuc c
ch MAO.
631
Levodopa
Phn tch: Tng tc dc lc. Procarbazin c cc tnh cht c ch MAO
t quan trng hn l thuc c ch MAO, nhng c th ghi nhn c. Cc thuc
c ch MAO chn s phn gii ca adrenalin; levodopa l tin cht ca
dopamin. Adrenalin v dopamin l hai amin co mch. S phi hp c th gy
tng huyt p nng.
X l: Khng phi hp cc thuc ny; tn trng khong cch 15 ngy gia
hai tr liu ny trnh tai bin.
Phn tch: Nguy c cn tng huyt p cht ngi, bnh no, co git, st
cao, t vong.
X l: Chng ch nh phi hp, ngay c khi mt s chuyn gia dng cho
mt vi ngi bnh tr vi thuc ti c s chuyn khoa.
632
Thuc ch vn morphin
Phn tch: Vi pethidin (Dolosal ), c kh nng xut hin cc triu chng
nghim trng v khng d on c, gi l hi chng serotonin vi cc ri
lon v tm thn (bn chn, l ln, c th hn m), vn ng (git rung c, run,
cng , tng hot ng), thn kinh thc vt (h hay tng huyt p, nhp tim
nhanh, st cao, ra m hi v rng mnh). Vi cc thuc gi m au khc thu c
loi morphin, nn thn trng v nu cn phi hp, lm test th vi 1/4 liu dng
thuc gim au v theo di phn ng ca ngi bnh.
X l: Trnh phi hp ny. Vi cc thuc gim au khc thuc loi
morphin, nn cn thn v nu cn phi hp lm mt test th vi 1/4 liu thuc
gim au v theo di cc phn ng ca ngi bnh trong cc gi tip theo.
Trnh dng thuc ho c cc thnh phn t thuc phin.
Thuc cng thn kinh giao cm alpha - beta
Phn tch: Nguy c ri lon huyt p nng (tng huyt p), do hip ng
s tch lu cc amin co mch: mt thuc em n cc amin, thuc kia li c ch
thoi ho cc amin gy co mch. Do procarbazin c tnh cht c ch MAO v
thi chm, nn tng tc ny cn c th biu hin 15 ngy sau khi ngng iu
tr.
X l: Cn trnh phi hp do cc nguy c.

Ru
Phn tch: Tc dng antabuse (ging disulfiram) km thm nguy c c
vi gan: mt t l bt thng acetaldehyd tch t ti cc m ( c ch enzym),
ko theo mt s du hiu lm sng nh cn bng vn mch , gin mch mnh,
nhp tim nhanh, st cao, bun nn, nn, ban da, i khi h huyt p v tru mch.
Cc triu chng ny t nhiu quan trng ty theo lng ru ung vo.
X l: Trong khi iu tr vi thuc, khuyn khng ung ru do tc dng
antabuse (ging disulfiram). Ch trnh dng mi ch phm cha ru.
Amineptin
Phn tch: Nguy c ri lon huyt p nng, do tc dng c ch MAO ca
procarbazin.
X l: Ch iu tr bng amineptin sau khi ngng procarbazin t nht 15
ngy. Theo chiu ngc li, ch cn 2 ngy sau khi ngng amineptin l c th
dng procarabazin.
Benzodiazepin
633
Cafein
Phn tch: ngi ung rt nhiu caf, c th tng nguy c lon nhp tim
nng v/ hay h huyt p nghim trng, do tc dng cng giao cm ca cafein
(nhc li l procarbazin c cc tnh cht c ch MAO).
X l: Hi ngi bnh v yu cu gim hay ngng ung c ph trong t
iu tr. Cng c cc thuc mua khng n c cha trimethyl xanthin (cafein):
cn cnh gic v im ny.
634
Heptaminol
Phn tch: Heptaminol c tnh cng giao cm. V l , thuc c th gy
cc cn tng huyt p khi phi hp vi cc thuc c ch MAO hay vi cc cht
c tnh cht c ch MAO.
X l: Chng ch nh phi hp; thay i chin lc iu tr. Cn khong
cch t nht 2 tun gia lc ngng iu tr bng thuc c ch MAO n khi bt
u dng heptaminol.
Phn tch: Nguy c ri lon huyt p nng, do tc dng c ch MAO ca
procarbazin.
X l: Nu phi can thip ngoi khoa, khuyn ngi bnh bo cho ngi
gy m mi th thuc m mnh ang dng.
Phn tch: Vi ephedrin, fenoterol, terbutalin, c tng tc dc lc: tng
cng cc tc dng ln h tim mch, thuc c ch monoamin gy tch lu amin
co mch, nguy c ri lon huyt p nng, nhc u, lon nhp tim, nn...
X l: Trnh k n cc thuc ny trong t nht 15 ngy sau khi ng ng
thuc c ch MAO.
Thuc c ch MAO typ B
Phn tch: c ch c hiu MAO typ B dn n ko di tc dng ca
levodopa, iu ny gii thch vic cng k n vi cht ny. Tng tc cng
ging nh ca levodopa v xin c gi c h ny. Procarbazin c tc dng
c ch MAO khng chn lc.
X l: Nn trnh phi hp ny, tm mt cch tr liu khc.
Phn tch: Tng tc dc lc, tc dng hip ng. Nguy c ri lon
huyt p nng, do hot tnh c ch MAO ca cc ch phm ny.
X l: Nn trnh phi hp, lp mt chin lc iu tr khc.
Vaccin sng gim c lc
Phn tch: Nguy c pht trin nhim khun tng ng vi vaccin, do hot
tnh c ch min dch ca thuc phi hp.
X l: Khong cch cn tn trng gia hai thuc l t 3 thng ti 1 nm v
ty theo cng c ch min dch.

Amphoterecin B
Phn tch: Phi hp amphoterecin B tim vi cc thuc c vi tu khc
i hi rt cn thn. Nguy c thiu mu v cc ri lon huyt hc khc.
635
X l: Nu cn phi hp, nn theo di cn thn huyt v ti n hnh

gim liu, nu cn.
cht; fluoro 5 uracil; ganciclovir; interferon alpha ti t hp; levamisol;
melphalan; mercaptopurin; methotrexat; thiotepa; thuc chng ung th; vincristin
hoc thuc tng t
Phn tch: Nguy c tng c tnh vi mu, do hip ng tc dng c ch
tu xng, c th dn n mt bch cu ht.
X l: Trnh phi hp nu c th. Nu cn phi hp, nn dng liu thp
cho mi thuc v theo di cn thn huyt . S phi hp ny do cc bc s
chuyn khoa thc hin v cc phc iu tr thng c xc lp tt.
Baclofen; benzamid; butyrophenon; carbamazepin; carbamat hoc thuc
tng t; khng histamin khng H1 an thn; oxaflozan; phenothiazin; phenytoin;
primidon hoc dn cht; thuc an thn kinh khc; thuc chng ng kinh khng
barbituric; thuc c ch thn kinh cc loi
Phn tch: Do tnh cht i khng dopamin ca procarbazin (c cc tnh
cht c ch MAO), nn c kh nng tng nng prolactin v i khng tc
dng ca bromocriptin.
X l: Tc dng i khng ny c nguy c nh hng n mc tiu iu
tr chnh. S phi hp ny cn c theo di hoc thay thuc phi hp. Lu l
tc dng i khng dopamin kh yu v tu thuc liu dng.
Buspiron
X l: Theo di huyt p lc u, trong khi iu tr v sau khi ngng mt
trong hai thuc. Nu khng, thay th hay ngng dng buspiron trong khi i u
tr thuc c ch MAO v c 15 ngy sau khi ngng iu tr. Khuyn ngi
bnh gp li bc s, trong trng hp c vn v huyt p.
Cc thuc gy m khc
X l: Khuyn ngi bnh phi phu thut cn bo cho ngi gy m bit
cc thuc ang dng.
636
Ciclosporin
Phn tch: Phi hp hai thuc c tnh cht c ch min dch. Do c ch
min dch ny qu mnh, c nguy c pht trin u lympho gi.
X l: Phi hp hai thuc suy gim min dch phi c suy tnh v tng
quan nguy c/li ch phi c cn nhc theo mc tiu iu tr. S phi hp ch
c th tin hnh ti c s chuyn khoa vi s theo di ngi bnh cht ch.
Clonidin hoc thuc tng t; gluthetimid hoc thuc tng t;
medifoxamin; methyldopa; reserpin; viloxazin
Phn tch: Phi hp hai thuc ny c th dn n nhng bin ng
huyt p quan trng. Ngoi ra cn tng thm cc tc dng c ch h thn kinh
trung ng.
X l: Cc thuc c ch MAO t c dng do cc tng tc c nhiu v
v him c k n, nn c t nhn xt v cnh gic thuc. Tuy nhin vn phi
cn thn tn trng thi hn t 2 n 3 tun sau khi ngng cc thuc trn mi
c k n mt thuc c ch MAO.
Clozapin
Phn tch: Nguy c tng c tnh v mu, do hip ng tc dng c ch
ty xng, c th dn n mt bch cu ht. Ch dng n c clozapin, cng
c th c mt bch cu ht nng, thm ch t vong (c tnh min dch).
X l: Nu cn phi hp, nn dng liu thp cho mi thuc. Khng th d
on mt bch cu ht khi dng clozapin. Vic theo di cn thn huyt , thc
hin bnh thng khi dng thuc km t bo, vn c gi tr. Tuy vy, ngi bnh
phi c bo l h hi st, vim hng v lot ming th phi ngng i u tr
bng clozapin.
Phn tch: Dng ng thi mt thuc km t bo v mt thuc chng
thng phong lm tng nng acid uric. Ngoi ra, tng nguy c gim bch cu
v gim tiu cu bi hip ng cc tc dng khng mong mun ca cc thuc.
X l: Nn trnh dng ng thi hai thuc, v nguy c iu tr chng thng
phong tht bi. Nn dng alopurinol (c ch tng hp uric) hn l cc thuc bi
acid uric trnh cc bnh v thn.
Diazoxid; dihydro pyridin; diltiazem; furosemid hoc thuc tng t;
guanethidin hoc cc thuc tng t; sotalol; thuc chn beta; thuc chng
gin mch chng tng huyt p; thuc c ch enzym chuyn dng angiotensin;
verapamil
Phn tch: Phi hp hai thuc ny c th dn n nhng thay i huyt p
quan trng.
X l: Cc thuc c ch MAO c nhiu tng tc v him c k n
nn c t nhn xt v cnh gic thuc. Tuy nhin, cn thn trng cch t 2
n 3 tun sau khi ngng dng thuc, mi k n thuc c ch MAO
(procarbazin)
637
Glycosid tr tim
Phn tch: Thuc km t bo lm tn thng nim mc rut, tuy hi phc
c, nhng lm thuc digitalis km hp thu khong 50%.
X l: Theo di cn thn nng digitalis trong huyt tng trong sut
thi gian iu tr.
X l: Interleukin ch c dng cho mt s bnh nng ti c s chuyn
khoa. Tng tc cn c cn nhc theo kt qu theo di thng xuyn mi
chc nng c th. Nht thit phi theo di huyt .
Mianserin
Phn tch: Tc dng hip ng c ch h thn kinh trung ng.
X l: Phi tnh n s tng tc dng an thn bun ng trong v sau khi
iu tr, c bit ngi li xe v ngi vn hnh my. Cnh gic vi cc ch
phm c cha ru.
Pentostatin
Phn tch: Dng ng thi hai thuc c ch tu xng c th dn n cc
ri lon huyt hc nng, tu theo thi gian iu tr.
X l: Khi phi hp, cn theo di u n v huyt hc.
Phenicol
Phn tch: Nguy c tng c tnh v mu, do tc dng hip ng c ch
ty xng, c th dn n mt bch cu ht. Ch dng n c thuc
phenicol, cng c th b mt bch cu ht nng, thm ch t vong ( c tnh
min dch).
X l: Nu cn phi hp, nn dng liu thp cho mi thuc. Khng th d
on mt bch cu ht khi dng phenicol. Vic theo di cn thn huyt ,
c lm bnh thng khi dng thuc km t bo, vn cn gi tr. Tuy nhin,
ngi bnh phi c cnh bo l h hi st, au hng v lot ming th phi
ngng iu tr bng cc phenicol.
Vng
Phn tch: Nguy c tn hi nng cc dng t bo mu (suy ty).
X l: Khi phi hp, cn theo di huyt .
Zidovudin
Phn tch: Phi hp zidovudin vi cc thuc c vi ty khc phi rt thn
trng. Nguy c thiu mu hay cc ri lon khc v huyt hc.
X l: Khi cn phi hp, nn theo di cn thn huyt v nu cn, tin
hnh gim liu.
638

Amphetamin hay dn cht
amphetamin.
Khuyn ngi bnh gp li bc s iu tr, nu thy kt qu iu tr khng n
nh.
Barbituric
Phn tch: C th cc thuc c ch MAO c ch chuyn ho barbituric
gan v ko di cc tc dng c ch h thn kinh trung ng. Hin tng xy ra
tc thi.
X l: Phi lu s tng tc dng an thn bun ng, trong v sau khi iu
tr, c bit nhng ngi li xe v ngi vn hnh my. Khuyn ngi bnh
Methadon
Phn tch: Tng thm tc dng c ch h thn kinh trung ng, km vi
an thn bun ng mnh, c hi c bit ngi li xe v ngi vn hnh my.
X l: Ngi k n phi lu s tng cng cc tc dng an thn bun
ng ny cho nhng li khuyn thch hp (trnh li xe hoc vn hnh my;
thng bo cho ngi xung quanh bit mi nguy him).
X l: Nu cn phi hp thuc, lu nguy c ny khi gy m v chn liu
dng.
PROGABID
Thuc chng ng kinh cn dng trong mt s trng hp
khng vi cc thuc chng ng kinh kinh in
CC THUC TRONG NHM

PROGABID bt ung 150 mg; vin nn 300 mg; 600 mg
Gabrene bt ung 150 mg
Gabrene vin nn 300 mg; 600 mg
639
CH KHI CH NH THUC

Suy gan: Nguy c vim gan (vng da), buc phi kim tra sinh hc c h thng
v chc nng gan, trc v trong khi iu tr. Cc bnh v gan l chng ch nh.
Cn theo di: mc 1
Thi k mang thai: Khng thy tc dng gy qui thai ng vt, tuy nhin khi
dng progabid ngi mang thai phi tnh n tng quan nguy c/li ch do cn t
kinh nghim trong s dng.
Suy thn: Gim s thanh lc progabid, cn gim liu dng.
TNG TC THUC

Amineptin; carmustin hay dn cht; dantrolen; estrogen hoc thuc nga
thai; estroprogestogen; fluvoxamin; griseofulvin; isoniazid hoc thuc tng t;
macrolid; methotrexat; natri valproat hoc dn cht; rifampicin; vng
Phn tch: Phi hp cc thuc c tim nng c vi gan (hip ng cc
tc dng khng mong mun).
chc nng gan (ASAT, ALAT, phosphatase kim, bilirubin), hoc nu c th
phi hon mt trong hai thuc iu tr. Xc minh l ngi bnh khng ung ru
chnh khng c hiu: bun nn, st, vng da. Phi hp ban da, nga v hch
to hng v bnh cn do thuc. Phn bit r, ty theo cc kt qu th nghim
mt phc hi c khi ngng iu tr.
Phn tch: Tng tc dc ng hc: c th tng chuyn ho gan bi
cm ng enzym, ko theo gim hot tnh ca progabid; cng c th lm tng
nng ca phenobarbital hay primidon trong huyt tng.
X l: Progabid l thuc chng ng kinh la chn hng hai v c vi
gan. Nn tnh n nguy c iu tr tht bi. Cn iu chnh liu.
Phn tch: Mc tiu chnh l iu tr ung th biu m dng tuyn thn.
Interleukin cng t ra c vi gan. Nh vy l phi hp hai thuc c kh nng
c vi gan.
X l: iu tr ch c tin hnh ti c s chuyn khoa. Interleukin i
hi phi theo di thng xuyn. Trong trng hp ny, nn i chiu vi th
trng chung ca ngi bnh. Khi phi hp hai thuc c vi gan th phi theo
640
di k chc nng gan (ASAT, ALAT, phosphatase kim, bilirubin), hoc phi
hon dng mt trong hai thuc iu tr.
Niridazol
Phn tch: Phi hp hai thuc c vi gan. Niridazol cn c vi thn kinh.
Nguy c xut hin co git, ri lon tm thn v c tnh vi gan, nu phi hp
hai thuc.
nng gan (ASAT, ALAT, phosphatase kim, bilirubin), hoc nu c th, phi
hon mt trong hai thuc. Xc minh l ngi bnh khng ung ru thng
khng c hiu: bun nn, st, vng da... Nu thy ng thi ban da, ng a v
hch to th hng v bnh cn do thuc. Cn phn bit r, cn c vo kt qu
th nghim sinh hc, nguy c xut hin vim gan tiu t bo khng hi phc vi
vim gan mt hi phc c khi ngng iu tr.
Phenytoin
Phn tch: Kh nng tng nng phenytoin trong huyt tng, c th
dn n qu liu (c tnh thn kinh).
X l: Progabid l thuc chng ng kinh la chn hng th hai, c c
tnh vi gan. Nn tnh n nguy c tht bi iu tr. iu chnh liu dng.
Phn tch: Phi hp hai thuc c tim nng c vi gan, c m t ch
yu vi ketoconazol (Nizoral ) v progabid.
chc nng gan (ASAT, ALAT, phosphatase kim, bilirubin), hoc nu c th
phi hon mt trong hai thuc iu tr. Xc minh l ngi bnh khng ung ru
chnh khng c hiu: bun nn, st, vng da... Phi hp ban da, nga v hch
to hng v bnh cn do thuc. Phn bit r, ty theo cc kt qu th sinh hc,
nguy c xut hin bnh vim gan tiu t bo khng phc hi vi vim gan t c
mt phc hi c khi ngng thuc.
Phn tch: Cc thuc chng trm cm ba vng lm h thp ngng gy
ng kinh v nh vy c nguy c to thun li cho vic xut hin cn co git
ngi bnh iu tr bng thuc chng ng kinh ny.
hp.
641
X l: Lu nguy c ny v iu chnh liu dng tu theo tng trng

Carbamazepin
Phn tch: Tng tc dc ng hc: Tng chuyn ho gan do cm ng
enzym, dn n vic gim hot tnh ca progabid.
X l: Progabid l thuc chng ng kinh la chn hng hai, c c tnh
vi gan. Nn tnh n nguy c tht bi iu tr cn iu chnh liu dng.
PROGESTOGEN HOC DN CHT

Hormon sinh dc vi progesteron l cht in hnh
CC THUC TRONG NHM

CYPROTERON
Androcur vin nn 50 mg
Climen vin nn 1 mg phi hp vi 2 mg estradiol valerat
Diane-35 vin nn 2 mg phi hp vi 35 mcg ethinylestradiol
DYDROGESTERON
Duphaston vin nn 5 mg; vin bao 10 mg
ETHISTERON
Lutocyclin vin nn 10 mg
LYNESTRENOL
Exluton vin nn 0,5 mg
MEDROXYPROGESTERON
Depo-Provera dch treo tim bp 250 mg; 500 mg
Plentiva vin nn 2,5 mg; 5 mg
NOMEGESTROL
Lutenyl vin nn 5 mg
PROGESTERON dung dch tim bp 5 mg; 10 mg; 25 mg, vin t di li 50
mg
Progestogel Gel bi ngoi da 1%
Utrogestan nang mm (ung hoc t m o) 100mg; 200 mg
Vageston vin t m o 100 mg; 200mg
642
PROMEGESTON
Surgestone vin nn 0,125 mg; 0,25 mg; 0,5mg
CH KHI CH NH THUC

Thi k mang thai: Progesteron khng gy nam tnh ho. Ngc li, cc
progestogen tng hp, gn vi methyltestosteron, dng ung nga thai, c th tc
ng ln s bit ho ng sinh dc bn ngoi (nam tnh ho rt r cc phi ca chut
ci). Trnh dng t tun th 36 (gn sinh n, v c th gy bng huyt hu sn v sau).
Suy gan: Cc steroid sinh dc chuyn ha gan. thy vng da t c mt do
alcoyl ha (alkyl ha) cc dn cht ny v tr 17 v gy c vi gan.
Ung th v.
Thn trng: mc 2
Thi k cho con b: Cc progestogen qua c sa m vi lng thay i. V
gy nn cc tc dng khng mong mun tr b m, nn trnh dng trong thi k cho
con b.
Cn theo di: mc 1
Suy tim/suy thn/suy h hp; hen: Nguy c gi nc c th lm nng thm cc
bnh .
TNG TC THUC

Etretinat hoc dn cht
Phn tch: Gim hiu qu ca thuc nga thai progestogen liu thp vi
nguy c tht bi trong nga thai cng tng khi tr liu cng ko di.
X l: Cn nhc li l do tc dng gy qui thai ngi, khi k n
etretinat hay dn cht cn c bin php nga thai c bit hiu qu. Trong
trng hp ny, nn thay thuc nga thai liu thp progestogen bng mt thuc
nga thai estroprogestogen hay chn mt phng php nga thai khc, trong
thi gian iu tr vi etretinat.

Phn tch: Acid ursochenodesoxycholic gp phn lm tng t l acid
mt/cholesterol. Khi lp li cn bng ca cc thnh phn trong mt, thuc c
th gp phn lm thoi trin cc si mt cha cholesterol. Khi to phc vi acid
ursodesoxycholic (dng cholestyramin, thuc khng acid), hoc khi lm tng s
bo ho ca mt (dng estrogen, progestogen, fibrat, neomycin ung), c s
gim hot tnh ca acid ursodesoxycholic.
643
X l: iu tr bng acid ursodesoxycholic phi di ngy (t 6 thng n 1

nm). Cn trnh tht bi trong iu tr v khng phi hp vi cc thuc lm
gim hiu qu ca ch phm c k n, tr khi vic iu tr ng thi ch
tin hnh trong giai on rt ngn.
Barbituric; carbamazepin; gluthetimid hoc thuc tng t; griseofulvin;
phenytoin; primidon hay dn cht; rifabutin
cm ng enzym, t c nguy c th thai.
X l: Trnh dng cc thuc nga thai liu thp v chn dng cc thuc
nga thai liu cao hoc khuyn dng mt phng php nga thai khc, nu
iu tr bng thuc gy cm ng ny ko di. Cm ng enzym khng bao gi l
mt hin tng tc thi.
Phn tch: Bromocriptin l cht ch vn dopamin, c ch prolactin. S
phi hp c th dn n mt kinh nguyt v/hoc tit nhiu sa, nh hng
n cc tc dng ca bromocriptin.
X l: Nn trnh phi hp, nht l ngi bnh ang iu tr mt kinh
nguyt hay tit nhiu sa.
Rifampicin
Phn tch: Tng chuyn ho progestogen gan, do rifampicin gy cm
ng enzym, do c nguy c th thai.
X l: Trnh dng cc thuc nga thai liu thp v chn dng cc thuc
nga thai liu cao hoc khuyn dng mt phng php nga thai khc, nu
iu tr rifampicin ko di. Cm ng enzym khng bao gi l hin tng tc thi.

Biguanid
Phn tch: Tc dng gy tiu ng ca cc thuc progestogen liu cao
i khng vi tc dng ca biguanid.
X l: Trng hp k n hai thuc, cn ch nh vic theo di chnh xc
glucose mu, khi bt u, trong khi iu tr v khi ngng dng thuc
progestogen. Cn thng bo cho ngi bnh bit.
Ciclosporin
Phn tch: C th tng nng ciclosporin trong mu, do gim o thi
gan v tng c creatinin mu v cc transaminase.
X l: Lu cc nguy c ny v tin hnh cc nh lng u n, c
bit ph n ung thuc nga thai. Ciclosporin phi c cc thy thuc
chuyn khoa ch nh. Cn phi nh lng u n ciclosporin trong mu do c
bin i ln v p ng gia cc ngi bnh. Cn ch ti mi thay i ca
ciclosporin trong mu.
644
Insulin; sulfamid h ng huyt

Phn tch: Progestogen liu cao c cc tc dng gy tiu ng v c th
i khng tc dng ca cc thuc chng tiu ng.
X l: Bo cho ngi bnh cc nguy c bin ng v glucose mu,
tng cng t kim tra. Ty theo cc kt qu, iu chnh liu thuc chng tiu
ng lc bt u v sau khi iu tr progestogen. Xy dng mt k hoch
dng thuc u n. Khuyn ngi bnh i khm li khi c vn ,.
645
PROPAFENON
Thuc chng lon nhp nhm 1c theo Vaughan - Williams, propafenon
lm gim tc kh cc v bin in th hot ng v ko di cht t thi gian
ti cc. Thuc c tnh cht chn beta va phi, lm cho thuc gn vi nhm II
CC THUC TRONG NHM

PROPAFENON vin nn 300 mg
Rythmol vin nn 300 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
H huyt p: H huyt p ng mch r rt.
Suy tim: Do tnh cht lm chm nhp tim ca thuc, chng ch nh dng trong
suy tim nng.
Suy thn: Chng ch nh khi suy thn nng v nh gi theo thanh lc
creatinin.
Suy h hp - hen: Bnh l phi ph qun tc nghn nng.
Trng hp khc: Chng ch nh tuyt i: bnh nt xoang, bnh tm nh v
bloc nh -tht hai hay ba khng t my to nhp. Chng ch nh tng i: bloc
nhnh, chm nhp tim nng(< 45 nhp/pht).

Thi k mang thai: Thiu cc c liu.
Trng hp khc: Ng c digitalis.
TNG TC THUC

Benzamid
Phn tch: Nguy c xut hin ri lon nhp tht v c bit xon nh, do
hip ng cc tc dng in sinh l. Tng tc dc lc.
Ritonavir
Phn tch: Ritonavir c i lc mnh vi isoenzym 3A 4 ca cc cytochrom
P450, do cnh tranh nn lm gim chuyn ho ca cc thuc c chuyn ho
mnh bi cc cytochrom P450 nh propafenon. Nh vy c tng nng trong
huyt tng ca propafenon v nguy c tng c tnh; nguy c lon nhp tim.
646

Cisaprid
Phn tch: Tng nguy c gy lon nhp tim nng c th t vong, bao gm
xon nh. Tng tc xy ra chm. C ch c th c tc dng hip ng ko
di khong QT.
X l: Chng ch nh dng cisaprid cho ngi bnh ang dng cc thuc
chng lon nhp loi Ia v loi III.
647
Digoxin
Phn tch: Nng trong huyt thanh ca digoxin c th tng, gy nhim
c. Tng tc xy ra chm. C ch cha r, c th do gim th tch phn b
v thanh lc qua thn v khng qua thn ca digoxin.
X l: Gim st nng trong huyt thanh ca digoxin v theo di cc
triu chng nhim c digoxin. iu chnh liu digoxin nu thm hoc ng ng
propafenon.
Flecainid hoc thuc tng t; sotalol
Phn tch: Phi hp cc thuc chng lon nhp thuc cc nhm khc nhau
c th dn n tng nguy c c cc tc dng khng mong mun vi tim ( khu
t ng, dn truyn, nhp, lc co c).
X l: Theo di lm sng v in tm cht ch.
Rifampicin
Phn tch: Rifampicin gy cm ng enzym micrsm gan c nhim v
chuyn ho propafenon. Do , s thanh lc propafenon tng, lm gi m nng
thuc trong huyt tng v tc dng iu tr mt i.
X l: ngi bnh ang t c cn bng trong iu tr bng cch
dng propafenon, th cn tm mt thuc chng nhim khun thay th rifampicin.
Nu bt buc phi dng phi hp thuc ny, phi theo di nng propafenon
trong huyt thanh, theo di tc dng iu tr ngi bnh. Nu cn, hiu chnh
liu propafenon.

Aminophylin (theophylin)
Phn tch: Tng nng trong huyt thanh ca aminophylin, c th gy
nhim c. Tng tc xy ra chm. C ch c th chuyn ho aminophylin b
c ch.
X l: Gim st nng trong huyt thanh ca aminophylin. iu chnh
liu aminophylin nu cn.
Tacrin
Phn tch: Nguy c chm nhp tim qu mc, do hip ng cc tc dng
gy chm nhp tim.
Thuc chn beta
Phn tch: Propafenon c cc tnh cht chng lon nhp v chn beta va
phi. S phi hp c th ko theo cc ri lon tnh co c, tnh t ng v d n
truyn vi s c ch cc c ch giao cm b tr.
X l: Nu phi hp, phi theo di in tm v lm sng thng xuyn.
Nu lon nhp, cn bo cho bc s.
648

Phn tch: Tng tc ch c m t vi warfarin (Coumadine ). Tng tc
dng chng ng mu v do tng nguy c chy mu, c l do c ch chuyn
ho oxy ho.
X l: iu chnh liu thuc chng ng mu ung tu theo INR (t s
chun ho quc t) v/hoc t l prothrombin, khi khi u, trong v sau khi
iu tr bng propafenon.
649

Cimetidin
Phn tch: Tc dng dc l ca propafenon c th tng. Tng tc xy
ra nhanh. C ch c ch chuyn ho propafenon.
X l: Da trn cc d liu hin c, khng cn phi thn trng c bit
ngoi theo di thng thng chc nng tim.
Thc n
Phn tch: Thc n c th lm tng tc dng ca propafenon mt s
ngi bnh. Tng tc xy ra nhanh. C ch tng kh dng sinh hc.
X l: Nn ung propafenon vo mt thi im nht nh so vi ba n
gi kh dng sinh hc c ng u.
PROSTAGLANDIN CHNG LOT

Thuc chng lot, chng tit dch, bo v t bo
CC THUC TRONG NHM

MISOPROSTOL vin nn 200 mcg
Cytotec vin nn 200 mcg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai: Nguy c xy thai ph n trong thi k hot ng sinh sn.
Ch nn k n cho ph n mn kinh hoc c nga thai hu hiu.
Qu mn vi prostaglandin.
Thi k cho con b: V thn trng, thiu cc c liu.
Cn theo di: mc 1
Tr em: Khng k n cho tr em di 15 tui, do thiu cc nghin cu v iu
tr cho tr em.
650
PROSTAGLANDIN TRONG PH KHOA

Cc cht tng hp tng t prostaglandin (E1, E2, F2) tc dng t cung
CC THUC TRONG NHM

DINOPROST ng tim 5 mg/1mL
Prostin F2 Alpha ng tim 5 mg/1mL
CH KHI CH NH THUC
Chng ch nh: mc 4
Tng huyt p: Tng mnh huyt p thng xuyn.
Qu mn vi thuc.

Thi k mang thai: Chng ch nh dng gemeprost v sulproston gy chuyn
d cho thai nhi thng c kh nng sng, do cc tc dng bt li cho thai.
Suy tim: Trong trng hp mt b.
Suy mch vnh: Trong trng hp c tin s v mch mu.
Suy h hp - hen: Trong trng hp c tin s hen hay co tht ph qun, trnh
dng cc thuc ny.
Trng hp khc: T cung c so; t cung d v; nhau tin o; a thai; cha
nhiu ln; tin s m .
Cn theo di: mc 1
Glcm: Nhn p tng.
Lot d dy/t trng; vim d dy: Trng hp dng sulproston.
TNG TC THUC

Oxytocin hay dn cht
Phn tch: Tng tc dng ca oxytocin bi cc prostaglandin v ng thi
c s gia tng mnh tn s v cng co t cung.
X l: Phi theo di lm sng rt chnh xc.
PROTAMIN
651
Thuc gii c heparin v cc heparin c phn t lng thp.

Vi heparin, 1mL dung dch protamin tim trung ho chnh xc 1000 n v heparin
CC THUC TRONG NHM

PROTAMIN dung dch tim 100.000 UAH/10 mL
Protamine dung dch tim 100.000 UAH/10 mL
CH KHI CH NH THUC
Qu mn vi protamin.
TNG TC THUC

Heparin
Phn tch: i khng ho l (pH) gia heparin v protamin sulfat, c
dng rng ri trong iu tr.
X l: Khi qu liu heparin hay heparin c phn t lng thp, protamin
sulfat c th c dng tim tnh mch chm theo cc phc iu tr chnh
xc, vi liu dng cht ch.
PYRANTEL HOC DN CHT

Thuc tr giun, c tc dng ln giun kim, giun a v giun mc,
do chn thn kinh-c v gy lit giun
CC THUC TRONG NHM

PYRANTEL PAMOAT vin nn 125 mg v 250 mg
Combantrin vin nn 125 mg
Helmintox vin nn 125 mg; 250 mg
Hetamintox 125 vin nn 125 mg
Hetamintox 250 vin nn 250 mg
Panatel vin nn 125 mg
Pyrantel vin nn bao phim 125 mg
CH KHI CH NH THUC
652

Thi k cho con b: Thiu d liu.
Thn trng: mc 2
Thi k mang thai: Cho ti nay, khng c tc dng no c thng bo, c
ng vt v ph n mang thai (nhng thi gian thm nh cha ).
Cn theo di: mc 1
Suy gan: Khi cn, nn theo di transaminase.
TNG TC THUC

Piperazin
Phn tch: i khng dc l. Pyrantel l thuc tr giun gy kh cc chc
nng thn kinh-c v gy lit giun. Piperazin cng l thuc tr giun, nhng lm
tng phn cc ni thn kinh-c. Hai tc dng ny i khng vi nhau.
X l: Trnh phi hp; thay chin lc iu tr.

Theophylin
Phn tch: Tng nng huyt thanh ca theophylin khi cho thm
pyrantel. Tng tc xy ra nhanh. C ch cha r. C kin cho rng pyrantel
c
ch cc enzym gan c lin quan n chuyn ho theophylin. Cng c kin cho
rng pyrantel lm tng nhanh gii phng theophylin thuc gii phng ko di.
X l: Khi phi hp, cn theo di lm sng, v nng huyt thanh
theophylin c th tng rt nhanh.
653
PYRAZINAMID
Thuc chng lao dng phi hp vi cc thuc chng lao khc
cho cc trng hp mi mc bnh
CC THUC TRONG NHM

PYRAZINAMID vin nn 500 mg
Lynamide vin nn 500 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Suy gan: Tnh n cc tc dng khng mong mun.
Thng phong: Do c ch bi tit acid uric.
Lon chuyn ho porphyrin: Nguy c gy ra cc cn porphyrin cp.

Suy thn: Tnh n cc tc dng khng mong mun.
TNG TC THUC

Cyclosporin
Phn tch: Nng cyclosporin trong mu ton phn c th b gim, c
th lm gim tc dng c ch min dch ca cyclosporin. Tng tc xy ra
chm. C ch cha r.
X l: Cn gim st nng cyclosporin trong khi dng pyrazinamid v
theo di cc du hiu gim c ch min dch. Nu nghi c tng tc, iu chnh
liu cyclosporin nu cn.

Alopurinol
Phn tch: Alopurinol c th khng c tc dng i vi tng acid uric mu
gy ra do pyrazinamid. Cc nh sn xut pyrazinamid cng cho l pyrazinamid
c chng ch nh dng khi c tng acid uric mu v phi ng ng pyrazinamid
nu xy ra vim khp do gt. C ch Pyrazinamid c thy phn trong c th
thnh acid pyrazinoic c kh nng lm tng acid uric mu, nhng cht ny b
xanthin oxydase oxy ho thnh acid 5-hydroxypyrazoic. V alopurinol l cht c
ch xanthin oxydase nn nu dng, alopurinol c th lm tng nng acid
pyrazinoic v lm nng thm tnh trng tng acid uric mu do pyrazinamid.
X l: Khng dng alopurinol iu tr tng acid uric mu do pyrazinamid.
654

Phn tch: S phi hp ny l kinh in, tuy nhin y l s phi hp ca
hai thuc chng lao c vi gan.
X l: Cn theo di hiu qu vi sinh ca s phi hp, nhng cng phi
theo di cht ch chc nng gan (ASAT, ALAT, phosphatase kim, bilirubin) hay
hon mt trong hai thuc iu tr, nu c th. Xc minh rng ngi bnh khng
ung ru thng xuyn v khng c tin s vim gan do virus. Cc triu chng
lm sng chnh khng in hnh: bun nn, st, vng da... Nu thy ng thi
ban da, nga v hch to hng v bnh cn do thuc.
655
PYRAZOL HOC DN CHT

Thuc chng vim khng steroid, u bng l phenylbutazon
CC THUC TRONG NHM

PHENYL-BUTAZON vin nn bao phim 100 mg; vin bao ng 200 mg; nang 100
mg
Novo-butazone vin nn bao phim 100 mg
Phenylbutazone vin bao ng 200 mg
Phenylbutazon nang 100 mg; vin bao phim 100 mg
Phetadine vin bao phim 100 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Bnh mu, tng chy mu (bnh v ng mu, gim tiu cu), mn cm vi h
thuc ny, bnh tuyn gip, lupus ban , hi chng Sjogren, mi c tin s vim tr c
trng hoc chy mu trc trng u chng ch nh dng thuc pyrazol.
Thi k mang thai: Ni chung, mi thuc chng vim khng steroid u c th
lm chm , to nh hng ln h tim mch thai nhi v chuyn qua sa m.
Tng huyt p: Do nguy c gi mui v nc bi cc thuc pyrazol km vi cc
ri lon v tit niu, tng huyt p v cc ri lon v tim, cn thn trng khi k n cho
ngi tng huyt p.
Suy tim: Cc thuc pyrazol y mnh sn xut hormon chng bi niu, c th
gy gi natri v nc km vi ph v tng cn, ko theo nguy c gim niu, tng huyt
p v suy tim cng vi ph phi v vim mng phi ngi suy tim.
Suy gan: Cc thuc pyrazol dng vi liu iu tr, c th gy cc tn thng gan,
vi thng tn t bo, i khi biu hin bng vng da, nhng thng ch tng bilirubin
huyt thanh, transaminase v phosphatase kim. Cng c nhng trng hp vim gan
gy t vong.
Suy thn: Cc pyrazol l thuc c vi thn nht trong cc thuc chng vim
khng steroid, km nguy c hoi t nh thn c th dn n suy thn cp hay mn
tnh.
Lot d dy - t trng; vim d dy: Ni chung, cc thuc pyrazol gy ri lon
tiu ho (vim d dy, chy mu d dy). Phenylbutazon lm ri lon phn b mch
nim mc d dy v lm gim s i mi nim mc, do c tc dng c t bo.
Thn trng: mc 2
Thi k cho con b: Cc pyrazol qua c sa m, nn trnh dng khi c con
b.
656
Cn theo di: mc 1
Ngi bnh cao tui: V nguy c gi mui v nc do cc pyrazol gy ra km
vi cc ri lon v tit niu, tng huyt p, v ri lon tim, cn thn trng khi k n
cho ngi bnh cao tui.
TNG TC THUC

Methotrexat
Phn tch: Tng nguy c mt bch cu ht v cc tc dng c vi mu
ca methotrexat, do b y khi cc v tr lin kt vi protein huyt tng
v/hoc gim o thi thn.
X l: Chng ch nh phi hp. Chn mt thuc chng vim khng
steroid khc nhng vn tn trng cc nguyn tc k n liu cao methotrexat,
khuyn ngng thuc chng vim khng steroid 12 n 24 gi trc, ti khi nng
ca methotrexat tr v cc gi tr khng c.

Phn tch: Nguy c chy mu tng ch yu do cc cephalosporin c nhn
thiomethyltetrazol (latamoxef, cefoperazon, cefamandol, cefmenoxim, cefotetan).
Nhn ny tc dng nh mt dn cht ca coumarin (khng vitamin K), nh vy,
thm cc tnh cht chng ng vo cc tnh cht khng vitamin K, hoc chng
kt tp tiu cu ca cc thuc nu.
X l: Cn trnh phi hp, ch yu vi latamoxef, do tng nguy c chy
mu. c bit cnh gic vi khng sinh ny khi dng liu cao.
Dng c t trong t cung
Phn tch: Ngi bnh n ung thuc chng vim khng steroid (nht l
aspirin) lm tng nguy c mt hiu lc ca dng c t t cung (c ch vim).
X l: Mc du trong y vn, nguy c th thai cn ang tranh ci, vn nn
trnh k n thuc chng vim cho ph n dng cch nga thai ny. Nu thy
vic k n thuc chng vim khng steroid khng lm gim hiu qu nga thai
ca dng c t trong t cung, bo cho Trung tm cnh gic thuc. Tng tc
ny cn cn b sung thm t liu.
Heparin; pentoxyfylin; ticlopidin
chng ng mu u lm tng nguy c chy mu. Nguy c ny tng thm do
tc dng xm hi ca cc thuc chng vim khng steroid ln nim mc d dy
(chy mu ng tiu ho).
X l: Nu cn phi hp, phi theo di bng cc th nghim ng mu
thch hp (thi gian Howell v thi gian cephalin kaolin). Nu c th, tm mt gii
php iu tr khc cho nhng ngi bnh c tin s lot ng tiu ho.
657
Mifepriston
Phn tch: Nguy c gim hiu lc ca liu php.
X l: Ngng iu tr bng thuc chng vim khng steroid 24 gi trc
Phenytoin
Phn tch: Tng tc dc ng hc lm tng nng phenytoin trong
mu, c l do chuyn ho cnh tranh gan.
X l: iu chnh liu dng theo nng phenytoin trong huyt tng.
Salicylat
Phn tch: Phi hp khng hp l, hip ng cc tc dng gy lot v tng
nguy c chy mu ng tiu ho.
X l: K n tha; thay chin lc iu tr, cn trnh phi hp.
Phn tch: Cc prostaglandin tham gia vo c ch iu ho glucose mu,
c th gy tng nguy c h glucose mu. Ngoi ra, cc thuc chng vim khng
steroid lin kt cht vi cc protein, c th c nguy c y sulfamid khi cc
protein huyt tng.
X l: Nhng thay i nh v glucose mu c th c ghi nhn, cn
phi iu chnh liu lng sulfamid chng tiu ng lc bt u, trong v sau
khi ngng iu tr bng thuc pyrazol. Bo cho ngi bnh tng cng t
theo di, xc lp k hoch dng thuc u n.
Phn tch: Phi hp khng hp l, hip ng cc tc dng gy lot v tng
nguy c chy mu ng tiu ho.
X l: K n tha v ch; i chin lc iu tr, khng nn phi hp.
Thuc tan huyt khi
chng ng mu u lm tng nguy c chy mu.
X l: Ni chung, vic k n v vic dng cc thuc lm tan huyt khi
c thc hin bi cc bc s c o to chuyn khoa (bc s tim mch v
cp cu) do phm vi iu tr hp ca cc thuc v quy trnh s dng tinh t.
Nu cn phi hp, phi theo di bng cc th nghim ng mu thch hp (thi
gian Howell v thi gian cephaline kaolin). Nu c th, tm mt gii php iu tr
khc.
Phn tch: Tng tc dng ca thuc chng ng bi b y khi cc lin
kt vi protein huyt tng; hip ng tc dng chng kt tp tiu cu. Cc
658
thuc chng vim khng steroid kch ng nim mc d dy, nn lm tng nguy
c lot chy mu, nht l ngi bnh cao tui.
X l: Cn trnh k n cc thuc cng nhau, do nguy c chy mu.
Vi aspirin, mc du c gp phi hp ny, nhng ch c th dng vi cc liu
thp (khong 200mg). Cn trnh v vn chnh thc chng ch nh phi hp liu
cao aspirin. Bo cho ngi bnh bit s nguy him phng trnh t dng
aspirin phi hp.
Vng
ty).
Phn tch: Nguy c lm nng thm tn thng cc dng t bo mu (suy
X l: Phi hp cn theo di v sinh hc nhng ngi bnh c nguy c

(huyt ).

Amphotericin B
Phn tch: Phi hp amphotericin B tim vi cc thuc khc c vi ty
xng buc phi rt cn thn. Nguy c thiu mu hay cc ri lon khc v
huyt hc.
X l: Nu cn phi hp, phi theo di cn thn huyt v tin hnh
gim liu phenylbutazon nu cn.
Cholestyramin
Phn tch: Gim hp thu pyrazol qua ng tiu ho.
X l: Nu hai ch phm c k n, khuyn dng thuc pyrazol (tc
dng gy lot) trc 2 gi hay 4 gi sau khi dng cholestyramin.
Glucocorticoid
Phn tch: Tng cc tc dng khng mong mun, do hip ng tc dng
gy lot nim mc d dy.
X l: Cn nhc li ch/nguy c trc khi k n mt phi hp nh vy.
S tng cc nguy c gy lot i hi phi xem xt li vic iu tr ngi bnh
cao tui v nhng ngi bnh c tin s lot d dy. Nu cn, cho phi hp
cc thuc bo v nim mc d dy.
659
Phn tch: Nguy c c ch tc dng sinh hc ca interferon, c m
t cho thuc h salicylat nhng c th cng c gi tr cho thuc chng vim
khng steroid khc. C ch khng bit r.
X l: Phi tnh n s gim tc dng ny trc khi phi hp cc thuc
. Cn nhc tng quan nguy c/li ch v chi ph/hiu qu.
Lithi
Phn tch: Cc thuc chng vim c th lm gim thanh lc lithi thn
do tng ti hp thu lithi ti ng thn, c th dn n qu liu lithi.
X l: Phi hp ny i hi phi iu chnh liu dng ca lithi lc bt u,
trong v sau khi tr liu bng thuc chng vim. Nu cn, theo di cn thn
nng lithi trong mu.
Phn tch: Dng ng thi hai thuc c ch ty xng c th dn n cc
ri lon huyt hc nng, tu theo thi gian iu tr. Cng cn theo di chc
nng thn.
X l: Phi hp cn c theo di v huyt hc v v thn.
Tetracosactid
Phn tch: Nguy c tng cc tc dng gy lot ng tiu ho chy mu.
Nhng trong mt s dng vim khp, phi hp c th c li.
X l: Bo cho ngi bnh, cn nhc tng quan nguy c/li ch trc khi
k n. Nu cn phi hp, phi theo di ngi bnh v lm sng.
Phn tch: Nguy c tng c tnh vi mu, do tc dng hip ng c ch
ty xng, c th dn n mt bch cu ht.
X l: Trnh phi hp, nu c th. Nu cn phi hp, nn dng liu thp
cho mi thuc v theo di cn thn huyt . S phi hp ny lin quan n
cc bc s chuyn khoa v cc phc iu tr thng c xc lp tt.
Verapamil
Phn tch: Nguy c tng c tnh ca hai thuc do b y khi cc v tr
lin kt vi protein huyt tng. y l tng tc dc ng hc khu phn
b. Cn cn nhc tng tc ny trong iu kin phn ln cc thuc pyrazol hin
nay c dng ti ch, nh vy gn nh khng chuyn vo ton thn, nu s
dng ng.
X l: Theo di p ng lm sng vi verapamil v iu chnh liu dng ca
thuc c ch calci ny. Theo di cc tc dng khng mong mun, c th gp vi
cc thuc nhm pyrazol (au bng, tiu chy, bun nn, kh tiu, chn n...).
660

Clonidin hoc thuc tng t; diazoxid; dihdropyridin; furosemid hoc
thuc tng t; guanethidin hoc thuc tng t; methyldopa; reserpin; sotalol;
thuc chn beta; thuc gin mch h huyt p; thuc li niu gi kali; thuc li
niu thi kali; thuc c ch enzym chuyn
Phn tch: Gim tc dng h huyt p; cc thuc chng vim khng
steroid c ch tng hp cc prostaglandin gin mch ca thn v/hoc ko theo
gi mui v nc. Nguy c suy thn cp nhng ngi bnh b mt nc.
X l: Cn bit ngi bnh phi c b nc y ; theo di chc
nng thn ( thanh lc creatinin), kim tra s n nh ca huyt p, c bi t
lc u tr liu. Khuyn ngi bnh theo di u n huyt p.
Dipyridamol
Phn tch: Phi hp vi dipyridamol, hoc vi mi thuc c cc tnh cht
chng kt tp tiu cu hay chng ng mu u lm tng nguy c chy mu.
Hin nay, tng tc ny hnh nh khng c tha nhn, khng mt nhn xt
lm sng no xc nhn nguy c chy mu.
X l: Nu vn phi hp hai thuc ny, phi theo di bng cc th nghim
ng mu thch hp.
Phn tch: Phenylbutazon gy cm ng enzym; dng phenylbutazon di
hn c th do cm ng enzym lm tng d ho gan, nn lm gim hot tnh
estrogen v cc thuc nga thai estroprogestogen.
X l: Ty theo thi gian iu tr phenylbutazon cho ph n ang dng
thuc estroprogestogen liu thp, c th phi i thuc chng vim.
PYRETHRIN HOC DN CHT

Thuc tr su t c, tc dng ln cc loi tit tc (mui, rui tse - tse,
chy, con gh), thng dng hip ng vi piperonil butoxid, l mt thuc c ch
cc enzym loi tr pyrethrinoid cc k sinh trng.
CC THUC TRONG NHM

PYRETHRIN thuc gi u
Marie Rose Suractive thuc gi u
PERMETHRIN thuc gi u 0,3 %
Pyreflor thuc gi u 0,3%
PHENOTHRIN thuc gi u
661
Itax thuc gi u
CH KHI CH NH THUC

Qu mn vi mt trong cc thnh phn ca ch phm.
Cn theo di: mc 1
Tr em; tr cn b: Khng dng tr di 30 thng tui.
662
PYRIDOXIN
Vitamin nhm B, tham gia vo nhiu phn ng enzym
CC THUC TRONG NHM

PYRIDOXIN vin nn 250 mg; ng tim 100 mg/1mL; 50 mg/1mL
Vitamin B6 vin nn 250 mg
Vitamin B6 ng tim 100 mg/1mL
Vitamin B6 ng tim 50 mg/1mL
PYRIDOXIN phi hp vi cc vitamin khc
Vitamin B1, B6, B12 (B6: 125 mg)
TNG TC THUC

Levodopa
Phn tch: Gim tc dng ca levodopa, c th do tng chuyn ho (kch
thch dopa-decarboxylase ngoi bin).
X l: Nu levodopa khng c cht c ch dopa-decarboxylase (cho php
chuyn mt lng levodopa quan trng hn vo no), phi hp vi pyridoxin l
chng ch nh. Phn ln cc ch phm levodopa c mt trn th trng c
phi hp vi cc cht c ch dopa-decarboxylase (benzerazid hay carbidopa),
v khi , khng chng ch nh phi hp thuc.
Thuc c ch MAO typ B
Phn tch: Pyridoxin c ch c hiu monoamin oxydase typ B dn n
ko di tc dng ca levodopa, iu ny gii thch vic kt hp vi thuc ny.
Cc tng tc nh vy cng ging nh cc tng tc ca levodopa (xem nhm
thuc levodopa).
X l: Nu levodopa khng c cht c ch dopa-decarboxylase (cho php
chuyn mt lng levodopa quan trng hn vo no), chng ch nh phi hp
vi pyridoxin. Phn ln cc ch phm levodopa c mt trn th trng c
phi hp vi cc cht c ch dopa-decarboxylase (benzerazid hay carbidopa),
v khi khng chng ch nh phi hp thuc.

Phn tch: Nguy c thiu mu hay vim dy thn kinh ngoi bin hoc do
i khng, hoc do tng o thi pyridoxin.
X l: Khi iu tr ko di, c th cn cho dng pyridoxin trong khi iu tr,
tu theo s xut hin cc triu chng.
663
PYRIMETHAMIN
Thuc chng k sinh trng, can thip vo qu trnh sinh tng hp acid folinic
CC THUC TRONG NHM

PYRIMETHAMIN vin nn 25 mg
Fansidar vin nn 25 mg
CH KHI CH NH THUC

Thi k cho con b: Pyrimethamin qua c sa m v c th ko theo thiu
ht acid folic tr s sinh.
Thi k c thai: Nguy c thiu ht acid folic: cho b thm.
Suy thn: Do cc tc dng khng mong mun.
Thiu mu nguyn hng cu khng l. Tn thng nng nhu m gan.
Cn theo di: mc 1
Thiu glucose- 6- phosphat -dehydrogenase (G6PD): Nguy c tan mu.
Suy gan: Do chuyn ho gan.
TNG TC THUC

Acid folic hay dn cht
Phn tch: Cc thuc ny tc dng nh cht i khng vi acid folic, bng
cch c ch enzym dihydrofolat reductase. Tng tc ny cng c ngha hn
khi dng liu cao v iu tr ko di.
X l: Kim tra huyt u n v cho dng acid folinic nu cn, c
bit ngi bnh phi dng thuc khng acid folic liu cao hay di hn. cc
ngi bnh , nn b sung acid folinic.
Didanosin
Phn tch: S c mt ca citrat nh mt t dc ca thuc ung
didanosin ko theo gim hp thu pyrimethamin. iu ny c h qu lm gim
hiu lc ca pyrimethamin.
X l: K n pyrimethamin 2 gi trc khi cho dng didanosin hay 6 gi
sau.
664
Methotrexat; phenytoin;
zidovudin
natri valproat hay dn cht; trimethoprim;

dng hip ng ln enzym dihydrofolat reductase, c th dn n thiu mu
nguyn hng cu khng l.
thn trng huyt . C th b sung thm acid folinic.
Thuc li niu gi kali
Phn tch: Ch c triamteren trong nhm thuc li niu gi kali tc ng
nh mt cht i khng acid folic, do c ch enzym dihydrofolat reductase.
Tng tc ny cng c ngha hn, khi dng liu cao v ko di.
X l: Kim tra huyt v cho dng acid folinic nu cn, c bit
nhng ngi dng thuc khng acid folic liu cao v di hn. nhng ng i
bnh ny, nn cho dng thm acid folinic, c bit trong thi k mang thai.
QUINIDIN HOC DN CHT

Alcaloid ca quinquina, c dng do cc tnh cht chng lon nhp
(nhm 1a theo Vaughan - Williams)
CC THUC TRONG NHM

HYDROQUINIDIN vin nn 150 mg
Hydroquinidine vin nn 150 mg
QUINIDIN vin nn 250 mg
Quinidurule vin nn 250 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Ri lon dn truyn trong tht (ngoi trng hp cp cu cn c tnh) l mt
chng ch nh dng quinidin; mi bloc nhnh; qu mn vi quinidin; bloc nh-tht khng
c my h tr; mi bnh ca tm nh; ng c digitalis; cn xon nh vi ko di
khong QT.

Thi k cho con b: Do thn trng v thiu cc c liu.
Suy tim: Cc tai bin v nhp ch yu do quinidin (ngoi tm thu tht; nhp nhanh,
thm ch rung tht) khng ph thuc vo liu dng v gy ra nhng cn ngt n ng.
Cn thn trng nh vi mi thuc chng lon nhp, ngi suy tim.
665
Nhc c: Quinidin lm nng thm bloc thn kinh-c c sn ngi bnh b

nhc c, bng cch lm thay i p ng ca mng vi cc kch thch v lm nng
thm nhc c.
Bloc nhnh.
Thn trng: mc 2
Thi k mang thai: Quinidin, do c tc dng oxy ho c th gy thiu mu tan
mu ngi d mc v nht l tr s sinh. Khng nn dng ph n sp n k sinh
.
Cn theo di: mc 1
Suy gan: Quinidin c chuyn ho mnh gan thnh cc dn cht mt hot
tnh. Suy gan lm cho c tnh ca thuc th hin r.
Suy thn: Suy thn t nh hng n nng ca quinidin, l cht c bi tit
di dng chuyn ho mt hot tnh, nhng c th gy tng kali trong mu, lm tng
tc dng v c tnh ca thuc.
TNG TC THUC

Amiodaron; bepridil; bretylium; vincamin
Phn tch: Tng nguy c xon nh, bi tc dng hip ng. Gim kali
mu, nhp tim chm v khong QT di c sn (ch thy trn in tm ) l cc
yu t thun li cho xut hin xon nh.
X l: Chng ch nh v khng c k n phi hp c th gy t vong
ny.
Benzamid
Phn tch: Tng nguy c xon nh, bi hip ng cc tc dng in - sinh
l. Ch , ch mi c m t vi sultoprid (Barnetil ) trong h cc benzamid.
Gim kali mu, nhp tim chm v khong QT di sn c (ch thy trn in tm
) l cc yu t thun li cho xut hin xon nh.
X l: Chng ch nh v khng c k n phi hp sultoprid v quinidin
c th gy t vong ny.
Disopyramid
Phn tch: Phi hp hai thuc chng lon nhp cng nhm. Phi hp
khng hp l.
ny.
666
Flecainid hoc thuc tng t

Phn tch: Phi hp hai thuc chng lon nhp, mt thuc nhm 1c, thuc kia
thuc nhm 1a (c ch dn truyn trong tht). Khi phi hp, cn theo di in tm
u n, do c nguy c tng cc tc dng khng mong mun vi tim.
X l: Phi hp gia hai thuc chng lon nhp ny l vic ca bc s
chuyn khoa v ch thc hin km vi theo di in tm .
Phn tch: Tng tc ch mi c m t vi astemizol (Hismanal ), mt
khng histamin khng H1, c coi l khng an thn: tng nguy c xut hin
xon nh.
X l: Chng ch nh phi hp. Nn chn mt khng histamin khng an
thn khc khng gy xon nh(cetiridin, loratadin).
Macrolid
Phn tch: Tng nguy c xon nh bi tc dng hip ng, c m
t duy nht vi erythromycin tim tnh mch. H kali mu, nhp tim chm v
khong QT di c sn (ch nhn thy trn in tm ) l cc yu t thun l i
cho xut hin xon nh. Trong nhm macrolid ch c erythromycin, c bit l
dng tim tnh mch, c th dn n cc ri lon nhp tim (ko di qung QT,
ngoi tm thu tht, xon nh, bloc nh-tht).
ny. Ngay khi dng mt mnh, erythromycin tnh mch cng c th dn n ri
lon nhp tim. Khng nn tim c liu ngay mt lc m truyn tnh mch lin tc
hay gin on, thi gian cho mi ln truyn phi t nht 60 pht.
Phenothiazin (thioridazin)
Phn tch: Do hip ng tc dng ko di khong QT khi kt hp vi
quinidin, nguy c lon nhp nng c th gy t vong tng, k c xon nh.
X l: Chng ch nh thioridazin nhng bnh nhn iu tr vi thuc
chng lon nhp, c th l quinidin v nhiu thuc khc.
Ritonavir
P450, nn cnh tranh chuyn ho vi cc thuc b chuyn ho mnh bi cc
cytochrom P450. Nh vy c s tng nng trong huyt tng ca cc thuc
ny v nguy c tng c tnh ca chng. Nguy c lon nhp tim. Tng tc dc
X l: Khng k n phi hp ny. Ch n thay th thuc.
Sparfloxacin
X l: Nn trnh phi hp. Chn mt fluoroquinolon khc hoc mt thuc
khc, ty theo mc tiu iu tr. Nu phi hp tuyt i cn, th bt buc phi
667
theo di lm sng v in tm , c bit ch n ngi d mc nguy c v

c khong QT ko di.
Ziprasidone
Phn tch: Do tc dng hip ng trong ko di khong QT khi phi hp
vi quinidin, nguy c lon nhp nng c th gy t vong, bao gm c xon nh
tng ln.
X l: Chng ch nh ziprasidone ngi bnh iu tr vi thuc chng
lon nhp, trong c quinidin.

Corticoid khong; pentamidin
Phn tch: Nguy c xon nh khi c phi hp ny do hip ng cc tc
dng in - sinh l. H kali mu, nhp tim chm v khong QT di c (ch
nhn thy trn in tm ) l cc yu t thun li cho xut hin xon nh.
X l: Khng nn phi hp. Dng cc thuc khng dn n xon nh.
Nu cn phi hp, nn theo di lin tc (monitoring) khong QT v tin hnh
kim tra u n kali mu. Phi ch cc du hiu lm sng c th bo hi u
h kali mu nh: mt mi, yu c, co cng c.
Didanosin
Phn tch: Cc mui magnesi dng lm t dc trong cc dng thuc
ung didanosin lm gia tng nng quinidin trong huyt tng v nguy c qu
liu.
X l: Nu khng trnh c phi hp ny, iu chnh k hoch dng
thuc hoc xem li vic iu tr.
Dihydropyridin
Phn tch: Dihydropyridin lm gim lc co c (gy nhp tim chm) nn c
th dn n nhp tim chm qu mc khi phi hp vi quinidin.
X l: Khng nn dng quinidin trong vng 48 gi trc hay trong vng 24
gi sau khi dng thuc chn calci c cc tnh cht gim lc co c. Trng hp
c phi hp, phi theo di in tm .
Halofantrin; sotalol
Phn tch: Khi phi hp thuc, c nguy c xut hin xon nh, nht l khi
c h kali mu. H kali mu, nhp tim chm v khong QT di ( c trn i n
tm ) l cc yu t thun li cho xut hin xon nh.
X l: Nn trnh phi hp ny. Dng cc thuc khng dn n xon nh.
Nu cn phi hp, nn theo di lin tc (monitoring) khong QT v kim tra u
n kali mu. Ch cc du hiu lm sng c th bo hiu h kali mu nh
mt mi, yu c, co cng c.
668
Magnesi
Phn tch: Cc ch phm khng acid sn xut t magnesi hydroxyd c
th, do tc dng kim ho nc tiu, lm tng nng quinidin trong huyt
tng v dn n qu liu.
X l: Lu nguy c ny tu theo liu lng ca cc thuc. Nu cn, xem
xt mt chin lc iu tr khc. C th theo di pH nc tiu bng cc bng
giy th.
Propafenon
Phn tch: Dng phi hp vi quinidin, nng propafenon trong huyt
thanh tng ln, lm tng tc dng dc l ca propafenon. C ch c th
do quinidin c ch s hydroxyl ho propafenon gan qua xc tc ca cytochrom
P450.
X l: Nu phi kt hp hai thuc, cn theo di chc nng tim. C th
phi gim liu propafenon.
Succinylcholin
Phn tch: Phi hp vi quinidin, tc dng phong b thn kinh c ca
succinylcholin c ko di, do quinidin lm gim hot ca cholinesterase
trong huyt tng, v vy tc chuyn ho ca succinylcholin s chm li.
X l: Phi thn trng khi phi hp hai thuc ny.
Thuc chng nm azol-itraconazol
Phn tch: Khi kt hp vi itraconazol, nng quinidin trong huyt tng
tng, lm tng tc dng dc l v c tnh ca thuc ny. C ch c th do
itraconazol c ch s chuyn ho ca quinidin (cytochrom P450 3A4).
X l: Khi bt buc phi phi hp quinidin vi itraconazol phi theo di
cht ch nng quinidin trong huyt tng v p ng ca ngi bnh vi
quinidin trn lm sng khi bt u iu tr, khi ngng hoc khi thay i liu
lng itraconazol. Hiu chnh liu quinidin nu cn.
Phn tch: Mt s thuc khng acid (nh loi c cha natri bicarbonat) c
tnh cht kim ho nc tiu. Trong trng hp ny, vic o thi quinidin b
chm li, nn lm tng hiu qu. Trong mi trng kim, quinidin c bi tit
di dng khng ion ho v c ti hp thu. Nh vy, trong trng hp ny,
ty theo pH, c nguy c tng nng quinidin trong huyt tng v qu liu.
X l: Trong mt s trng hp tr liu, cn theo di pH nc tiu. C th
o pH ny bng cc bng giy th kim tra tnh acid hoc kim ca nc
tiu. Trong trng hp nc tiu kim, theo di in tm v nng quinidin
trong huyt thanh, iu chnh liu dng ty theo kt qu xt nghim, trong khi v
khi ngng iu tr bng thuc lm kim nc tiu. Cc thuc khng acid, c th
lm thay i pH nc tiu thnh kim nhng tng tc t hn, do s kim ho
thng khng . D sao vn cn theo di phi hp.
669

Amphotericin B
Phn tch: Nguy c xon nh khi phi hp vi amphotericin B bng ng
tim. H kali mu, nhp tim chm v khong QT di c sn (ch thy trn in
tm ) l cc yu t thun li cho xut hin xon nh.
X l: Nu cn phi hp amphotericin tim vi quinidin, nn phng h
kali mu bng tng cng theo di ngi bnh v kim tra in tm . Trng
hp xut hin xon nh, khng dng thuc chng lon nhp (quinidin). Khuyn
ngi bnh t theo di , nu thy mi mt, yu c, ngay c chut rt th phi
gp li bc s iu tr.
Phn tch: Tng chuyn ho quinidin gan, do cm ng enzym, ko theo
gim hot tnh ca quinidin (v cc dn cht). iu chnh liu dng. Nu cn,
theo di thn trng nng trong huyt tng v vn phi cnh gic khi ngng
iu tr.
X l: Lu nguy c ny iu chnh liu dng ca hai thuc nu phi
hp ny t ra cn thit. Ch n gim tnh to ngi li xe v vn hnh
my. Khuyn khng ung ru.
Dextropropoxyphen
Phn tch: Tc dng h huyt p nh ca dextropropoxyphen lm cho khi
phi hp vi cc thuc h huyt p khc s lm tng tc dng h huyt p v
tng nguy c h huyt p th ng.
X l: Cn theo di huyt p trong khi phi hp (trong v sau khi ng ng
mt trong hai thuc). Tu theo loi thuc, h huyt p c th nng hay nh. Lp
mt chng trnh ung thuc u n. Tng cng theo di khi s dng
ngi bnh cao tui (nguy c b ng).
Phn tch: Nguy c xut hin xon nh khi phi hp mt thuc li niu
thi kali vi mt thuc chng lon nhp nhm 1 theo Vaughan Williams, nht l
khi c gim kali mu, nhp tim chm v khong QT ko di
X l: Nu cn phi hp, phi phng gim kali mu bng cch b sung
kali da trn tnh ton v theo di in tm . Khi xut hin xon nh, phi
ngng thuc chng lon nhp.
Glycosid tr tim
Phn tch: Cc tng tc dc ng hc v dc lc hc khi kt hp vi
digoxin: 1/Nguy c tng nng digoxin trong huyt tng do gim thanh lc
thn. 2/Kh nng xut hin ri lon tnh t ng ca tim (nhp tim chm) v ri
lon dn truyn nh tht.
670
X l: Phi theo di lm sng, v nu cn, thc hin in tm . iu

chnh liu dng theo nng digoxin trong mu trong v khi ngng iu tr
quinidin hay hydroquinidin.
Phn tch: Nguy c xut hin xon nh khi phi hp mt thuc h kali
mu v mt thuc chng lon nhp nhm 1 theo phn loi Vaughan Williams,
nht l khi c gim kali mu, nhp tim chm v khong QT ko di.
X l: Nu cn phi hp gia cc glucocorticoid v ch phm ny, d
phng h kali mu bng vic b kali c tnh ton v lm in tm . Nu xut
hin cn xon nh, khng dng thuc chng lon nhp. Khuyn ngi bnh t
theo di, nu thy mt mi, yu c, thm ch co cng c th phi gp li bc s
iu tr.
Lidocain hoc thuc tng t; mexiletin
.
Phn tch: Nguy c xut hin xon nh. Ko di khong QT in tm
X l: S phi hp ny phi c theo di c bit (in tm ). Ni

chung, phi trnh phi hp vi cc thuc chng lon nhp nhm 1 theo
Vaughan- Williams, do vic ko di thi hn dn truyn tim.
Phn tch: Tng cc tnh cht khng cholinergic, do hip ng cc tc dng
khng mong mun. Biu hin bng tng nguy c b i, kh ming v to bn.
X l: Phi ch n cc tc dng khng mong mun . Nu cn phi
hp, phi bo cho ngi bnh bit cc tc dng ph ny. Trnh dng cho ngi
b ph i tuyn tin lit v bnh tng nhn p.
Khng histamin khng H2 chng lot d dy kiu cimetidin
Phn tch: Cimetidin l cht c ch enzym. c bit, cimetidin c ch
oxydase gan (cytochrom P450) cn cho chuyn ho mt s thuc (quinidin).
Ngoi ra, cimetidin lm gim lu lng mu gan. Cho nn, nng trong
huyt tng ca mt s thuc (quinidin) tng ln (nguy c qu liu). Ngoi ra,
khi c ch chuyn ho, cimetidin cn ngn cn c ch kh c.
X l: Quinidin l thuc c phm vi iu tr hp, khi chuyn ho ca
quinidin b c ch s dn n nguy c qu liu. Do vy phi thay thuc chng
lot, hoc l iu chnh liu lc u, trong v sau khi iu tr quinidin ty theo
nng quinidin trong mu v/hoc tu theo cc du hin qa liu xut hin.
Trong y vn, liu quinidin c xut: gim 25% liu ung v 35% liu tim
tnh mch. Cc du hiu qu liu quinidin gm ri lon tiu ho, ri lon thn
kinh gic quan, vt v, ngng th, h huyt p.
Reserpin
Phn tch: Nguy c lon nhp.
X l: Tng tc ny c th xy ra theo dc l hc, nhng khng c
m t v lm sng. Phi thn trng v cn bo cho Trung tm cnh gic thuc
671
nu thy bt thng. Tng tc thy vi liu di mc bnh thng. Cn

c khng nh thm.
Thuc chn beta
Phn tch: Lm mt c ch b ca thn kinh giao cm v lm tng tc
dng ca cc thuc chn beta (ngay c dng thuc nh mt), nh lm gim
tn s tim v lm gim dn truyn ca tim.
X l: Cn theo di in tm .
Thuc cholinergic (thuc cng ph giao cm)
Phn tch: Tnh cht khng cholinergic ca quinidin ngn cn tc dng
cholinergic mong mun.
X l: Phi ch n nguy c iu tr tht bi hoc km hiu qu nu
mc ch chnh ca iu tr i hi phi dng thuc cng ph giao cm.
Thuc ch vn morphin
ng.
X l: Theo di huyt p trong qu trnh phi hp. Tu theo thuc dng, h

huyt p c th t hoc nhiu. iu chnh liu dng ca mt hay hai thuc, tu
theo trng hp. Khuyn ngi bnh nu thy chng mt khi bt u iu tr,
nn gp li bc s iu chnh liu dng ca mt hay hai thuc, nn cn. Xy
dng mt k hoch dng thuc u n. Tng cng theo di ngi bnh
cao tui (nguy c ng) v khuyn h khi t th nm hay ngi chuyn sang t
th ng phi t t.
X l: Cn iu chnh liu ca thuc gin mch chng tng huyt p, thit
lp mt chng trnh ung thuc v phi nhn mnh ngi bnh phi tun th
iu tr. Khi bt u iu tr, khuyn ngi bnh phi o huyt p u n cho
ti khi t c huyt p n nh.
Thuc kim ha nc tiu
Phn tch: Trong mi trng acid, phn ln quinidin c bi tit bi thn
di dng ion ho. Trong mi trng kim, quinidin c bi tit di dng
khng ion ho v b ti hp thu. Trong trng hp sau, nh vy s c nguy c
tng nng quinidin trong huyt tng v qu liu, ty theo pH.
X l: Trong mt s trng hp iu tr, nn theo di pH nc tiu. C th
dng cc bng giy th pH kim tra acid hay kim ca nc tiu. Nu
nc tiu kim, theo di in tm v nng quinidin trong huyt thanh,
iu chnh liu dng theo kt qu, trong v sau khi iu tr bng thuc lm kim
nc tiu. Cc thuc khng acid c th lm thay i pH, do kim ho nc tiu;
trong trng hp ny, tng tc t hn do vic kim ho thng khng . D
sao, vn phi theo di phi hp.
672
Thuc loi cura

Phn tch: Tng nguy c lit h hp do cura cc loi.
X l: Khi gy m, tng tc ny c th gii quyt bng thng kh t ng.
Theo di hu phu cn thn, ty theo c kt hp hai thuc ny khng.
Thuc li niu thi kali

Phn tch: Nguy c xut hin xon nh (ri lon nhp tht) khi phi hp
mt thuc li niu thi kali vi mt thuc chng lon nhp, nht l khi c gim
kali mu, nhp tim chm v khong QT ko di.
X l: Nu cn phi hp, phi phng h kali mu bng cch b sung
kali da trn tnh ton v bng theo di in tm . Khi xon nh xut hi n,
phi ngng thuc chng lon nhp.
Phn tch: Cc thuc nhun trng lm trn c th v lu di dn n h
kali mu v nh vy, lm tng nguy c xut hin xon nh khi phi hp v i
quinidin. H kali mu, nhp tim chm v khong QT di (in tm ) l cc yu
t thun li cho s xut hin xon nh.
X l: Cn theo di s phi hp ny. Nn ngng thuc nhun trng hoc
dng cc thuc khng dn n xon nh. Khuyn thay thuc nhun trng bng
gii php ch n ung. Nu khng, ch n cc du hiu lm sng c th
bo trc h kali mu nh ri lon nhp tim, mt, yu c, co cng c.
Thuc nhun trng lm mm; thuc nhun trng nhy v thm thu
Phn tch: Dng di hn thuc nhun trng c th dn n h kali mu.
Nguy c xut hin xon nh.
X l: D nguy c ny t xy ra, vn nn bit d phng.
Phn tch: Nguy c xut hin xon nh khi phi hp mt thuc gy h
kali mu vi mt thuc chng lon nhp nhm 1 theo Vaughan Williams. H
kali mu, nhp tim chm v khong QT di c sn (in tm ) l cc yu t
thun li cho xut hin xon nh.
X l: Nu cn phi hp gia thuc nhun trng kch thch v thuc chng
lon nhp, phng h kali mu bng b kali c tnh ton v thc hin in tm
. Nu xut hin xon nh, khng dng thuc chng lon nhp. Khuyn ngi
bnh t theo di, nu thy mt mi, yu c, thm ch co cng c th phi gp
li thy thuc iu tr. Khuyn h b kali bng thc phm (chui, mn...)
673

Phn tch: C kh nng tng hiu lc ca cc thuc khng vitamin K, do
gim tng hp gan mt s yu t ng mu, nhng cng do tng i lc cc
th th vi thuc khng vitamin K.
X l: Nu cn phi hp, theo di t l prothrombin v/hoc t l chun
ho quc t, lc bt u, trong v sau khi iu tr bng quinidin. iu chnh liu
dng tu theo trng hp.
Verapamil
Phn tch: Tng tc dc ng hc: verapamil l mt cht c ch mt
s cytochrom P450 v c th ko theo tng nng quinidin trong huyt thanh
vi kh nng gy nhim c.
X l: Phi ch n tng tc dc ng hc ny, nn theo di cn thn
nng trong huyt thanh ca quinidin, l mt thuc c phm vi iu tr hp.

Saquinavir
Phn tch: Do cnh tranh khu cc cytochrom P 450, saquinavirc th lm
gim chuyn ho thuc phi hp (quinidin), nn lm tng nng quinidin trong
huyt tng v c tnh.
X l: Theo di cht ngi bnh v triu chng nhim c.
Thuc khng cholinergic; thuc chng trm cm ba vng hoc thuc
tng t
Phn tch: Tng cc tnh cht khng cholinergic, do hip ng cc tc
dng khng mong mun. Cc tc dng ny biu hin bng tng nguy c b i,
kh ming v to bn.
X l: Cn lu n tc dng ph ca loi thuc ny. Nu cn phi hp,
bo cho ngi bnh bit cc tc dng ph . Trnh dng cho ng i b bnh
tuyn tin lit v bnh tng nhn p.
QUININ HOC THUC TNG T

Alcaloid ca quinquina, c dng v cc tnh cht chng st rt v h st
CC THUC TRONG NHM

MEFLOQUIN vin nn 250 mg
Lariam vin nn 250 mg
QUININ ETYLCARBONAT gi thuc bt
674
Euquimol gi thuc bt
Mequinol gi thuc bt
QUININ HYDROCHLORID ng tim 25 %; 0,5 g
Quinoserum ng tim 0,5 g
Quinin dihydrochlorid ng tim 25 %
QUININ SULFAT nang 250 mg; vin bao
Analgin quinin vin bao
Quinin sulfat nang 250 mg
Mekoquinin nang
CH KHI CH NH THUC
Chng ch nh: mc 4
Ri lon dn truyn tm tht, qu mn cm vi thuc.

Thiu ht glucose 6 phosphat deshydrogenase (G6PD): Quinin gy thiu mu
tan mu ngi thiu G6PD hng cu.
Nhc c: Nguy c nng thm chng nhc c, do tng chn thn kinh- c.
Thn trng: mc 2
Thi k cho con b: t qua c sa m.
Thi k c thai: Vi liu cao (mc ch lm xy thai), c nguy c i vi s pht
trin ca thai. c thng bo gim tiu cu thai nhi v ngi m, khi dng vo cui
thai k. Cc d dng v mt v tai gp c l khng lin quan n quinin (khng c
tng quan v tn s vi cc vng c st rt).
Bnh v mu: Nguy c ban xut huyt, gim tiu cu.
Cn theo di : mc 1
Suy h hp; hen: c bit trong bnh hen.
TNG TC THUC

Phn tch: Nguy c xut hin cc ri lon nhp tht v c bit xon nh,
do cng thm cc tc dng in sinh l. Tng tc dc lc hc.
675
Natri valproat hay dn cht

Phn tch: Gim na i ca valproat, km nguy c xut hin co git khi
phi hp vi mefloquin (Lariam).
X l: Chng ch nh phi hp ny. Thay i cch iu tr.

Digoxin
Phn tch: Quinin lm tng nng ca digoxin trong huyt thanh, do
c tnh ca thuc tng. C ch l quinin lm gim thanh lc ca digoxin
qua mt.
X l: Theo di s tng nng digoxin trong huyt thanh v s xut hin
cc du hiu nhim c digoxin ngi bnh. C th phi gim liu digoxin
nu cn thit.
Succinylcholin
Phn tch: Quinin lm tng thi gian phong b thn kinh-c do
succinylcholin gy ra. C ch l quinin lm gim hot cholinesterase trong
huyt tng, lm cho tc chuyn ho succinylcholin gim.
X l: Phi rt thn trng khi dng phi hp thuc ny.
Phn tch: Quinin lm tng tc dng ca cc thuc gy th doi c khng
kh cc, c th do hip ng cc tc dng dc l.
X l: Cn theo di lin tc chc nng thn kinh-c khi dng phi hp
thuc ny, v dng bin php h tr h hp bng my t ng nu cn.
Vng
Phn tch: Nguy c tng tn hi cc dng t bo mu (suy ty).
hp.
X l: Cn theo di v huyt hc nhng ngi bnh c nguy c khi phi

Amphotericin B
Phn tch: Phi hp amphotericin B tim vi cc thuc khc c vi ty i
hi ht sc thn trng. Nguy c thiu mu hay cc ri lon khc v huyt hc.
X l: Trong iu kin cn phi hp, nn theo di cht ch huyt v
nu cn, tin hnh gim liu.
Phenicol
Phn tch: Nguy c lm tn hi thm cc dng t bo mu (suy ty).
X l: Phi hp cn c theo di v huyt ngi bnh c nguy c.
676
Thuc chng ng mu
Phn tch: Quinin c th lm h prothrombin mu, c th tng thm tc
dng chng ng mu ca heparin v nhiu thuc khc nh warfarin. Quinin
cn c ch sinh tng hp cc yu t ng mu gan.
X l: C th b sung vitamin K cho ngi bnh. Tng cng theo di sinh
hc v nu cn, iu chnh liu dng ca thuc chng ng mu trong v sau khi
iu tr bng quinin. Bo cho y t v nguy c i vi dng thuc tim.
Rifampicin
Phn tch: Tng chuyn ho gan do cm ng enzym ko theo gim hot
tnh ca quinin (v thuc tng t). iu chnh liu dng. Theo di cn thn cc
nng trong huyt tng nu cn v hy cnh gic khi ngng iu tr.
phi hp.

Thuc chn beta
Phn tch: V nguy c nhp tim chm ( c thng bo vi mefloquin).
X l: Nu cn phi hp, nn cn nhc tng quan nguy c/li ch
ngi b tng huyt p hay au tht ngc. Nu dng thuc chn beta ln u,
nn chn mt thuc chn beta c hot tnh cng giao cm ni ti. Vic dng
mefloquin thng l tm thi. Bo cho ngi bnh v nguy c, c bit l ngi
bnh cao tui. Phi theo di u n ngi bnh.
QUINOLON
Khng sinh dit khun. Sparfloxacin l mt fluoroquinolon,
thuc mt nhm ring
CC THUC TRONG NHM

ACID NALIDIXIC vin nn 500 mg; 1g
Naligram vin nn 500 mg
Negram forte vin nn 1g
Nevamycin vin nn 500 mg
Urodic vin nn 500 mg
CINOXACIN vin nn bao 500 mg
Cinoxacin Denk 500 vin nn bao 500 mg
677
CIPROFLOXACIN vin nn 250 mg; 500 mg; 750 mg; dung dch tim 100 mg/50
mL; dung dch nh mt 0,3%x 5mL; vin nn bao 250 mg
C-Flox vin nn 500 mg
Ciprobay vin nn 250 mg; 500 mg; 750 mg
Ciplox 500 vin nn 500 mg
Ciproquin vin nn 500 mg
Ciprobay dung dch tim 100 mg/50 mL
Ciplox dung dch nh mt 0,3% x 5mL
Lyproquin vin nn 250 mg; 500 mg
Opecipro vin nn bao 250 mg
Sepratis vin nn bao 500 mg
FLUMEQUIN vin nn 400 mg
Apurone vin nn 400 mg
NORFLOXACIN vin nn 400 mg; 800 mg; vin nn bao phim 400 mg; dung dch
nh mt 0,3%
Anquin vin nn 400 mg ; 800 mg
Chibroxin dung dch nh mt 0,3% x 5mL
Negaflox vin nn bao phim 400 mg
Norbactin dung dch nh mt 3 mg/mL x 5 mL
Quinolox vin nn 400 mg
Urobacid vin nn 400 mg
OMEFLOXACIN vin nn 400 mg; dung dch nh mt 3 mg/ mL
Lomaday vin nn 400 mg
Okacin dung dch nh mt 3 mg/mL x 5 mL
OFLOXACIN vin nn 100 mg; 200 mg; dch truyn 200 mg/100mL; dung dch
nh mt 3 mg/mL x 10 mL; m tra mt 3 mg/g; vin bao 200 mg
Cilox vin bao phim 200 mg
Effexin vin nn 200 mg
Oflocet vin bao 200 mg
Oflocet dung dch tim truyn 200 mg/100 mL
Oflocet vin nn 200 mg
Ofus vin nn 200 mg
Oflovid m tra mt 3mg/g; dung dch nh mt 3 mg/mL
Sudo-Ofloxacin vin nn 200 mg
678
Zanocin vin nn 100 mg; 200 mg; dch truyn 200 mg/100mL; dung d ch
nh mt 3 mg/mL x 10 mL
PEFLOXACIN vin nn 400 mg ; dung dch tim 400 mg/125 mL ; 400 mg/5mL ;
400 mg/100 mL; vin nn bao phim 400 mg
Peflacine vin nn 400 mg
Peflacine dung dch tim 400 mg/125 mL ; 400 mg/5mL
Peflacine monodose vin nn bao phim 400 mg
Pelox 400 dung dch tim 400 mg/100 mL
Peflox 400 vin nn 400 mg
CH KHI CH NH THUC
Cn nhc cc nguy c/li ch: mc 3

Thi k cho con b: Cc quinolon qua c sa m.
Thiu ht glucose- 6- phosphat deshydrogenase (G6PD): Cc quinolon gy ra
cc cn tan mu cp, trong trng hp thiu G6PD hng cu.
Tr em tr cn b : S cha trng thnh ca gan tr cn b, dn n
chm bt hot, do cha to c lin hp glucuronic. Thm na, cc tn thng vnh
vin sn tip hp c m t.
Thi k mang thai: Khng c dng cc quinolon cho ph n mang thai ti k
sinh (c th xy ra tr s sinh nhim acid chuyn ho nng sau khi ngi m
c iu tr vi acid nalidixic). Do khng chng minh c tc dng ca cc quinolon
ch gii hn ADN vi khun, phi trnh dng nhng thuc ny trong 3 thng u thai
k.
Trng hp khc: Qu mn vi quinolon; tin s bnh gan vi mt
fluoroquinolon.
Cn theo di: mc 1
ng kinh: Acid nalidixic c th gy co git.
Suy gan: Do chm bt hot.
Suy thn: Do quinolon thi ch yu qua thn.
TNG TC THUC

Didanosin
Phn tch: Nguy c gim hiu qu, c bit m t vi cc
fluoroquinolon sau y: ciprofloxacin v ofloxacin. Qua cc hin tng to phc
trong ng tiu ho gia cc fluoroquinolon v cc ion magnesi v nhm c trong
cc t dc dng thuc ung didanosin, nn c s gim nng trong huyt
tng ca ciprofloxacin v ofloxacin.
679
gi.
X l: Dng cc fluoroquinolon trc khi ung didanosin 2 gi hoc sau 6
St
Phn tch: Cc quinolon ni chung v cc fluoroquinolon ni ring dng
ng ung, to phc vi cc cation ho tr 2 hay 3 nh nhm, magnesi, calci,
st v km. Nht thit phi tn trng khong cch hn 2 gi gia cc ln dng
hai thuc. Cn theo di.
X l: Tng tc phi lu v khuyn ngi bnh gi khong cch ung
gia hai thuc t nht 2 gi.
Sucralfat
Phn tch: Gim hp thu c m t vi ciprofloxacin, norfloxacin v
lomefloxacin khi phi hp vi sucralfat.
X l: Khuyn ngi bnh tn trng khong cch 2 gi gia cc ln ung
hai thuc.
Theophylin hoc cc dn cht
Phn tch: Tng na i ca theophylin, c th do c ch cnh tranh v
tr gn trn cytochrom P450 (c bit vi ciprofloxacin, enoxacin, norfloxacin v
pefloxacin). Tng nng cc thuc trn trong huyt thanh v tng c tnh
thn kinh ca xanthin.
X l: Theo di lm sng v iu chnh liu dng ty theo nng
theophylin trong huyt thanh, trong v sau khi ngng iu tr quinolon. Cng c
th tu theo nguy c qu liu theophylin m thay i chin lc iu tr khng
sinh.
Phn tch: Cc quinolon ni chung v cc fluoroquinolon ni ring, s dng
bng ng ung, to phc vi cc cation ho tr 2 v 3 nh nhm, magnesi,
calci, st v km.
X l: Phi ung hai thuc cch nhau t nht 2 gi. Cn nhc li l cc
khng acid thng c dng sau khi n 1 gi 30 pht, v thc n l ngun gc
tng tit dch v.
Phn tch: Do lin kt mnh vi protein huyt tng, quinolon c th y
cc thuc khng vitamin K khi v tr lin kt vi protein huyt tng, c bit
vi acenocoumarol (Sintrom). Nguy c chy mu.
X l: Theo di nng prothrombin hay t l chun ho quc t INR v
iu chnh liu dng thuc ung chng ng mu lc bt u, trong v 8 ngy
sau khi ngng iu tr quinolon.
Thc n (sa)
Phn tch: Lm gim tc dng dc l ca quinolon. Tng tc nhanh. C
ch lm gim hp thu quinolon
680
X l: Nu khng th trnh ung sa c, th nn ko di khong cch

gia ung sa v quinolon cng xa cng tt.
Tng tc cn theo di vi mc 1
Cafein
Phn tch: Chuyn ho cafein gan v thanh lc cafein c th b gim
(gim d ho cafein), nh vy lm tng nguy c kch thch h thn kinh trung
ng.
X l: Tng tc ny c m t, vi mc khc nhau, mt mt vi
enoxacin v acid pipemidic (phi hp cn trnh), mt khc vi ciprofloxacin v
norfloxacin (cn theo di). Hi ngi bnh v mc ung c ph v ty theo m
khuyn h gim, thm ch ngng dng trong khi iu tr bng cc fluoroquinolon.
RANITIDIN
Thuc chng lot khng H2, thuc khng histamin chn cc th th H2 dng lm
thuc chng lot d dy t trng. Cn ch n tc dng c ch monooxygenase gan
(cytochrom P450), nht l vi cc dng thuc c hm lng cao
CC THUC TRONG NHM

RANITIDIN vin nn 150 mg; 300 mg; vin nn si 150 mg; ng tim 50 mg/2mL;
vin nn bao 150 mg
Aciloc vin nn 150 mg v 300 mg
Dudine vin nn bao 150 mg
Histac vin nn si 150 mg
Lykalydin vin nn 150 mg v 300 mg
Ranitidin vin nn 150 mg
Rantac vin nn 150 mg
Ranitidin ng tim 50 mg/2mL
Zantac vin nn 150 mg
Zantac ng tim 50 mg/2mL
Zoran vin nn bao 150 mg
FAMOTIDIN vin nn 20 mg; 40 mg
Apo- Famotidine vin nn 20 mg
Fadin40 vin nn 40 mg
Gasmodin vin nn bao 40 mg
681
Famonit vin nn 40 mg
Medofadin vin nn bao 40mg
Pepcidine vin nn 20 mg; 40 mg
Quamatel vin nn 20 mg; 40 mg; bt pha tim 20 mg/l
Topcid vin nn bao 20 mg
Topcid vin nn bao 40 mg
NIZATIDIN nang 150 mg; 300 mg
Axid nang 150 mg; 300 mg
Zastidin nang 150 mg; 300 mg
CH KHI CH NH THUC

Thi k cho con b: Ranitidin v famotidin qua c sa m.
Thi k mang thai: Cng nh i vi tt c cc thuc tng i mi, khuyn
khng nn k n ranitidin v famotidin cho ngi mang thai v khng c c liu.
Cn theo di: mc 1
Tr em: Ranitidin dng tr em cha lu rt c kinh nghim.
Suy tim: Nhp tim chm (tuy rt him) c m t.
Suy gan: Tng tm thi aminotransferase (transaminase) c m t.
Suy thn: iu chnh liu ty thuc nng creatinin trong mu, v ranitidin c
o thi ch yu qua thn di dng khng thay i.
Ngi bnh cao tui: ngi bnh cao tui, cc nguy c ri lon tim (nhp tim
chm) gp ph bin hn.
TNG TC THUC

Pentagastrin
Phn tch: Tc dng dc l i khng gia pentagastrin vi cc khng H2.
X l: Khuyn ngi bnh ung pentagastrin 24 gi cch thuc khng H2.

Phn tch: Thuc khng acid lm gim hp thu ng tiu ho, nn gim
tc dng ca thuc c phi hp.
X l: Nht thit phi c mt khong cch t nht 1 n 2 gi gia ln ung
thuc khng acid v ln ung thuc chng lot d dy. Thuc khng acid thng
682
c ung 1 gi 30 pht sau cc ba n, khi n ung l nguyn nhn tng ti t

dch v.

Thuc chng nm dn xut ca imidazol
Phn tch: Gim tc dng, c bit vi ketoconazol. Tng pH d dy - rut c
th dn n gim hp thu ketoconazol, v vy gim tc dng ca thuc ny.
X l: Cn thng bo cho ngi bnh, phi ung thuc chng nm cch
thuc khng H2 2 gi.
RIFABUTIN
Rifabutin l khng sinh thuc nhm rifamycin, c bit tc dng trn
Mycobacterium khng in hnh, nh Mycobacterium avium complex. Dng lm thuc
iu tr lao
trong cc trng hp lao khng rifampicin, v thuc d phng cho cc ngi
bnh AIDS, trnh ly nhim Mycobacterium khng in hnh
CC THUC TRONG NHM

RIFABUTIN nang 150 mg
Ansatipine nang 150 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Suy thn: Gim o thi cht ny.
Suy gan: Chng ch nh dng cc rifamycin khi suy gan, hay tc ng dn mt.
Cc trng hp khc: Qu mn vi cc rifamycin, c bit vi rifampicin.

Thi k mang thai, cho con b: thn trng, v l thuc mi, cha c d liu
trong y vn.
Lon chuyn ho porphyrin: Rifamycin gy ra tng t kch pht lon chuyn
ho porphyrin nhng ngi bnh c t bm.
TNG TC THUC
683
Cn nhc nguy c/ li ch : mc 3
Amprenavir
Phn tch: Trong nhm rifamycin, th rifampin lm gim nng amprenavir
trong huyt tng, lm gim tc dng dc l ca thuc. C ch do rifampin lm
tng s chuyn ho ca amprenavir thng qua CYP 3A4. Ngc li, amprenavir li
lm tng nng mt s rifamycin trong huyt tng (nh rifabutin), lm tng cc
tc dng ph. C ch do amprenavir lm gim s chuyn ho ca rifabutin
(CYP3A4).
X l: Trnh dng ng thi amprenavir vi rifampin. Nu dng ng thi
amprenavir vi rifabutin, phi theo di cn thn ngi bnh pht hin nhng
tc dng ph, v gim liu rifabutin nu cn.
Benzodiazepin
Phn tch: Khi kt hp vi rifabutin, hay ni chung vi cc thuc nhm
rifamycin, tc dng dc l ca nhiu benzodiazepin b gim, do s chuyn ho
oxy ho thng qua xc tc cytochrom P450 ca cc benzodiazepin tng.
X l: Theo di p ng vi liu php benzodiazepin ngi bnh khi bt
u v khi ngng dng rifamycin. Hiu chnh liu nu cn. Nu iu kin cho
php, chn loi thuc benzodiazepin khng b oxy ho (nh temazepam) thay
th.
Buspiron
Phn tch: Dng kt hp vi rifamycin, nng buspiron trong huyt tng
s gim, ko theo gim tc dng dc l, do rifamycin gy cm ng s chuyn
ho ca buspiron thng qua CYP3A4.
X l: ngi bnh iu tr vi buspiron, phi theo di cht ch ngi bnh
khi bt u dng thm, khi ngng dng, v khi thay i liu dng rifamycin. Hi u
chnh liu ca buspiron khi cn.
Cc dn cht quinin
Phn tch: Khi kt hp vi rifamycin, s chuyn ho ca cc dn cht ca
quinin tng, ko theo gim tc dng iu tr. C ch: cc rifamycin l nhng cht
cm ng mnh cc enzym ca microsom gan, lm tng s thanh lc quinin v
dn cht. Cm ng enzym c th tn ti nhiu ngy sau khi ngng rifamycin.
X l: ngi bnh c hiu qu n nh trong iu tr bng cc dn
cht quinin, khi thm rifamycin, th c th phi tng liu cc dn cht quinin mi
gi c hiu qu iu tr mong mun. Khi ngng rifamycin, c th hin c tnh
ca dn cht quinin. Theo di nng quinin trong huyt thanh v in tm .
Corticosteroid
Phn tch: Khi kt hp vi rifabuin, hay ni chung vi cc thuc nhm
rifamycin, tc dng dc l ca cc corticoid c th gim v khng kim sot
c bnh. iu ny xy ra sau khi dng rifabutin c vi ngy. C ch: l do
rifamycin lm tng chuyn ho corticosteroid gan. Cc nghin cu dc ng
hc cho thy s thanh lc prednisolon tng ln r rt.
684
X l: Trnh kt hp thuc ny. Nu bt buc phi dng kt hp thuc,

phi tng liu corticosteroid sau khi dng thm rifamycin.
Delavirdin
Phn tch: Rifamycin nh hng ln dc ng hc ca thuc khng virus.
delavirdin lm tng cng s chuyn ho gan (gy cm ng CYP3A4), nn nng
delavirdin huyt tng b gim i.
X l: Khng dng ng thi delavirdin vi rifamycin.
Doxycyclin
Phn tch: Rifamycin lm tng s chuyn ho doxycyclin gan, lm gim
nng trong huyt tng, ko theo lm gim hiu qu iu tr.
X l: Theo di p ng ca ngi bnh vi thuc. Nu cn, tng liu
doxycyclin.
Phn tch: Tng chuyn ho cc estroprogestogen gan, do cm ng
enzym, nn c nguy c th thai.
X l: Trnh dng thuc nga thai liu lng thp v nu cn chn cc
thuc nga thai liu lng cao, hay tt hn nn dng mt bi n php ng a thai
khc, nu iu tr vi rifabutin di ngy. Cn nh, cm ng enzym khng bao gi
l phn ng tc th.
Haloperidol
Phn tch: Rifamycin c th lm gim nng haloperidol trong huyt tng
v lm gim hiu qu iu tr ca thuc ny. C ch c th do cm ng
enzym gy tng cng s chuyn ho ca haloperidol.
X l: Vi ngi bnh ang dng haloperidol, nu dng thm, ngng dng
rifamycin, th phi theo di cht ch p ng ca h vi thuc. Hiu chnh li u
ca haloperidol khi cn.
Hydantoin
Phn tch: Rifamycin gy cm ng enzym microsom gan chu trch nhim
chuyn ho hydantoin, nn nng hydantoin trong huyt thanh gim, ko theo
gim tc dng dc l.
X l: Theo di thng xuyn nng hydantoin trong huyt thanh v theo
di ngi bnh v cc du hiu gim hiu qu ca thuc khi dng thm
rifamycin, theo di s xut hin c tnh ca hydantoin khi ngng dng rifamycin.
Nu cn, phi hiu chnh liu hydantoin.
Lamotrigin
Phn tch: Rifamycin c th gy cm ng h enzym gan xc tc cho qu
trnh lin hp lamotrigin vi acid glucuronic, lm nng thuc trong huyt tng
b gim, lm gim tc dng dc l.
685
X l: Nu cn, phi hiu chnh liu lng lamotrigin khi bt u dng, khi
ngng dng hay khi thay i liu dng rifamycin. Cng cn ch n p ng
lm sng ca ngi bnh hiu chnh liu.
Morphin
Phn tch: Khi kt hp vi rifamycin, tc dng gim au ca morphin c th
gim i. C ch cha r.
X l: Theo di p ng ca ngi bnh vi morphin. Nu cn, dng mt
thuc gim au khc thay th morphin.
Ondansetron
Phn tch: Khi dng cng vi rifamycin, nng ondansetron trong huyt
tng c th b gim i, lm gim tc dng chng nn ca thuc. C th l
rifamycin gy cm ng CYP3A4 gan c chc nng xc tc s chuyn ho ca
ondansetron.
X l: Nu nghi ng c tng tc thuc, thay ondansetron bng mt thuc
chng nn khc.
686

Phn tch: Tng chuyn ho cc thuc nga thai progestogen gan, do
cm ng enzym, nn c nguy c th thai.
X l: Trnh dng thuc nga thai liu lng thp, v nn dng thuc nga
thai liu lng cao, hoc khuyn nn dng mt bin php ng a thai khc, n u
vic iu tr vi cht cm ng enzym ko di. Cn nh, cm ng enzym khng
bao gi l phn ng tc th.
Propafenon
Phn tch: Rifamycin gy cm ng h enzym microsom gan chu trch
nhim chuyn ho propafenon, lm tng s thanh lc v lm gim nng ca
propafenon trong huyt tng, ko theo gim hiu qu iu tr.
X l: Vi ngi bnh t n nh trong iu tr vi propafenon, khng
nn dng rifamycin, m thay bng mt thuc khng khun khc. Nu khng th
thay th c, phi theo di nng propafenon trong huyt tng, v theo di
ngi bnh xem hiu qu iu tr c gim i khng. Nu cn, phi hiu chnh liu
propafenon.
Repaglinid
Phn tch: Rifamycin gy cm ng lm tng chuyn ho ca repaglinid
thng qua cytochrom P450, lm tng nng ca thuc trong huyt tng, ko
theo l gim tc dng dc l.
X l: Vi ngi bnh ang dng repaglinid, phi theo di cht ch nng
glucose mu khi bt u dng thm, khi ngng dng rifamycin. Hiu chnh li u
repaglinid khi cn.
Ritonavir
Phn tch: Rifabutin l cht cm ng enzym mnh, nn lm tng rt mnh
chuyn ho ritonavir thng qua isoenzym 3A4 ca cytochrom P450. Do nng
dng hot ng ca ritonavir gim trong huyt tng v hiu qu iu tr ca
ritonavir b gim. y l tng tc dc ng hc khu chuyn ho thuc.
Ngoi ra cn thy nng rifabutin v cht chuyn ho hot ng ca n tng r
rt (din tch di ng cong-AUC ca cht chuyn ho hot ng ca rifabutin
tng 35 ln), km vi gim hiu qu ca ritonavir v tng c tnh ca rifabutin
(nguy c au c, au khp v gim bch cu trung tnh).
X l: Nu cn phi hp thuc, phi theo di u n trn lm sng.
Saquinavir
Phn tch: Cc cht cm ng enzym lm tng chuyn ho ca saquinavir
nn nng trong huyt tng ca dng hot ng ca saquinavir gim, v hiu
qu iu tr ca cht ny cng gim theo.
X l: Nn chn gii php khc thay cho liu php dng ng thi saquinavir.
Nu khng th c cch gii quyt khc nn tng liu saquinavir hiu lc khng
virus khng b gim.
687
Sulfonyl urea
Phn tch: Rifamycin lm tng s thanh lc ca nhiu thuc sulffonylur,
ko theo lm gim na i ca thuc trong mu, gim nng thuc trong huyt
thanh, c th dn n tng glucose mu. C ch c th do rifamycin lm tng s
chuyn ho ca mt s sulfonylurea gan.
X l: Theo di cht ch glucose mu khi kt hp thuc. Khi cn phi tng
liu dng sulffonylurea.
Tacrolimus
Phn tch: Tc dng c ch min dch ca tacrolimus c th b gim vo
khong 2 ngy sau khi bt u dng thm rifamycin. C ch c th l do rifamycin
cm ng enzym CYP3A4 gan v rut, xc tc cho chuyn ho tacrolimus.
X l: Theo di cht ch nng tacrolimus trong mu ton phn khi bt
u dng hay khi ngng dng rifamycin. Hiu chnh liu tacrolimus.
Tamoxifen
Phn tch: Tc dng khng estrogen b gim i do nng tamoxifen trong
huyt tng b h thp, do rifamycin lm tng s chuyn ho v gy cm ng
CYP3A4.
X l: Theo di cht ch p ng vi thuc ngi bnh. C th phi tng
liu tamoxifen khi dng cng vi rifamycin.
Theophylin
Phn tch: Khi thm rifamycin, nng theophylin trong huyt tng gim i
v cc triu chng h hp nng ln. C ch c th do rifamycin cm ng chuyn
ho theophylin gan.
X l: Vi ngi bnh ang dng theophylin, khi bt u dng thm, hoc
khi thi dng rifamycin u phi theo di nng theophylin trong huyt tng,
theo di p ng ca ngi bnh v hiu chnh liu dng khi cn.
Toremifen
Phn tch: Khi dng ng thi vi rifamycin, tc dng khng estrogen ca
toremifen b gim i, do nng thuc trong huyt tng h thp. C ch do
rifamycin lm tng cng s chuyn ho ca toremifen thng qua cm ng
CYP3A4.
X l: Theo di p ng ca ngi bnh vi thuc. C th phi tng liu
dng toremifen khi dng ng thi vi rifamycin.
Thuc chn beta
Phn tch: Tc dng dc l ca mt s thuc chn beta b gim khi dng
ng thi vi rifamycin, c th do lm tng s chuyn ho thuc chn beta
688
gan. Phi cn 3 n 4 tun l ngng rifamycin, th tc dng lm tng chuyn

ho ny mi ht.
X l: Theo di cht ch s p ng vi thuc ngi bnh (o huyt p)
nu cc du hiu lm sng xu i, phi tng liu thuc chn beta.
Thuc chng ng mu
Phn tch: Rifamycin gy cm ng enzym chu trch nhim chuyn ho
warfarin microsom gan, lm gim tc dng chng ng mu ca thuc ny.
X l: Nu dng kt hp vi rifamycin, th thuc chng ng mu cn c
tng liu, v phi theo di cc thng s ng mu mt cch cht ch khi ng ng
dng rifamycin, nhm trnh h prothrombin-huyt qu mc v chy mu.
Thuc chng trm cm ba vng
Phn tch: Khi dng ng thi vi rifamycin, nng thuc chng trm cm
ba vng trong huyt tng gim, dn ti gim tc dng dc l. C ch do s
chuyn ho cc thuc chng trm cm ba vng gan tng.
X l: Theo di thng xuyn nng thuc chng trm cm ba vng khi
bt u dng, khi ngng dng hay khi thay i liu dng rifamycin. Nu cn, hiu
chnh liu thuc chng trm cm.
689
Thuc c ch HMG-CoA reductase (cc statin)

Phn tch: Khi kt hp vi rifabutin hay ni chung vi cc thuc nhm
rifamycin, tc dng dc l ca cc thuc c ch HMG-CoA reductase b gim i,
do rifamycin gy cm ng s chuyn ho cc thuc ny gan v rut thng
qua xc tc ca CYP3A4.
X l: Theo di p ng ca ngi bnh vi cc thuc statin. Nu nghi ng
c tng tc thuc, thay th loi statin ang dng bng pravastatin, l loi thch
hp hn, v c l t c tng tc vi cc thuc nhm rifamycin.

Phn tch: Tc dng iu tr ca acetaminophen (paracetamol) nh mt
thuc h st, gim au b gim i mt cht khi dng phi hp vi rifamycin. ng
thi rifamycin li lm tng c tnh ca acetaminophen. C ch do rifamycin cm
ng cc enzym microsom gan, y mnh s chuyn ho ca acetaminophen
thnh cc cht chuyn ho c vi gan.
X l: Nguy c cao khi dng acetaminophen qu liu li kt hp vi rifamycin.
Cn nguy c khi dng cc liu iu tr thng thng ca acetaminophen v
rifamycin th cha c xc nh. Phi theo di cn thn c tnh vi gan ngi
bnh dng ng thi acetaminophen vi rifamycin.
Amiodaron
Phn tch: Rifamycin lm tng s chuyn ho amiodaron thng qua cm
ng enzym CYP3A4. Do nng amiodaron cng nh cht chuyn ho c hot
tnh ca n trong huyt thanh s gim, lm gim tc dng dc l.
X l: Phi theo di cht ch nng amiodaron trong huyt thanh khi bt
u v khi ngng dng rifamycin.
Ciclosporin
Phn tch: Gim nng ciclosporin trong huyt tng do cm ng enzym
trn cytochrom P450. Tng tc dc ng hc v chuyn ho thuc.
X l: Nn tng liu lng ciclosporin. Phi theo di nng ciclosporin
trong huyt tng trong khi iu tr v sau khi ngng thuc.
Indinavir; nelfinavir
Phn tch: L cht cm ng enzym, rifabutin lm tng chuyn ho ca
nelfinavir, indinavir thng qua isoenzym 3A4 ca cytochrom P450, gy gim nng
ca dng hot ng ca cc thuc ny trong huyt tng. ng thi din tch
di ng cong (AUC) v c nng nh ca chng tng. T , gim hiu
qu iu tr ca indinavir v nelfinavir v tng tc dng c ca rifabutin (au c,
au khp, gim bch cu trung tnh)
X l: Gim liu rifabutin cn mt na.
690
Macrolid
Phn tch: Tng tc c m t vi clarithromycin, qua thy nguy c
tng cc tc dng ph ca rifabutin (vim mng mch nho) do tng nng cht
ny v cc cht chuyn ho hot ng.
X l: Phi theo di u n trn lm sng.
Methadon
Phn tch: Tng tc dc ng hc v chuyn ho thuc km theo gim
nng methadon trong huyt tng v nguy c xut hin hi chng cai nghin.
X l: iu chnh s ln dng methadon, t 2 n 3 ln mt ngy, thay cho
mt ln mt ngy.
Phn tch: Gim nng fluconazol, itraconazol, ketoconazol trong huyt
tng do cm ng enzym (gim hiu qu).
X l: Nguy c tht bi trong iu tr nu phi hp vi cht cm ng enzym
ko di t nht 10 ngy. Trong trng hp ny, iu chnh liu thch hp v nu
cn, nh lng nng dn cht imidazol chng nm trong huyt tng.
Zidovudin
Phn tch: Gim nng zidovudin do tng chuyn ho cht ny (cm ng
enzym).
X l: Khi thy gim p ng trong iu tr bng zidovudin sau khi dng
rifabutin, phi hiu chnh liu lng zidovudin cho thch hp
RIFAMPICIN
Khng sinh iu tr lao
CC THUC TRONG NHM

RIFAMPICIN nang 150 mg; 300 mg; 250 mg; 450 mg; hn dch ung 100 mg/5mL;
siro 2% chai 100 mL; l 600 mg bt ng kh pha tim; siro 100 mg/5 mL x 120 mL;
dch truyn 600 mg/20 mL
R-cin hn dch ung 100 mg/5mL
Rifacin nang 300 mg
Rifampicin nang 150 mg; 300 mg
Rifadin bt ng kh pha tim 600 mg
691
Rifampicin thuc m 1 %; 3 %
Co- Barcine nang 250 mg; 450 mg
Rifadin siro 2 % chai 100 mL; l 600 mg bt ng kh pha tim
Canarif nang 450 mg
Rimpin nang 150 mg; 300 mg
Rifadin nang 150 mg; 300 mg; siro 100 mg/5 mL x 120 mL; dch truyn
600 mg/20 mL
CH KHI CH NH THUC

Thi k cho con b: Rifampicin qua c sa m.
Thi k mang thai: Rifampicin gy d tt thn kinh loi gm nhm, nhng hnh
nh khng gy qui thai cho phi ngi. Khi dng thuc ny trong thai nghn, nn thm
vitamin K vo nhng tun cui thai k cho m v khi cho tr s sinh.
Suy gan: Rifampicin vn c c tnh vi gan thp. Chnh vic phi hp vi cc
thuc chng lao khc (INH, ethambutol) lm tng c tnh ny v thng km theo
phn ng tiu t bo.
Lon chuyn ho porphyrin: Rifampicin gy cc t kch pht ri lon chuyn
ho porphyrin nhng ngi c t bm v chng ny.
Cc trng hp khc: Qu mn cm vi rifamycin.
Cn theo di: mc 1
Tr em: Rifampicin liu cao c th y bilirubin ra khi v tr lin kt vi albuminhuyt tng. Do , khi xc nh liu dng cho tr rt nh phi l u n gan ch a
trng thnh.
Suy thn: Gim liu lng, do thuc chm o thi.
TNG TC THUC

Amprenavir
Phn tch: Rifampicin lm gim nng amprenavir trong huyt tng, nn
lm gim tc dng dc l. C ch l rifampicin gy cm ng enzym lm tng
chuyn ho ca amprenavir thng qua CYP3A4.
X l: Trnh kt hp rifampicin vi amprenavir.
Buspiron
Phn tch: Rifampicin lm gim nng buspiron trong huyt tng, nn
lm gim tc dng dc l. C ch l rifampicin lm tng s chuyn ho ca
buspiron thng qua CYP3A4.
692
X l: Vi ngi bnh dng buspiron, phi theo di cht ch khi bt u

dng rifampicin, khi ngng hoc khi thay i liu dng thuc ny. Hiu chnh li u
buspiron nu cn.
Cc thuc c ch HMG CoA reductase (cc statin)
Phn tch: Khi kt hp vi rifampicin hay cc thuc nhm rifampicin ni
chung, tc dng dc l ca cc thuc c ch HMG CoA reductase b gim i, do
rifampicin cm ng chuyn ho cc thuc trn gan v rut, thng qua CYP3A4.
X l: Theo di p ng ca ngi bnh vi cc statin. Nu nghi ng c
tng tc thuc, thay th loi statin ang dng bng pravastatin, l loi thch hp
hn c do t c tng tc vi rifampicin.
Delavirdin
Phn tch: Rifampicin lm tng chuyn ho ca thuc khng virus delavirdin
gan (cm ng CYP3A4) lm gim nng ca thuc ny trong huyt tng.
X l: Khng dng ng thi delavirdin vi rifampicin.
Doxycyclin
Phn tch: Khi kt hp vi rifampicin, chuyn ho ca doxycyclin gan tng,
nn nng ca n gim trong huyt tng, ko theo hiu qu iu tr gim.
X l: Theo di p ng vi thuc ngi bnh v khi cn, nn tng liu
doxycyclin.
Estrogen hoc thuc nga thai estrogen-progestogen; progestogen
Phn tch: Tng chuyn ho progestogen gan, do cm ng enzym, nn c
nguy c th thai.
X l: Trnh dng thuc nga thai liu thp, nn dng thuc nga thai liu
cao, hoc dng bin php nga thai khc nu phi iu tr bng rifampicin di
ngy. Cn nh, cm ng enzym khng phi l mt hin tng tc thi.
Haloperidol
Phn tch: Rifampicin c th lm tng chuyn ho ca haloperidol nn nng
thuc trong huyt tng gim, km theo gim hiu qu iu tr.
X l: Vi ngi bnh ang dng haloperidol, nu dng thm rifampicin
hoc ngng dng thuc ny, phi theo di cht ch p ng vi thuc. Hiu
chnh liu haloperidol nu cn.
Indinavir
Phn tch: Cm ng mnh cytochrom P450, km theo tng chuyn ho
indinavir. T , gim nng dng hot ng ca indinavir v nh vy gi m
hiu qu iu tr.
X l: Cn theo di nng rifampicin trong huyt tng, v khi cn, phi
tng liu dng.
693
Lamotrigin
Phn tch: Dng kt hp vi rifampicin, nng lamotrigin trong huyt
tng b gim, lm tc dng dc l gim i. C ch c th do rifampicin cm
ng h enzym gan chu trch nhim lin hp vi acid glucuronic ca lamotrigin.
X l: Nu cn, phi hiu chnh liu dng lamotrigin khi bt u dng, khi
ngng hoc khi thay i liu ca rifampicin. Hiu chnh liu da theo p ng lm
sng ca ngi bnh vi thuc.
Methadon
Phn tch: Tng tc kiu dc ng hc v chuyn ho thuc, km theo
gim nng methadon trong huyt tng, v nguy c xut hin hi chng cai
nghin.
X l: iu chnh s ln dng methadon cho thch hp, t 2 n 3 ln trong
ngy thay cho 1 ln trong ngy.
Mifepriston
Phn tch: Nguy c gim hiu qu iu tr v tng chuyn ho mifepriston do
cm ng enzym.
X l: Cn nh cm ng enzym l mt qu trnh chm xut hin v cng
chm ht. C th cn tng liu.
Morphin
Phn tch: Khi kt hp vi rifampicin, tc dng gim au ca morphin c th
gim i. C ch cha r.
X l: Theo di p ng ca ngi bnh vi morphin. Nu cn, thay th
morphin bng mt thuc gim au khc.
Nelfinavir
Phn tch: Rifampicin lm gim nng nelfinavir trong huyt thanh, do
lm gim tc dng dc l ca thuc ny. C th l rifampicin lm tng
chuyn ho ca nelfinavir thng qua cm ng cytochrom P4503A4.
X l: Khng dng ng thi rifampicin vi nelfinavir.
Nifedipin
Phn tch: Rifampicin lm gim tc dng dc l ca nifedipin, do lm tng
chuyn ho rut (thng qua cytochrom P450 3A4).
X l: Theo di huyt p hoc triu chng au tht ngc ngi bnh v
hiu chnh liu nifedipin cho ph hp. C th thay nifedipin bng mt thuc chng
tng huyt p khc.
Ondansetron
Phn tch: Nng ondansetron trong huyt tng c th gim khi dng
cng rifampicin, nn tc dng chng nn ca thuc cng gim. C ch c th l
rifampicin cm ng CYP3A4 trong chuyn ho ca ondansetron.
694
X l: Nu nghi ng c tng tc thuc, thay ondansetron bng mt thuc

chng nn khc.
Propafenon
Phn tch: Rifampicin gy cm ng h enzym ca microsom gan chu trch
nhim chuyn ho propafenon, lm tng s thanh lc v lm gim nng
propafenon trong huyt tng, ko theo gim hiu qu iu tr ca thuc ny.
X l: Vi ngi bnh n nh trong iu tr vi propafenon, khng nn
dng rifampicin m thay bng mt thuc khng khun khc. Nu khng th thay
c, phi theo di nng propafenon trong huyt tng v theo di hiu qu
iu tr xem c gim khng. Nu cn th hiu chnh liu propafenon.
Repaglinid
Phn tch: Rifampicin lm tng chuyn ho ca repaglinid thng qua CYP
3A4, lm gim nng thuc trong huyt tng, ko theo l gim tc dng dc
l ca thuc ny.
X l: Ngi bnh ang dng repaglinid, phi theo di glucose mu khi bt u
dng hoc khi ngng dng rifampicin. Hiu chnh liu repaglinid nu cn.
Saquinavir
Phn tch: Cm ng enzym lm tng chuyn ho saquinavir, gy gim nng
dng hot ng ca saquinavir trong huyt tng v gim hiu qu iu tr.
X l: Nn tm liu php khc thay cho cc liu php ny, khi phi dng
ng thi saquinavir. Nu khng c, phi tng liu saquinavir khng gim
hot tnh khng virus.
Phn tch: Rifampicin lm gim nng cc thuc chng trm cm ba vng
trong huyt tng, lm gim tc dng dc l. C ch do cm ng, lm cho
chuyn ho thuc chng trm cm ba vng gan tng ln.
X l: Theo di thng xuyn nng thuc chng trm cm ba vng khi
bt u dng, khi ngng hoc khi thay i liu ca rifampicin. Hiu chnh li u
thuc chng trm cm nu cn.

Amineptin; carmustin hoc dn cht; dantrolen; doxorubicin hoc dn
cht; fluvoxamin; griseofulvin; isoniazid hoc thuc tng t; macrolid;
mercaptopurin; methotrexat; progabid; natri valproat hoc dn cht; vng
Phn tch: Phi hp thuc c tim nng c vi gan (hip ng cc tc
dng ph).
gan (ASAT, ALAT, phosphatase kim, bilirubin) hoc hon dng nu c th mt
trong hai th thuc. Cn xc nh chc chn ngi bnh khng thng xuyn
ung ru, v khng c tin s vim gan virus. Cc triu chng chnh trn lm
sng khng c hiu: bun nn, st, vng da... Khi thy ng thi pht ban ngoi
695
da, nga, hch to, nhiu kh nng nguyn nhn do thuc. Da theo cc xt
nghim sinh hc, cn phn bit r nguy c xut hin vim gan tiu t bo khng
hi phc vi nguy c vim gan mt hi phc c sau khi ngng thuc.
Carbamazepin
Phn tch: Tng chuyn ho gan do cm ng enzym, ko theo gim hot
tnh carbamazepin.
X l: Phi lu n nguy c ny iu chnh liu ca hai thuc, nu cn
phi hp thuc. Phi theo di cht ch nu cn nng thuc trong huyt tng
v phi thn trng khi ngng iu tr. Phi ngh n gim tnh to ngi li xe
v ngi vn hnh my. Khuyn ngi bnh khng ung ru v cc ch phm
c ru.
Ciclosporin
Phn tch: Gim nng ciclosporin trong huyt thanh do cm ng enzym
lm thuc tng d ho. Do vy, nng ciclosporin c th gim xung cn mt
na, thm ch cn mt phn ba.
X l: Nu cn phi hp thuc ny, phi theo di cht ch nng
ciclosporin trong huyt thanh, v hiu chnh liu lng cho thch hp lc bt u
v khi ngng iu tr vi rifampicin. Cn lu l nng ciclosporin bi n ng
mnh ty theo c th ngi bnh nn vic theo di phi u n, thng xuyn.
Corticoid - khong; glucocorticoid
Phn tch: Tng cng d ho thuc ny do cc thuc cm ng enzym.
Cm ng enzym ch biu hin sau khi bt u dng thuc 10 n 12 ngy.
X l: Cm ng enzym khng phi l mt hin tng tc th. iu tr bng
mt thuc cm ng enzym di hay trung hn phi tnh ti nguy c gim hiu qu
iu tr. Hiu chnh liu lng cho thch hp trong khi dng v sau khi ngng
thuc cm ng enzym.
Dihydropyridin
Phn tch: Do rifampicin c tnh cht cm ng enzym, nn lm gim nng
dihydropyridin trong huyt tng.
X l: Cn theo di lm sng (huyt p), v hiu chnh liu lng cho thch
hp khi bt u kt hp vi thuc th hai.
Disopyramid
Phn tch: Do cm ng enzym, c s gim nng disopyramid trong huyt
thanh ti nng khng cn hiu lc.
X l: Theo di in tm , cc biu hin lm sng, v nng thuc
chng lon nhp tim trong huyt thanh v khi cn iu chnh liu lng cho thch
hp.
696
Glycosid tr tim
tnh ca digitalis b chuyn ho (tc l digitalin, khng phi digoxin, t b chuyn
ho gan).
X l: Tnh ti nguy c ny hiu chnh liu lng ca digitalin (digoxin
c o thi qua thn) nu cn phi hp thuc. Hiu chnh liu lng trong v
sau khi iu tr.
Hormon tuyn gip
Phn tch: Tng chuyn ho ca thuc phi hp vi thuc cm ng enzym.
Cm ng enzym ch th hin sau khi iu tr 10 n 12 ngy.
X l: Cm ng enzym khng phi l hin tng tc th. iu tr bng thuc
cm ng enzym di hay trung hn i hi phi tnh n nguy c gim hiu qu
iu tr. Hiu chnh liu lng thch hp trong v sau khi ngng dng cht cm
ng enzym.
Phn tch: Mc tiu ch yu l iu tr ung th tuyn thn. Interleukin cng
c vi gan. Nh vy, y phi hp hai thuc c tim nng c vi gan.
X l: iu tr ny ch c thc hin c s chuyn khoa. Dng
interleukin i hi phi theo di lin tc. Trong trng hp ny, mi vic u tu
thuc vo tnh trng chung ca ngi bnh. Khi phi hp hai thuc c vi gan,
cn theo di cht ch chc nng gan (ASAT, ALAT, phosphatase kim, bilirubin),
hoc nu c th, hon dng mt trong hai thuc.
697
Mexiletin
Phn tch: Gim nng mexiletin trong huyt tng do cm ng enzym.
X l: Hiu chnh liu lng ca mexiletin theo lm sng v in tm .
Niridazol
Phn tch: Phi hp hai thuc c vi gan. Ngoi ra, niridazol cn c vi
thn kinh. Nguy c xut hin co git, ri lon tm thn v c vi gan khi phi
hp hai thuc.
X l: Phi hp hai thuc c vi gan, theo di cht ch chc nng gan
(ASAT, ALAT, phosphatase kim, bilirubin) hoc nu c th hon dng mt trong
hai thuc. Xc nh chc chn ngi bnh khng thng xuyn ung ru, v
khng c tin s vim gan virus. Cc triu chng lm sng chnh khng c hiu:
bun nn, st, vng da... Khi thy ng thi pht ban ngoi da, nga v hch to,
c th nguyn nhn do thuc. Cn phn bit r, theo kt qu th sinh hc, nguy
c xut hin vim gan tiu t bo khng hi phc c vi nguy c vim gan
mt hi phc c sau khi ngng thuc.
Paracetamol
Phn tch: Dng di ngy paracetamol, vi liu vt qu 6 gam/ ngy (tu
theo th trng) s c vi gan (vim gan tiu t bo). Khi phi hp vi mt thuc
khc c vi gan, nguy c ny tng ln.
(ASAT, ALAT, phosphatase kim, bilirubin) hoc hon dng mt trong hai thuc
nu c th. Xc nh chc chn ngi bnh khng thng xuyn ung ru v
khng c tin s vim gan virus. Trn lm sng cc triu chng chnh khng c
hiu: bun nn, st, vng da... Khi thy ng thi pht ban ngoi da, ng a v
hch to, c th do thuc. Cn phn bit r, theo kt qu th sinh hc, nguy c
xut hin vim gan tiu t bo khng hi phc vi nguy c vim gan mt hi
phc c sau khi ngng iu tr.
Phenytoin
tnh ca thuc ny.
X l: Nu cn, theo di cn thn nng phenytoin trong huyt tng, v
cn thn trng lc ngng thuc. Hiu chnh liu lng thch hp theo kt qu
nh lng thuc trong huyt tng.
Pyrazinamid
Phn tch: L phi hp kinh in, tuy nhin l phi hp hai thuc iu tr lao
c vi gan.
X l: Phi theo di hiu qu khng khun khi phi hp thuc, nhng cng
phi theo di cht ch chc nng gan (ASAT, ALAT, phosphatase kim, bilirubin)
hoc nu c th, hon mt trong hai thuc. Xc nh chc chn ngi bnh
khng thng xuyn ung ru, v khng c tin s vim gan virus. Cc tri u
698
chng lm sng chnh khng c hiu: bun nn, st, vng da... Nu xut hin
ng thi pht ban ngoi da, nga v hch to, th c th do thuc.
Quinidin hoc dn cht
Phn tch: Tng chuyn ho gan, ko theo gim hot tnh ca quinidin
(hay cc dn cht).
X l: Tnh ti nguy c ny hiu chnh liu lng hai thuc cho thch
hp, nu cn phi hp, phi theo di cht ch nng thuc trong huyt tng
v phi cnh gic khi ngng iu tr. Cn ngh ti gim tnh to ngi li xe,
ngi ng my. Khuyn khng ung ru v cc ch phm c ru.
699

tnh ca quinin (hay thuc tng t).
X l: Lu nguy c ny hiu chnh liu lng hai thuc cho thch hp,
nu cn phi hp thuc. Theo di cn thn, nu cn hiu chnh nng quinin
trong huyt tng v cn cnh gic khi ngng iu tr.
Phn tch: Tng tc ny c m t vi tolbutamid: gim nng
tolbutamid trong huyt tng do cm ng enzym cytochrom P450. Tng tc dc
X l: Nn tng liu tolbutamid. Theo di glucose mu trong v sau khi
ngng thuc.
Tacrolimus
Phn tch: Gim nng tacrolimus trong huyt tng do cm ng enzym
trn cytochrom P450. Tng tc dc ng hc v chuyn ho thuc.
X l: Nn tng liu tacrolimus. Theo di nng tacrolimus trong huyt
tng trong v sau khi iu tr.
Tamoxifen
Phn tch: Khi kt hp vi rifampicin, nng tamoxifen c th gim, lm
gim tc dng khng estrogen. C ch l do rifampicin lm tng chuyn ho ca
tamoxifen do gy cm ng CYP3A4.
X l: Theo di p ng lm sng ca ngi bnh. C th phi tng liu
tamoxifen khi kt hp vi rifampicin.
Tetracosactid
Phn tch: Tng d ho cc adrenocorticoid do cm ng enzym. Cm ng
enzym ch biu hin sau 10 n 12 ngy, k t khi bt u iu tr.
X l: Cm ng enzym khng phi l hin tng tc th. Khi iu tr cng
vi mt thuc cm ng enzym di hoc trung hn, phi tnh ti nguy c gim hiu
qu iu tr. Hiu chnh liu lng thch hp trong khi iu tr v sau khi ng ng
dng cht cm ng enzym.
Phn tch: Phi hp theophylin hoc dn cht vi mt cht cm ng enzym.
Sau 10 n 12 ngy, cht cm ng enzym thc y chuyn ho theophylin gan
lm gim hot tnh v gim nng cht ny trong huyt tng.
X l: Theo di ngi bnh v mt lm sng. Khi cn, hiu chnh liu lng
theo nng theophylin trong mu trong v sau khi ngng iu tr vi cht cm
ng enzym.
700

Phn tch: Gim nng fluconazol, itraconazol, ketoconazol trong huyt
tng do cm ng enzym (gim hiu qu iu tr).
X l: C nguy c tht bi trong iu tr, nu phi hp cc cht cm ng
enzym ko di t nht trong 10 ngy. Trong trng hp ny, hiu chnh liu lng
cho thch hp, v nu cn nh lng dn cht imidazol chng nm trong huyt
tng.
Phn tch: Rifampicin cm ng enzym lm tng nhanh d ho thuc chng
ng mu gan. Cm ng enzym khng phi l hin tng tc th, v iu tr vi
cht cm ng enzym phi t nht 10 ngy mi th hin tc dng.
X l: Phi tnh ti hiu ng ny iu chnh liu lng thch hp. Vic
theo di sinh hc (t l prothrombin v t l chun ha quc t - INR) phi
thng xuyn hn khi bt u iu tr vi thuc chng ng mu cng nh
trong v sau khi iu tr vi thuc cm ng enzym. Ch trnh t thi gian dng
thuc.
Tocainid
Phn tch: Tc dng dc l ca tocainid b gim khi kt hp vi rifampicin.
C ch cha r, nhng ngi ta cho rng rifampicin lm tng chuyn ho tocainid
gan.
X l: Vi thng tin hin c, khng c khuyn ngh g c bi t. Theo di
nng tocainid trong huyt tng v hiu chnh liu lng cho ph hp.
Toremifen
Phn tch: Khi kt hp vi rifampicin, nng toremifen trong huyt t ng
gim, lm gim tc dng khng estrogen. C ch l do rifampicin lm tng
chuyn ho toremifen thng qua cm ng CYP3A4.
X l: Theo di p ng vi thuc ngi bnh khi dng kt hp vi
rifampicin, v da vo , hiu chnh liu toremifen khi cn thit.
Verapamil
Phn tch: Gim nng verapamil trong huyt thanh, c th do tc dng
cm ng enzym ca rifampicin (tng tc dc ng hc v chuyn ho thuc).
X l: Theo di lm sng v p ng vi verapamil, ng thi theo di nng
verapamil trong huyt tng. C nguy c tht bi trong iu tr, nn hiu chnh
liu lng cho thch hp khi cn.
Vitamin nhm D
Phn tch: Khi iu tr di ngy, nhng cht cm ng enzym c th thc y
chuyn ho vitamin D, lm gim tc dng ca thuc v gy ri lon chuyn ho
calci.
701
X l: Phi lu n thi gian iu tr, vi l do trn. Cm ng enzym ch

hnh thnh dn dn. Nh vy, khi iu tr di ngy, phi hiu chnh li liu lng
v nu cn th b sung thm vitamin D.
Zidovudin
Phn tch: Gim nng zidovudin v tng chuyn ho (do cm ng
enzym).
X l: Nu thy gim p ng vi zidovudin khi cng iu tr vi rifampicin,
phi hiu chnh liu lng zidovudin cho thch hp.

Thuc chn beta
Phn tch: Tng d ho cc cht chn beta gan, do cm ng enzym
(acebutolol, alprenolol, betaxolol, labetalol, metoprolol, oxprenolol, propranolol,
timolol).
X l: Theo di lm sng, trnh tht bi trong iu tr bng cch hiu chnh
liu lng cho thch hp.
702
RITONAVIR
Khng protease, dng trong iu tr bnh AIDS
CC THUC TRONG NHM

RITONAVIR nang mu 100 mg
Norvir nang mu 100 mg; dung dch ung 80 mg/mL
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai v cho con b: Do cha c thng tin.
Cc trng hp khc: Qu mn vi thuc ny.
Thn trng: mc 2
Suy gan: Do tnh cht c ch cytochrom P450.
TNG TC THUC

Amiodaron; flecainid hoc thuc tng t; propafenon; quinidin hoc dn
cht
Phn tch: Ritonavir c i lc mnh vi isoenzym 3A4 ca cytochrom P450;
qua c ch cnh tranh, lm gim chuyn ho ca cc thuc b cytochrom P 450
chuyn ho mnh. Do c s tng nng cc thuc trong huyt t ng,
tng c tnh ca chng: c nguy c lon nhp tim. Tng tc dc ng hc v
chuyn ho thuc.
X l: Khng k n phi hp thuc ny; ngh n thay th thuc.
Alcaloid nm ca g
Phn tch: Nguy c nhim c cc alcaloid ny tng ln khi kt hp vi
ritonavir hay nhiu thuc khng protease khc (co tht mch ngoi bin, thiu
mu cc b cc u chi). C ch l cc thuc khng protease c ch s chuyn
ho cc alcaloid ca nm ca g gan, thng qua CYP3A4.
X l: Chng ch nh kt hp cc khng protease vi cc alcaloid ca nm
ca g.
Benzodiazepin
Phn tch: Ritonavir c i lc mnh vi isoenzym 3A4 ca cytochrom P450
nn lm gim chuyn ho cc thuc b cytochrom P450 chuyn ho mnh, theo c
ch cnh tranh. Nh vy, c s tng nng cc thuc ny trong huyt tng,
v nguy c tng c tnh ca chng. C nguy c an thn ko di, v suy h hp
703
nng ( m t vi alprazolam, dikali clorazepat, diazepam). Tng tc dc

X l: Khng k n phi hp thuc ny. Ngh n thay th thuc.
Bepridil; cisaprid
ch cnh tranh. Do , nng cc thuc trn trong huyt tng tng, v nguy
c tng c tnh. C nguy c c vi tim km theo ko di on QT v xut hin
xon nh. Tng tc dc ng hc v chuyn ho thuc.
Cht ch vn morphin
Phn tch: Ritonavir c i lc mnh vi isoenzym 3A4 ca cytochrom P450,
lm gim chuyn ho cc thuc b cytochrom P450 chuyn ho mnh, theo c ch
cnh tranh. Do c s tng nng cc thuc trong huyt tng, km theo
nguy c tng c tnh. Nguy c suy h hp nng ( c m t vi pethidin),
km nguy c an thn ko di ( c m t vi fentanyl). Tng tc d c ng
hc v chuyn ho thuc.
Clozapin
ht.
Phn tch: Nguy c hip ng tc dng c vi mu cng vi mt bch cu

X l: Khng k n phi hp thuc ny. Ngh n thay th ritonavir
Dextropropoxyphen
Phn tch: Ritonavir c i lc mnh vi isoenzym 3A4 ca cytochrom P450, nn
lm gim chuyn ho cc thuc b cytochrom P450 chuyn ho mnh, do c ch
cnh tranh. Do c s tng nng cc thuc trn trong huyt tng, v nguy c
tng c tnh. C nguy c suy h hp nng (c m t vi dextropropoxyphen,
Antalvic*). Tng tc dc ng hc v chuyn ho thuc.
Encainid
Phn tch: Khi phi hp vi ritonavir, nng encainid trong huyt tng
tng rt nhiu, lm tng c tnh ca thuc. L do l ritonavir c ch s chuyn
ho ca encainid thng qua cytochrom P450 2D6.
X l: Chng ch nh ritonavir cho ngi bnh ang dng encainid.
Fentanyl
Phn tch: Khi kt hp vi ritonavir hay nhiu thuc khng protease khc,
nng fentanyl trong huyt tng tng v na i ca thuc trong mu ko di,
lm tng nguy c c tc dng ph (suy h hp). C ch c th do cc thuc
704
khng protease c ch s chuyn ho ca fentanyl thnh rut v gan thng qua

CYP3A4.
X l: ngi bnh dng ritonavir, nu dng fentanyl phi theo di cht ch
chc nng h hp, v tip tc theo di nhiu ngy sau khi ngng fentanyl. Nu
dng fentanyl lu di, phi gim liu.
Phn tch: Cm phi hp vi astemizol (Hismanal*). Trnh phi hp vi
loratadin (Clarytine*). Ritonavir c i lc mnh vi isoenzym 3A 4 ca cytochrom
P450 qua c ch cnh tranh, lm gim chuyn ho cc thuc b cytchm P 450
chuyn ho mnh. Do , c s tng nng cc thuc ny trong huyt tng,
v nguy c tng c tnh ca chng. C nguy c c vi tim, km theo ko di
khong QT v xut hin xon nh (ch c m t ring vi astemizol). Tng
tc dc ng hc v chuyn ho thuc. Vi loratidin, c nguy c nhc u nng
v tng tc dng "kh ming".
X l: Khng k n phi hp astemizol - ritonavir v nu c th, thay th
loratidin. Nu khng thay th c, phi theo di lm sng, hoc bo trc nguy
c cho ngi bnh bit t theo di (nguy c nhc u nng).
Sildenafil
Phn tch: Dng kt hp sildenafil vi ritonavir hay nhiu thuc khng
protease khc, nng sildenafil trong huyt tng c th tng cao, gy h huyt
p nghim trng, c th t vong. C ch l cc khng protease c ch s chuyn
ho sildenafil thng qua CYP3A4.
X l: Vi ngi bnh iu tr vi cc thuc khng protease, vic dng
sildenafil phi rt cn thn. Khng c dng sildenafil qu 25 mg trong mt l n
trong vng 48 gi.
705
Thuc an thn kinh

nn lm gim chuyn ho cc thuc b cytochrom P450 chuyn ho mnh, do c
ch cnh tranh. Do c s tng nng cc thuc ny trong huyt tng, v
nguy c tng c tnh. C nguy c c vi tim cng vi ko di khong QT v
xut hin xon nh (ch c m t vi cht pimozid: Orap*). Tng tc dc
ng hc v chuyn ho thuc. Tng tc nn trnh vi risperidon v thioridazin.
ch cnh tranh. Nh vy c s tng nng cc thuc ny trong huyt tng, v
nguy c tng c tnh ca chng. C nguy c c vi thn ( c m t vi
piroxicam). Tng tc dc ng hc v chuyn ho thuc.

Bupropion
Phn tch: Dng kt hp vi ritonavir, nng bupropion trong huyt thanh
tng ln nhiu, lm tng nguy c nhim c (co git). C ch l do ritonavir c
ch s chuyn ho ca bupropion.
X l: Chng ch nh phi hp ritonavir vi bupropion.
Butyrophenon
Phn tch: Ritonavir c i lc mnh vi isoenzym 3A4 ca cytochrom P450.
Nh vy c nguy c cnh tranh mnh gia ritonavir vi cc thuc b chuyn ho
bi isoenzym ny. S cnh tranh ny lm gim chuyn ho cc thuc , v c
nguy c tng nng ca chng trong huyt tng. Nguy c h huyt p, an
thn, v tng cc tc dng ngoi thp (c m t vi haloperidol). Tng tc
dc ng hc, v chuyn ho thuc.
X l: Theo di ngi bnh cht ch v s xut hin cc tc dng c, v
khi cn, gim liu thuc an thn kinh.
Carbamazepin
Phn tch: Ritonavir c i lc mnh vi isoenzym 3A4 ca cytochrom P450. Nh
vy c nguy c cnh tranh mnh gia ritonavir vi cc thuc b chuyn ho bi
isoenzym ny. S cnh tranh ny lm gim chuyn ho cc thuc , v c nguy
c tng nng ca chng trong huyt tng. Nguy c ri lon thn kinh c (b
kch ng, run) v ri lon thc r rt. Nguy c co git nghim trng, c bit
tr em. Tng tc dc ng hc v chuyn ho thuc.
X l: nh lng nng carbamazepin huyt tng, v khi cn gim liu
carbamazepin.
706
Ciclosporin; tacrolimus
Nh vy, c nguy c cnh tranh mnh gia ritonavir vi cc thuc b chuyn ho
bi isoenzym ny. S cnh tranh ny lm gim chuyn ho ca chng, v c
nguy c lm tng nng ca chng trong huyt tng. Nguy c tng c tnh
ca hai thuc ny vi thn. Nguy c c ch min dch mnh, to iu kin xut
hin nhim khun nng. Nguy c thiu mu, gim tiu cu i vi tacrolimus.
X l: Theo di iu tr thng qua nh lng cc cht c ch min dch
trong huyt tng, v khi cn hiu chnh liu lng cho thch hp, theo nng
thuc trong huyt tng.
Dihydropyridin
Nh vy c nguy c cnh tranh cao gia ritonavir vi cc thuc b chuyn ho bi
c gy tng nng ca chng trong huyt tng. Nguy c h huyt p v ph
n ngoi bin vi cc dn cht ca dihydropyridin (nifedipin v nicardipin). Tng
tc dc ng hc v chuyn ho thuc.
ty trng hp, gim liu cht chn knh calci.
Phn tch: Gim din tch di ng cong (AUC) ca estroprogestogen,
theo mt c ch cn cha bit. C nguy c th thai.
X l: xut mt bin php nga thai khc.
Glucocorticoid
Nh vy, c nguy c cnh tranh cao gia ritonavir vi cc thuc b chuyn ho
nguy c gy tng nng ca chng trong huyt tng. C nguy c ph n v
tng huyt p km theo bn chn, cu gt ( c m t vi prednisolon v
prednison). Tng tc dc ng hc v chuyn ho thuc.
tu trng hp, cn gim liu corticoid.
Indinavir
nguy c gy tng nng ca chng trong huyt tng. Nguy c si ng tit
niu v tng nng bilirubin trong mu khng c triu chng. Tng tc d c
707
X l: Theo di chc nng thn (nh lng u n creatinin mu) khi cn

thit, gim liu indinavir.
Macrolid
nguy c gy tng nng ca chng trong huyt tng. Nguy c co cng c bng
km theo bun nn v nn ( c m t vi erythromycin, azithromycin,
clarithromycin). Tng tc dc ng hc v chuyn ho thuc.
X l:
Erythromycin: Theo di cht ch ngi bnh v s xut hin cc hin
tng c, v khi cn gim liu khng sinh.
Clarithromycin: nh lng thng xuyn creatinin trong mu. Khng hiu
chnh liu lng nu chc nng thn bnh thng. Khi suy thn, iu chnh liu
lng da vo thanh lc creatinin.
708
Meperidin
Phn tch: Dng kt hp vi ritonavir, nng meperidin trong huyt thanh
gim, ng thi nng normeperidin tng, lm cho hiu qu iu tr gim v
c tnh vi thn kinh tng. C ch l do ritonavir y mnh s chuyn ho
meperidin.
X l: Chng ch nh ritonavir ngi bnh ang dng meperidin.
Methadon
Phn tch: Ritonavir c i lc mnh vi isoenzym 3A4 ca cytochrom P450. Nh
vy, c nguy c cnh tranh cao gia ritonavir vi cc thuc b chuyn ho bi
isoenzym ny. S cnh tranh ny lm gim chuyn ho thuc , v c nguy c
tng ng k nng ca chng trong huyt tng. Nguy c an thn mnh v suy
h hp nng. Tng tc dc ng hc v chuyn ho thuc.
X l: Theo di ngi bnh cht ch xem c xut hin cc tc dng c,
v khi cn, gim liu lng methadon.
Nevirapin
Phn tch: Dng kt hp vi ritonavir hay vi nhiu thuc khng protease
khc, nevirapin c th lm tng chuyn ho cc thuc trn gan, thng qua CYP
3A4. Hu qu l nng ritonavir hay cc khng protease khc b gi m i, lm
gim hiu qu iu tr.
X l: Theo di cn thn nng ritonavir trong huyt tng, theo di p
ng ca ngi bnh, khi bt u dng v khi ngng nevirapin. Nu cn, hiu
chnh liu ritonavir.
Phenothiazin
Nh vy c nguy c cnh tranh cao gia ritonavir vi cc thuc b chuyn ho bi
c tng ng k nng ca chng trong huyt tng. C nguy c h huyt p,
an thn v tng cc tc dng ngoi thp ( c m t vi thioridazin trong h
ny). Tng tc dc ng hc v chuyn ho thuc.
v nu cn gim liu lng cc thuc an thn kinh.
Rifabutin
Phn tch: Rifabutin l cht cm ng enzym rt mnh, lm tng rt nhiu
chuyn ho ca ritonavir thng qua isoenzym 3A4 ca cytochrom P450. Kt qu l
gim nng dng c hot tnh ca ritonavir trong huyt tng, v gim cng hiu
ca ritonavir. Tng tc dc ng hc v chuyn ho thuc. Ngoi ra, cng thy
tng r rt nng rifabutin v cht chuyn ho ca n (din tch di ng cong
(AUC) ca cht chuyn ho c hot tnh ca rifabutin c nhn ln 35 ln), km
theo gim tc dng ca ritonavir v tng c tnh ca rifabutin (nguy c au c, au
khp, gim bch cu trung tnh).
X l: Nu cn phi hp thuc ny, phi theo di lm sng u n.
709
Saquinavir
nguy c tng ng k nng ca chng trong huyt tng. C nguy c tng
c tnh vi gan v c tnh v huyt hc (thiu mu tan mu, bnh bch cu ty
cp tnh). Tng tc dc ng hc v chuyn ho thuc.
X l: Theo di huyt hc u n (huyt ). Theo di chc nng gan
(nh lng u n cc enzym gan). Khi cn, gim liu lng saquinavir.
nguy c tng ng k nng ca chng trong huyt tng. C nguy c h
glucose mu dn ti hn m ( c m t vi tolbutamid). Tng tc dc
X l: nh lng u n glucose mu v khi cn, gim liu lng ca
sulfamid chng tiu ng.
Theophylin
Phn tch: Gim din tch di ng cong (AUC) ca theophylin, km theo
gim hiu qu iu tr.
X l: nh lng u n nng theophylin trong huyt tng v khi cn
tng liu lng.
nguy c tng ng k nng ca chng trong huyt tng. Nguy c h huyt
p, an thn v tng cc tc dng ngoi thp ( c m t vi risperidon Risperdal*, trong h ny). Tng tc dc ng hc v chuyn ho thuc. Phi
hp nguy him vi pimozid.
v khi cn gim liu lng cc thuc an thn kinh.
nn c nguy c cnh tranh mnh gia ritonavir vi cc thuc b chuyn ho bi
c tng ng k nng ca cc thuc trong huyt tng. Nguy c tng c
tnh vi gan ( c m t vi ketoconazol, itraconazol). Tng tc dc ng
hc v chuyn ho thuc.
710
X l: Theo di cht ch chc nng gan (nh lng cc enzym gan) v khi
cn gim liu lng thuc chng nm.
isoenzym ny. S cnh tranh ny lm gim chuyn ho, gy nguy c tng ng
k nng ca cc thuc trong huyt tng. Nguy c an thn, l ln, lon
nhp tim, v nht l nguy c tc dng ph kiu atropin (c m t vi imipramin,
amitriptylin, nortriptylin). Tng tc dc ng hc, v chuyn ho thuc.
X l: Theo di cht ch ngi bnh xem c xut hin cc tc dng c v
gim liu thuc chng trm cm nu cn.
isoenzym ny. S cnh tranh ny lm gim chuyn ho v c nguy c tng ng
k nng ca cc thuc trong huyt tng. C tng nguy c chy mu
(c m t vi warfarin). Tng tc dc ng hc v chuyn ho thuc.
X l: Tng thi gian ngn, xc nh t l prothrombin (hay t l chun ho
quc t - INR), v nu cn, gim liu lng warfarin.
711
Verapamil
nguy c tng ng k nng ca chng trong huyt tng. C nguy c h
huyt p nng v chong do tim i vi verapamil. Tng tc dc ng hc v
chuyn ho thuc.
nu cn phi gim liu cc thuc chn knh calci.
Zolpidem
Phn tch: Dng cng vi ritonavir, nng ca zolpidem trong huyt tng
c th tng rt nhiu, gy an thn nng (bun ng, mt tnh to) v suy h hp.
C ch do ritonavir c ch chuyn ho zolpidem gan. Tng tc dc ng
hc.
X l: Khng dng ng thi ritonavir vi zolpidem.
RU
Ru ethylic dng y khng phi l mt hot cht, m ch l mt t dc ca
thuc (th d ru thuc). Nu cn nu ra nhng tng tc gia thuc vi ru,
th tc dng c ch h thn kinh trung ng li c th l quan trng
CC THUC TRONG NHM

Cc loi ru thuc
Bch tu tu
Nhn sm dc tu
Ru bt trn i b
Ru b linh chi sm
Ru b sm dng huyt
Ru b sm quy
Ru b sm thc
Ru cao kh
Ru cao xng
Ru ng quy b huyt c ch
Ru hi m
712
Ru ng gia b
Ru nhn sm
Ru phong t thp
Ru phong thp A
Ru rn
Ru rn Hi Phng
Ru tc k
Ru tc k I v II
Ru thp ton i b
Ru trng th
Sm nhung kin lc tu
Xun xun m. v.v...
TNG TC THUC

Amantadin hoc thuc tng t; barbituric; benzamid; benzodiazepin;
butyrophenon; cc thuc an thn; carbamat hoc thuc tng t; carbamazepin;
dantrolen; dextropropoxyphen; fluoxetin; fluvoxamin; gluthetimid hoc thuc
tng t; interferon alpha ti t hp; medifoxamin; methyldopa; mianserin;
oxaflozan; phenothiazin; primidon hoc dn cht; thuc chng ng kinh khng
phi barbituric; thuc chng trm cm ba vng hoc thuc tng t; thuc
khng histamin khng H1 c tc dng an thn; thuc c ch h thn kinh trung
ng khc
tc dng an thn gy bun ng. Vi mt s thuc c th thy mt s tc d ng
tm thn - vn ng, c bit trong tun l i u tr u tin. Tng tc d c
lc.
X l: Khng nn phi hp vi cc thuc c ru v ch l ngi k n
khng kim sot c vic ung ru ca ngi bnh. Nguy c tc dng an thn
c bit nguy him vi ngi li xe hay ngi ng my. Khuyn khng nn ung
ru cng vi cc thuc ghi trong n, cng nh khng dng thm thuc hoc
ung c ru.
Biguanid
Phn tch: Ru to thun li cho cc thuc chng tiu ng gy h
glucose mu qua mt c ch cha bit r. C th s tn to glycogen gan b
c ch do ru. Ngoi ra, vi clorpropamid (Diabinese*) v mc t hn vi
tolbutamid (Dolipol) ngi ta thy mt ng v phn ng ny c coi l tc
dng antabuse, do tng nng acetaldehyd trong mu. Thm na, vi cht
metformin, thy tng nguy c nhim acid lactic khi nhim c ru, nht l khi
i, suy dinh dng, hoc thiu nng t bo gan.
713
X l: Hn ch mt s ngi bnh ung ru thng l vic kh. Phi

cnh bo cho h v nguy c h glucose mu gia tng, nn cn rt hn ch ung
ru. c bit phi trnh ung ru lc i. Nu bit ngi bnh
nghin ru, trnh ghi n clorpropamid (Diabinese*) v chn mt sulfonylur
khc.
Cc cht chn alpha 1 adrenergic
Phn tch: Nguy c h huyt p tng ln, c bit ngi thiu ht aldehyd
dehydrogenase (c th nhn bit nhng ngi ny hin tng mt ngay khi
ung mt t ru). C kin gii thch l khi h thn kinh giao cm b cc cht
chn alpha adrenergic c ch, th tc dng ca ru gy nn h huyt p s tng
ln.
X l: Phi cnh bo nhng ngi dng cc cht chn alpha -1 adrenergic
khng c ung ru, c bit i vi nhng ngi d mt khi ung ru.
Cephalosporin c nhn thiomethyltetrazol (cefamandol,
cefoperazon, cefonicid, cefotetan, ceforanid, latamoxef, moxalactam...)
cefmenoxin,
Phn tch: Tc dng antabuse (kiu disulfiram), cng thm nguy c c vi

gan. Mt hm lng bt thng acetaldehyd tch lu trong cc m (c ch
enzym) ko theo mt s du hiu lm sng, nh cn vn mch, gin mch mnh,
nhp tim nhanh, nhit cao, bun nn, nn, ban ngoi da, i khi h huyt p
v try tim mch. Cc triu chng ny c th nng, nh ty thuc lng ru
ung vo nhiu hay t. Nguy c tc dng antabuse ch th hin vi cefamandol,
latamoxef, cefoperazon v cefmenoxin, do phn t cc cht trn c nhn tetrazol.
Tc dng ny xy ra khi ung ru sau khi iu tr bng cephalosporin. Tc dng
c th xy ra ngay hoc c th sau 5 ngy.
X l: Khi iu tr bng thuc ny, trnh dng ru, do c tc dng antabuse.
Phn tch: Tng c ch thn kinh trung ng (tng tc dng an thn gy
bun ng) c ch h hp v h huyt p.
X l: Vi ngi bnh nghin ru phi gim liu thuc loi morphin. Ch
trng hp ngoi tr, i vi ngi li xe hay ngi ng my. Khi k n mt
cht c ch h thn kinh trung ng, khuyn ngi bnh trong thi gian iu tr
khng ung ru, khng dng thm thuc hoc ung c ru.
Citalopram
Phn tch: Tng tc dng an thn gy bun ng ca cht c ch ti thu hi
serotonin.
X l: Trnh kt hp vi cc thuc c ru v ch ngi k n khng
m bo c l ngi bnh khng ung ru. Nguy c an thn gy bun ng
c bit nghim trng i vi ngi li xe hoc ng my.
Phn tch: Tng tc dng c ch h thn kinh trung ng, ko theo tng tc
dng an thn gy bun ng. Mt s thuc trong nhm clonidin, c bi t trong
714
tun u iu tr ta thy mt s tc dng tm thn vn ng. y l tng tc

dc lc. Rilmenidin dng vi liu thng thng, th ru v thuc cha ru
khng lm tng nhng tc dng c ch trn h thn kinh trung ng ca cc
thuc ny.
X l: Tt hn ht l khng kt hp vi cc thuc c ru v ch ng i
k n khng phi lc no cng c th m bo l ngi bnh khng ung
ru. Nguy c tc dng an thn c bit nguy him vi ngi li xe v ng i
ng my.
Disulfiram
Phn tch: Tc dng disulfiram (antabuse) cng thm nguy c c vi gan.
Khi ngi bnh dng ng thi ru v disulfiram, mt lng ln bt thng
acetaldehyd s tch lu trong m (c ch enzym), ko theo mt s du hiu lm
sng, nh cc cn bc vn mch (mt bng), gin mch mnh, nhp tim
nhanh, nhit cao, bun nn, nn, ban ngoi da, i khi h huyt p v tr y
tim mch. Nhng triu chng ny nng hay nh tu thuc vo lng ru ung
vo nhiu hay t. Tc dng antabuse c dng iu tr nghin ru, trong
nhng t iu tr gii c.
X l: Trong qu trnh iu tr bng cht ny, khuyn ngi bnh khng nn
ung ru, do tc dng disulfiram. Cn ch n tt c cc ch phm hay cc
thuc c cha ru.
Furazolidon
Phn tch: C tc dng kiu disulfiram ( mt, vim kt mc, chy nc
mt, suy nhc khi ung ru sau khi dng furazolidon). C ch l furazolidon
c ch enzym chuyn ho acetaldehyd thnh acetat.
X l: Nhc nh ngi bnh khng c ung ru.
Griseofulvin; nitrofuran; phenicol; procarbazin
Phn tch: Tc dng antabuse (kiu disulfiram) cng thm nguy c c vi
gan. Mt lng acetaldehyd bt thng tch ly m (c ch enzym) ko theo
mt s du hiu lm sng, nh mt bng, gin mch mnh, tim p nhanh,
nhit cao, bun nn, nn, ban ngoi da, i khi h huy t p v tr y tim
mch. Cc triu chng ny nng nh ty thuc lng ru ung vo nhiu hay t.
X l: Trong thi gian iu tr bng cht ny, khuyn ngi bnh khng
dng ru do tc dng antabuse. Ch n tt c cc ch phm hoc cc thuc
c cha ru.
Phn tch: Tng nguy c h huyt p t th ng.
X l: Thng bo cho ngi bnh, c bit vi ngi bnh cao tui; khuyn
h khng ung ru.
715
Insulin
Phn tch: Ru thun li cho cc thuc chng tiu ng gy h glucose
mu theo mt c ch cha hon ton bit r. C th vic tn to glycogen gan
b ru c ch.
X l: i vi mt s ngi bnh, rt kh khuyn h hn ch ung ru.
Cho nn phi cho h bit c tng nguy c h glucose mu, v phi hn ch ti a
ung ru. Trnh ung ru lc i.
Methadon
Phn tch: Tng tc dng an thn ca ru do tng thm tc dng c ch
h thn kinh trung ng.
X l: Trnh ghi n cc thuc m t dc l ru. Khuyn ngi bnh
trnh ung ru trong khi iu tr cai nghin, nht l i vi ngi li xe hay iu
khin my.
Phn tch: Nguy c tng tc dng h huyt p do cng thm tc dng gin
mch. Tc dng c bit quan trng khi dng thuc mt gi trc khi ung ru.
X l: Phi trnh phi hp ny, v gy phin toi cho ngi bnh. Yu cu
ngi bnh trnh ung ru trong thi gian iu tr. Trnh t dng nhng thuc
hay ung c cha ru.
Nitroimidazol
Phn tch: Hiu ng antabuse vi nhng nitroimidazol nh metronidazol
(Flagyl*) secnidazol (Flagentyl*), ornidazol (Tiberal*, Ornidazol*), tinidazol
(Fasigyne*). Antabuse (disulfiram ) s tc ng n c ch chuyn ho ca ru.
Mt lng bt thng acetaldehyd s tch lu cc m (c ch enzym) ko theo
mt s du hiu lm sng, nh cc cn vn mch (mt bng), gin m ch
mnh, nhp tim nhanh, tng nhit , bun nn, nn, ban ngoi da, i khi h
huyt p v try tim mch. Nhng triu chng ny nng hoc nh l tu thuc
lng ru ung vo nhiu hay t.
X l: Trong khi iu tr vi thuc ny, khuyn ngi bnh khng ung ru
hoc thuc c t dc l ru do hiu ng antabuse.
Phenytoin
Phn tch: Gim nng phenytoin trong huyt thanh do cm ng enzym.
Phi theo di cht ch nhng ngi nghin ru (c nguy c gim tc dng
chng co git). Trong cn say ru cp tnh, nng phenytoin trong huyt thanh
li tng.
X l: Tt hn ht khng nn kt hp vi cc thuc c ru v khng m
bo l ngi bnh khng ung ru. Nguy c an thn gy bun ng c bi t
nguy him i vi ngi li xe v ngi ng my.
716
Phn tch: Ru to thun li cho cc thuc chng tiu ng gy h
glucose mu theo mt c ch cha hiu r hon ton. C th v s tn to
glycogen gan b c ch do ru. Thm vo , hiu ng antabuse (kiu
disulfiram) vi clorpropamid (Diabinese*), v mc t hn vi tolbutamid
(Dolipol*), glibenclamid (Daonil*, Euglucan*), glipizid (Glibenese*, Minidiab*), do c
tc ng n chuyn ho ca ru. Mt lng bt thng acetaldehyd s tch
ly m (c ch enzym) gy ra mt s du hiu lm sng nh: cn vn mch
(mt bng), gin mch mnh, tim p nhanh, tng nhit , bun nn, nn,
ban ngoi da, i khi h huyt p v try tim mch. Cc triu chng ny nng
hay nh l tu theo lng ru ung vo nhiu hay t.
X l: i vi mt s ngi bnh, lun lun c kh khn trong vic khuyn
h gim ung ru. Cn phi nhc h cnh gic vi nguy c h glucose mu s
tng ln v nn ung ru cng t cng tt. c bit cn trnh ung ru lc i.
Nu bit ngi bnh nghin ru, trnh khng ghi n chlorpropamid
(Diabinese*) v chn mt sulfonylur khc.
Tacrin
Phn tch: Nguy c tng c tnh vi gan
X l: Nu cn, tng cng theo di gan. Tt nht trnh cc kt hp thuc
c nhiu nguy c i vi ngi bnh cao tui.
Phn tch: Tc dng antabuse (kiu disulfiram), cng thm nguy c c tnh
vi gan. Mt hm lng bt thng acetaldehyd tch lu trong m (c ch
enzym), ko theo mt s du hiu lm sng, nh cn vn mch, gin mch
mnh, tim nhanh, nhit cao, bun nn, nn, ban ngoi da, i khi h huyt
p v try tim mch. Cc triu chng ny quan trng t hay nhiu l ty l ng
ru ung vo. Ngoi ra vi mt vi dn cht ca imidazol chng nm
(ketoconazol), nguy c c vi gan tng cao.
X l: Theo di rt cht ch chc nng gan, c bit khi k n
ketoconazol. Yu cu ngi bnh trnh ung ru trong sut thi gian iu tr vi
thuc chng nm.
Phn tch: Tc dng hip ng c ch h thn kinh trung ng. Ch
trng hp ngoi tr, i vi ngi li xe v ngi ng my. Phi theo di.
X l: Tt nht, khng nn phi hp vi cc thuc c ru v ch khng
phi trng hp no ngi k n cng can ngn c ngi bnh ung ru.
Nguy c an thn gy bun ng c bit nguy him vi ngi li xe v ngi ng
my.
Viloxazin
Phn tch: Tng tc dng c ch h thn kinh trung ng (tng tc dng an
thn gy bun ng), tc dng c ch h hp v h huyt p.
717
X l: i vi ngi bnh nghin ru, phi gim liu thuc chng trm
cm viloxazin. Ch trng hp ngoi tr, i vi ngi li xe v ngi ng
my. Khi ghi n mt thuc c ch h thn kinh trung ng, khuyn ngi bnh
trnh ung ru, khng dng cc ch phm c ru.

Baclofen; clozapin; natri valproat hoc dn cht
Phn tch: Tng tc dng c ch h thn kinh trung ng, km theo tng
tc dng an thn gy bun ng. Tng tc dc lc.
X l: Nu phi kt hp thuc, phi tnh n nguy c ni trn khi xc nh
liu lng ca hai thuc. Phi ngh n gim tnh to ngi li xe v ngi
ng my. Khuyn ngi bnh khng ung ru, khng dng thm thuc hoc
ung c cha ru.
Buspiron
dng an thn gy bun ng. Vi mt vi thuc loi buspiron, nht l trong tun
u iu tr, ta thy mt s tc dng tm thn vn ng. Tng tc dc lc.
X l: Tt nht l khng nn kt hp vi cc thuc c ru v khng chc
ngi bnh khng ung ru. Nguy c an thn gy bun ng c bit nguy him
i vi ngi li xe v ngi ng my.
Cisaprid
Phn tch: Tng tc hp thu ru, do nguy c tng c ch h thn
kinh trung ng (an thn).
X l: Khuyn ngi bnh khng ung ru sut thi gian iu tr bng
cisaprid, c bit vi ngi li xe v ngi ng my do b gim tnh to. Ch
ti nhng thuc khuyn dng hoc ngi bnh t dng, xem c cha ru
khng.
Phn tch: Tng c tnh vi d dy- rut, c bit ngi nghin ru.
Ru lm tng nng acid uric trong mu, v do , c th lm gim tc dng
iu tr bnh thng phong (gt).
X l: V ch dinh dng, khuyn ngi bnh thng phong (gt) trnh
ung ru trong thi gian iu tr.
Didanosin
Phn tch: Hip ng cc tc dng khng mong mun: tng nguy c vim
ty do thuc.
X l: Theo di lm sng, v nu cn, theo di sinh hc v chc nng ty
(amylase trong mu v trong nc tiu).
Etretinat hay dn cht
Phn tch: Cc thuc ny, ring tng thuc gy tng triglycerid mu.
718
X l: Phi chc chn rng ngi bnh khng ung ru. Khuyn ngi
bnh khng ung ru trong sut thi gian iu tr. Phi theo di cht ch hm
lng triglycerid trong mu, nu c nghi ng.
Phn tch: Ngi nghin ru chuyn ho isoniazid nhanh hn, dn ti
gim hiu qu ca thuc. Ngoi ra, cn c hiu ng antabuse thm vo nguy c
c vi gan.
X l: Khi phi hp hai thuc c vi gan, cn theo di cht ch chc nng
gan (ASAT, ALAT, phosphatase kim, bilirubin) hoc nu c th hon li mt
trong hai th thuc. Phi chc chn ngi bnh khng thng xuyn ung ru,
v khng c tin s vim gan virus. Nhng triu chng lm sng chnh khng c
hiu l bun nn, st, vng da. Nu thy ban ngoi da, nga, hch to th c
nhiu kh nng do thuc. Dng kt qu cc test sinh hc, phn bit ng nguy c
vim gan tiu t bo khng hi phc vi nguy c vim gan tc mt hi phc c
sau khi ngng iu tr.
Methotrexat
Phn tch: Tng nguy c x ho gan v l hai cht c vi gan.
X l: Phi tnh n mc ch iu tr. Khi bt u iu tr, thng bnh
vin, ngi bnh khng c php ung ru na. Nu tip tc iu tr nh,
yu cu ngi bnh khng c ung ru.
Nicorandil
Phn tch: Phi hp vi mi thuc chng tng huyt p c th lm tng
nguy c h huyt p, i khi dn n sc.
X l: Theo di huyt p trong khi iu tr phi hp hai thuc v khi ng ng
dng mt thuc. Cn c bit ch iu ny ngi bnh cao tui.
Paracetamol
Phn tch: Tng to thnh cc cht chuyn ho c vi gan ca
paracetamol do cm ng enzym ca ru khi ngi bnh nghin ru.
X l: Trnh ko di vic dng paracetamol ngi bnh nghin ru.
Gim liu thuc gim au, v nu cn, thay bng mt thuc gim au khc.
Paroxetin
dng an thn gy bun ng. Tng tc dc lc.
X l: Phi ngh n gim tnh to ngi li xe v ngi ng my.
Khuyn khng ung ru v khng dng cc ch phm c ru.
Reserpin
dng an thn gy bun ng. Tng tc dc lc.
719
X l: Phi ngh n gim tnh to ngi li xe v ngi ng my. Khuyn

khng ung ru v khng dng ch phm c ru.
Salicylat
Phn tch: Dng phi hp hai cht kch ng nim mc ng tiu ho mt
cch thng xuyn c th gy chy mu ng tiu ho.
Thuc chng lot khng H2 loi cimetidin
Phn tch: Cimetidin c ch enzym oxydase ca gan (cytochrom P 450) xc
tc chuyn ho mt s thuc. Ngoi ra, n cn lm gim lu lng mu gan.
Do , nng trong mu ca mt s thuc s tng (nguy c qu liu) v ngoi
ra, do c ch mt s chuyn ho sinh hc, nn cimetidin phong b mt s c ch
gii c. C nguy c tng nng nh ca ru trong huyt tng, do tng
tc dng gy say. Tng tc ny cn ang tranh ci.
X l: Thng bo tng tc ny cc cn b y t c thc v vn ny
v khi cn, c th chuyn cc nhn xt nguy c ny v Trung tm cnh gic dc.
Phn tch: Vi ngi nhim c ru (say ru) cp tnh (ngi bnh cp
cu): tng cng tc dng gy ng do c ch enzym. Vi ngi nghin ru
(nhim c ru mn tnh): i khng vi tc dng gy ng do cm ng enzym,
nn i hi tng liu thuc gy m.
X l: Khi phi phu thut, khuyn ngi bnh thng bo cho bc s gy m
tt c nhng thuc dng.
Phn tch: Tng cng tc dng chng tng huyt p.
X l: Cn phi hiu chnh liu lng. Lp mt k hoch dng thuc v
nhc nh ngi bnh phi tun th k hoch iu tr. Trong thi gian u t
iu tr, nhc nh ngi bnh o (hoc nh ngi o) huyt p thng xuyn cho
n khi t ti cn bng trong iu tr.

X l: Nu cn phi hp vi cc thuc c ru, phi tnh n nguy c ny
khi gy m v khi quyt nh liu lng.
Phn tch: Khi ung lng ln ru s c tc dng nh mt cht c ch
enzym, do c th c ch s chuyn ho sinh hc ca thuc chng ng mu,
dn n lm tng tc dng ca thuc chng ng mu. Ru ung thng
xuyn, li c tnh cht cm ng enzym, v do lm tng s
chuyn ho sinh hc ca thuc chng ng mu, dn n lm gim tc dng ca
thuc.
720
X l: iu tr ngi bnh nghin ru bng thuc khng vitamin K rt kh.

Nhng thay i ca t l prothrombin v ca t l chun ho quc t - INR l ng
lo ngi. Vi ngi bnh nghin ru, phi tnh n tnh hnh ny gii thch cc
bin i kt qu test th sinh hc v quyt nh liu ban u ca thuc khng
vitamin K; sau iu chnh liu theo kt qu iu tr thu c. Ch : Cn iu
chnh li liu lng, nu ngi bnh quyt nh ngng ung ru trong thi gian
iu tr bng thuc chng ng mu.
SALICYLAT (dn cht)

Thuc gim au, h st, chng vim liu cao, m thuc u nhm l aspirin
CC THUC TRONG NHM

ACID ACETYL SALICYLIC
Alka-Seltzer vin nn si bt 324 mg
Aspirin Domesco vin bao tan rut 81 mg
Aspirin pH8 vin bao tan rut 500 mg
GLYCOL SALICYLAT
Salonpas, Gel-patch cao dn 1,25%
LYSIN ACETYL SALICYLAT bt pha dung dch ung 500 mg; 100 mg; 1000 mg
Aspegic bt pha dung dch ung 500 mg
METHYL SALICYLAT
Deep Heat- kem bi da
Salonpas cao dn
Salonpas gel
Salonpas liniment
SALICYLIC ACID dung dch nh mt 0,1%
Betnovate-S kem bi da 3% phi hp vi betamethason
Sophtal dung dch nh mt 0,1% x 10 mL
CH KHI CH NH THUC
721
Chng ch nh: mc 4
Bnh mu: Bnh chy mu do th tng hoc mc phi, v tnh cht chng kt
tp tiu cu ca salicylat.
Lot d dy - t trng; vim d dy : Cc thuc nhm salicylat gy au d dy
v chy mu ng tiu ho, hay gp hn ngi c tin s bnh ng tiu ho (lot
d dy hay t trng). c ch kt tp tiu cu v gii phng ti ch histamin lm chy
mu nng thm.
Cc trng hp khc: Chng ch nh dng thuc nhm salicylat khi: chy mu
do th tng hoc mc phi; bng huyt; kinh nguyt ko di; qu mn cm vi
salicylat.

Thi k cho con b: Salicylat qua c sa m. Khng nn cho con b khi dng
nhiu ln lin tip, do c tnh ca chng i vi tr s sinh.
Thi k mang thai: Salicylat c th lm chm v gy tai bin chy mu nng
i vi ph n mang thai cng nh vi thai nhi.
Thn trng: mc 2
Suy thn: Nguy c hoi t nh thn c th xy ra, nht l vi liu dng c
c tc dng chng vim (liu vt qu 4 gam/ ngy).
Cn theo di: mc 1
Tr em: Tr em rt nhy cm vi nhng bin i chy mu do salicylat gy ra.
Thm vo , ri lon in gii do nhim c salicylat rt nng tr em t tui.
Suy h hp; hen: Salicylat, do c ch tng hp prostaglandin, l cht gy gin
ph qun, nn c th gy hen ngi c t bm vi bnh ny.
TNG TC THUC
Ketorolac
Phn tch: Kt hp ketorolac vi aspirin hay cc salicylat khc s lm tng
cc tc dng ph nghim trng ca ketorolac. C ch l cc salicylat c th y
ketorolac khi lin kt vi protein huyt tng v c tc dng hip ng v cc
phn ng ph.
X l: Chng ch nh ketorolac cho ngi bnh ang dng aspirin hay cc
salicylat khc.
Methotrexat
Phn tch: Tng tc dng c vi mu ca methotrexat do y thuc khi
lin kt vi protein huyt tng v/ hoc do gim o thi qua thn. Tc dng
ny ph thuc vo liu (tc dng r nht vi ketoprofen).
722
X l: C th gp tng tc ny bnh vin. Khi dng methotrexat liu cao,

phi ngng thuc chng vim khng steroid 12 n 24 gi trc, cho n lc
nng methotrexat tr v tr s khng c. D tng tc ny khng c m t
vi tt c cc thuc chng vim khng steroid, nhng nn tun theo qui t c ny,
trnh dng hai thuc ng thi.

Benzofuran hoc dn cht
Phn tch: Gim tc dng o thi acid uric qua nc tiu ca hai thuc khi
dng phi hp. Hnh nh c tc dng cnh tranh trong o thi acid uric thn.
Khng nhng c nguy c tht bi trong iu tr, m bnh cnh lm sng c th
nng ln.
X l: Nn dng mt thuc gim au, chng vim khc thay cho cc salicylat.
Phn tch: Tng nguy c chy mu, ch yu vi cc cephalosporin cha
nhn thiomethyltetrazol (nh: latamoxef, cefoperazon, cefamandol, cefmenoxin,
cefotetan). Nhn ny tc dng nh mt dn cht coumarin c hot tnh chng
ng mu (khng vitamin K), v b sung thm tc dng ca n vo cc tc d ng
khng vitamin K, hoc tc dng chng kt tp tiu cu ca cc thuc salicylat.
X l: Nn trnh phi hp ny, nht l vi latamoxef, do tng nguy c chy
mu. Cn cnh gic c bit khi dng cc khng sinh ny vi liu cao.
Dng c t trong t cung (vng nga thai)
Phn tch: Thuc chng vim khng steroid (nht l aspirin) lm tng nguy
c tht bi trong nga thai bng vng nga thai (c ch hin tng vim).
X l: Mc du trong y vn cn tranh ci v nguy c th thai, nhng vn
nn trnh dng cc thuc chng vim cho cc ph n dng bin php nga thai
ny. Tng tc ny cn cn thm nhng ti liu nghin cu b sung.
Heparin; pentoxyfylin; ticlopidin
Phn tch: Phi hp vi mi thuc c tnh kt tp tiu cu hay tnh chng
ng mu u lm tng nguy c chy mu. Nguy c ny li tng thm do tnh
kch ng ca cc thuc chng vim khng steroid trn nim mc d dy (chy
mu ng tiu ho).
X l: Nu cn phi hp thuc ny, phi theo di cht ch bng cc test
ng mu thch hp (thi gian Howell v thi gian cephalin - kaolin) trong v sau
khi iu tr bng cc thuc chng vim khng steroid. Thay th liu php khi
ngi bnh c tin s lot ng tiu ho.
Indometacin hoc dn cht; pyrazol
Phn tch: Phi hp thuc khng khoa hc. Hip ng tc dng gy lot d
dy v tng nguy c chy mu ng tiu ho.
X l: n thuc tha v ch. Thay i chin lc iu tr, v tng tc ny
nn trnh.
723
Mifepriston
Phn tch: Nguy c gim hiu qu iu tr.
X l: Ngng iu tr bng cc thuc chng vim khng steroid 24 gi trc
Probenecid
Phn tch: Salicylat dng thng xuyn vi liu thp hn liu bnh thng
s c ch hot tnh o thi acid uric qua nc tiu ca probenecid. Probenecid
c ch s o thi acid uric qua nc tiu ca cc salicylat, c th lm gim o
thi salicylat v lm xut hin c tnh ca cht ny.
X l: Phi hp nn trnh. Cn thay i chin lc iu tr.
Sulfinpyrazon
Phn tch: Nu kt hp cng salicylat, tc dng o thi acid uric qua nc
tiu ca sulfinpyrazon b c ch. Cc salicylat cn ngn cn tc dng c ch ti
hp thu acid uric tiu qun ca sulfinpyrazon.
X l: Khuyn ngi bnh dng sulfinpyrazon vi mc ch tng s o thi
acid uric khng dng cc thuc c salicylat.
Phn tch: Phi hp thuc khng hp l do hip ng tc dng gy lot, v
tng nguy c chy mu ng tiu ho.
X l: K n tha, v ch. Cn thay i chin lc iu tr, v nn trnh
phi hp ny.
Phn tch: Tng tc dng chng ng mu do y thuc khi lin kt vi
protein huyt tng v hip ng cc tc dng chng kt tp tiu cu. V thuc
chng vim khng steroid gy kch ng nim mc d dy nn lm tng nguy c
lot chy mu, nht l ngi bnh cao tui.
X l: Nn trnh k n phi hp cc thuc ny v nguy c chy mu. Vi
aspirin, tuy phi hp thuc ny c th gp trong thc t, nhng ch vi liu thp
(c 200mg). Vi liu cao, vn chng ch nh chnh thc. Thng bo cho ng i
bnh bit nguy c chy mu trnh t dng thuc.
724
Thuc c ch anhydrase carbonic

Phn tch: Dng cc thuc ny phi hp vi cc salicylat s gy tch lu cc
thuc c ch anhydrase carbonic gy c, bao gm c ch h thn kinh trung
ng v nhim acid chuyn ho. C ch Aspirin y acetazolamid khi v tr lin
kt vi protein huyt tng v c ch s thanh lc cht ny qua thn. Mt khc
cc thuc c ch anhydrase carbonic gy nhim acid, to iu kin cho cc
salicylat khng ion ho tng thm nhp vo h thn kinh trung ng.
X l: Trnh dng ng thi salicylat vi cc thuc c ch anhydrase
carbonic. Ngi bnh cao tui v ngi bnh suy thn c t bm d tch lu
acetazolamid. Khi bt buc dng cc thuc c ch anhydrase carbonic cho ngi
bnh dng salicylat, phi theo di nng salicylat trong huyt tng, theo di
cc biu hin tc dng ph trn h thn kinh trung ng v cc thng s acidbase.

Phn tch: Cc salicylat dng di ngy vi liu cao c th gy c vi tai, v
tc dng ny s tng khi ngi bnh dng thm mt aminosid vi liu cao.
X l: Kim tra chc chn l ngi bnh khng dng thng xuyn
salicylat. Ch c bit n cc thuc ngi bnh t dng. Tu theo yu cu
ca iu tr, ghi thnh lc .
Cht acid ho nc tiu
Phn tch: Tng nng salicylat trong huyt tng, do gim o thi qua
nc tiu b acid ho.
X l: Tng tc dng dc l ca cc salicylat; nu cn phi hp thuc,
phi hiu chnh li liu lng cho thch hp. C th o pH nc tiu bng giy
ch th, bit c cn hiu chnh hay khng.
Cholestyramin
Phn tch: Gim hp thu salicylat qua ng tiu ho.
X l: Nu cn ghi n c hai thuc ny, khuyn ngi bnh ung salicylat
hai gi trc hay bn gi sau khi dng cholestyramin.
Glucocorticoid
Phn tch: Tng cc tc dng ph do hip ng cc tc dng gy lot trn
nim mc d dy.
X l: Phi cn nhc li ch/ nguy c trc khi k n phi hp thuc nh
vy. Tng nguy c gy lot nn cn xem li liu php cho ngi bnh cao tui v
ngi bnh c tin s lot d dy. Nu cn, nn dng phi hp thm cc cht
bo v nim mc d dy.
725
Insulin
Phn tch: Liu cao aspirin c th gy h glucose mu v lm tng tc dng
ca insulin.
X l: Khi iu tr di ngy mt s trng thi vim bng cc salicylat, phi
thng bo cho ngi bnh tiu ng bit nguy c tng cng t theo di.
Hiu chnh li liu lng, khi cn, nu vic iu tr c tip tc.
Phn tch: Nguy c c ch tc dng sinh hc ca interferon do salicylat v
cng c th do cc thuc chng vim khng steroid khc. C ch cn cha r.
X l: S gim hot tnh ny cn c tnh ti trc khi phi hp hai thuc.
Cn cn nhc nguy c/ li ch v gi thnh/ hiu qu.
Phn tch: Ch c dng interleukin cc c s chuyn khoa. C nguy c
hip ng cc tc dng c vi thn ca hai cht.
X l: Ch c thc hin iu tr interleukin cc c s chuyn khoa, v
tnh cht nghim trng ca ch nh. Khi cc tng tc cn c cn nhc
theo th trng chung ca ngi bnh. Nu khng th hon mt trong hai thuc,
cn phi theo di cht ch ion v thanh lc creatinin.
Lithi
Phn tch: Thuc chng vim c th lm gim thanh lc ca lithi thn
bng cch gy tng ti hp thu thuc ng thn, c th dn n qu liu lithi.
X l: Phi hp thuc ny i hi phi hiu chnh liu lithi cho thch hp khi
bt u, khi ang v khi ngng iu tr thuc chng vim. Nu cn, phi theo di
k nng lithi trong mu.
Phn tch: C th nhiu c ch tham gia y. Hip ng cc tc dng
chng kt tp tiu cu km theo nguy c chy mu; nguy c tim tng chy mu
ng tiu ho ngi bnh iu tr bng cc salicylat c tng cng bi natri
valproat. Cc salicylat y natri valproat khi lin kt protein huyt tng (tng
tc dc ng hc v phn b thuc) km theo gim chuyn ho v o thi. Kt
qu l tng natri valproat t do km theo nguy c qu liu (hn m, gi m tr ng
lc c, gim phn x, co ng t, gim h hp t ng).
X l: Theo di nng natri valproat trong huyt tng, theo di lm sng.
Hiu chnh liu lng cho thch hp. Nhc ngi bnh dng natri valproat phi
hp vi cc salicylat, nu thy au bng phi bo ngay cho bc s k n bit.
Khuyn ngi bnh dng natri valproat khng nn t ng ung cc salicylat (c
th ung paracetamol, nu cn).
Phenytoin
Phn tch: Cc salicylat c th y phenytoin khi lin kt vi protein huyt
tng, v nh vy lm tng nng thuc chng ng kinh trong huyt tng.
726
X l: Vi ngi ng kinh, cn phi c nng phenytoin c hiu

lc. Hiu chnh liu lng tu theo nng phenytoin trong mu.
Reserpin
Phn tch: Gim tc dng h huyt p. Cc thuc chng vim khng steroid
c ch tng hp thn cc prostaglandin gy gin mch, v/hoc lm tng
nc v natri. C nguy c suy thn cp ngi bnh b mt nc.
X l: Phi lu n tng tc ny, c bit khi dng cc salicylat liu cao.
m bo ngi bnh c cung cp nc, theo di chc nng thn ( thanh
lc creatinin), xc nh tnh n nh huyt p, c bit lc bt u iu tr.
Ru
Phn tch: Dng ng thi v thng xuyn hai cht kch ng nim mc d
dy v rut c th gy chy mu ng tiu ho. Cc dng aspirin c tc d ng
m s khng c nhc im ny.
X l: Nu ngi bnh ung ru thng xuyn, nn dng aspirin c tc
dng m, nhm trnh tc dng gy lot v trnh chy mu ng tiu ho do
thng tn dn dn nim mc d dy - rut.
nn c th tng nguy c h glucose mu khi phi hp hai thuc.
X l: Do c th c nhng bin ng nht thi v nng glucose mu
trong khi iu tr thuc chng vim, nn cn thng bo cho ngi bnh tng
cng t theo di.
Tetracosactid
Phn tch: Nguy c tng tc dng gy lot v chy mu. Nhng trong mt
s dng vim khp, phi hp c th c ch.
X l: Phi cn nhc nguy c/ li ch trc khi k n. Nu cn phi hp
thuc, phi theo di cn thn trn lm sng, v phi thng bo nguy c cho ngi
bnh bit phng.
Thuc kim ho nc tiu
Phn tch: S kim ho nc tiu lm tng s thanh lc salicylat, lm gim
nng thuc trong huyt tng, gim tc dng iu tr v tc dng c. S
thanh lc qua thn tng rt mnh khi pH nc tiu vt qu 7.
X l: Ngi bnh dng cc thuc kim ho nc tiu ng thi vi cc
salicylat phi dng salicylat vi liu cao hn bnh thng. Vic xc nh liu da
vo vic theo di pH nc tiu hoc nng salicylat trong huyt tng.
Phn tch: S dng cc thuc nhun trng nhy v thm thu cng vi cc
salicylat s lm gim hp thu v hot tnh cc salicylat.
727
gi.
X l: Tng tc ny c th trnh c nu dng thuc cch nhau t nht 2
Thuc c ch bm proton
Phn tch: Cc thuc c ch bm proton lm tng pH ca dch v, v vy lm
cho cc vin salicylat, aspirin c v bao d tan hn trong d dy, gy ra cc tc
dng ph d dy.
X l: Trnh dng cc vin thuc c v bao salicylat cng vi cc thuc c
ch bm proton.
Verapamil
Phn tch: Nguy c tng c tnh ca hai thuc do b y khi lin kt vi
protein huyt tng. y l tng tc dc ng hc v phn b thuc.
X l: Theo di p ng lm sng vi verapamil, v hiu chnh liu thuc
chn knh calci ny. Theo di tc dng ph ca thuc salicylat (au bng, chy
mu cam, chy mu li, tai, nhc u).
Zidovudin
Phn tch: Tng c tnh ca mi thuc do c ch cnh tranh s lin hp
vi aicd glucuronic trong microsom gan.
X l: Theo di tc dng ph ca aspirin v ca zidovudin: theo di huyt
hc (cng thc mu) v lm sng (suy nhc, bun nn, nn...)

Clonidin hoc thuc tng t; diazoxid; dihydropyridin; furosemid hoc
thuc tng t; methyldopa; sotalol; thuc chn beta; thuc li tiu gi kali;
thuc li tiu thi kali; thuc c ch enzym chuyn dng angiotensin
Phn tch: Gim tc dng h huyt p. Cc thuc chng vim khng steroid
c ch tng hp thn cc prostaglandin gy gin mch v/ hoc ko theo gi
nc v natri. Nguy c suy thn cp ngi bnh b mt nc.
X l: Lu tng tc ny khi k n, nht l khi k dng indometacin v
cc salicylat liu cao. m bo vic tip nc y cho ngi bnh. Theo di
chc nng thn ( thanh lc creatinin). Kim tra tnh n nh ca huyt p, c
bit khi bt u iu tr. Khuyn ngi bnh kim tra u n huyt p.
Dipyridamol
chng ng mu u lm tng nguy c chy mu. n nay, tng tc ny c
coi nh cha c s, cha nhn xt no trn lm sng ni ln c nguy c chy
mu.
X l: Nu cn phi hp thuc ny, phi theo di cht ch bng cc test
ng mu thch hp trong khi v sau khi iu tr bng thuc chng vim khng
steroid.
728

Phn tch: Gim tc dng chng tng huyt p: Cc thuc chng vim
khng steroid c ch tng hp thn cc prostaglandin gy gin mch v/ hoc
ko theo gi nc v natri. Nguy c suy thn cp ngi bnh mt nc.
X l: Phi tnh n tng tc ny khi k n, nht l khi k n c
indometacin v cc salicylat liu cao. m bo cung cp y nc cho ngi
bnh. Theo di chc nng thn ( thanh lc creatinin), v kim tra tnh n nh
ca huyt p, c bit lc bt u iu tr. Khuyn ngi bnh t kim tra u
n huyt p. Phi thn trng vi ngi bnh cao tui (suy thn sinh l).
Thuc khng acid dng ng ung hoc than hot tnh
Phn tch: Gim hp thu ng tiu ho v gim ti hp thu ng thn, do
gim nng salicylat huyt thanh nu thuc khng acid c tnh cht kim
ho nc tiu.
X l: Ung thuc khng acid v salicylat cch nhau t nht 2 gi. Cc thuc
khng acid thng c ung 1 gi 30 pht sau ba n v thc n c coi l
ngun gc tng bi tit dch v.
Thuc tan huyt khi
Phn tch: Phi hp vi mi thuc c tnh chng kt tp tiu cu hay chng
ng mu u lm tng nguy c chy mu.
X l: Thng thng k n v s dng cc thuc tan huyt khi u do
bc s chuyn khoa thc hin (bc s tim mch v bc s khoa c p c u), v cc
cht ny c phm vi iu tr hp, v cch dng thuc rt t nh. Nu cn phi
hp thuc ny phi theo di bng nhng test ng mu thch hp (thi gian
Howell v thi gian cephalin kaolin). Tt hn, nu c th, tm liu php khc.
SAQUINAVIR
Thuc khng protease, dng trong iu tr bnh AIDS
CC THUC TRONG NHM

Saquinavir mesylat nang 200 mg
Invirase nang 200 mg
CH KHI CH NH THUC
V l thuc mi, cc chng ch nh ca thuc ny cn cn c khng nh tip.
TNG TC THUC
729

Alcaloid nm ca g
Phn tch: Khi dng cng vi saquinavir hoc mt s khng protease khc,
c tnh ca cc alcaloid nm ca g c nguy c tng cao (co mch ngoi bin,
thiu mu cc b u chi). L do l cc khng protease c ch chuyn ho ca
cc alcaloid nm ca g gan, thng qua CYP3A4.
X l: Chng ch nh dng ng thi cc khng protease vi cc alcaloid
nm ca g.
Cisaprid; thuc khng histamin H1 khng an thn
Phn tch: Saquinavir, do hin tng cnh tranh khu cytochrom P450, lm
cc thuc ny gim chuyn ho, hu qu l tng nng trong huyt tng v
tng c tnh (ko di khong QT, xon nh). Tng tc dc ng hc v
chuyn ho thuc.
X l: Nn tm mt liu php khc thay th, khi phi dng ng thi vi
saquinavir. Nu khng c cch thay th no khc, phi theo di k ngi bnh v
hin tng c vi tim (theo di in tm thng xuyn).
Barbituric; phenytoin; rifabutin; rifampicin
Phn tch: Cc cht cm ng enzym lm tng chuyn ho saquinavir, ko
theo hu qu l lm gim nng dng hot ng ca saquinavir trong huyt
tng v lm gim hiu qu iu tr.
X l: Nn tm cch iu tr khc, khi phi dng ng thi saquinavir. Nu
khng c cch thay th khc, phi tng liu saquinavir khng lm gim hot
tnh khng virus.
Indinavir
Phn tch: Indinavir, do hin tng cnh tranh khu cytochrom P450, lm
gim chuyn ho cc thuc no m b isoenzym 3A4 ca cytochrom P450 chuyn
ho mnh. Kt qu l tng nng cc thuc ny trong huyt tng, do tng
c tnh. C nguy c c vi gan v mu (thiu mu tan mu, bnh bch cu ty
cp). Tng tc dc ng hc v chuyn ho thuc.
X l: Theo di huyt hc u n (huyt ). Theo di chc nng gan
(nh lng u n enzym gan). Gim liu saquinavir, khi cn.
Ritonavir
nn c nguy c cnh tranh mnh gia ritonavir vi cc thuc b isoenzym ny
chuyn ho. S cnh tranh ny lm gim chuyn ho ca chng, v c nguy c
lm tng nng ca chng trong huyt tng mt cch ng k. Nguy c tng
c tnh vi gan v vi mu (thiu mu tan mu, bnh bch cu ty cp). Tng
tc dc ng hc v chuyn ho thuc.
X l: Theo di u n v mu (huyt ). Theo di chc nng gan ( nh
lng thng xuyn cc enzym gan). Gim liu saquinavir khi cn.
730
Sildenafil
Phn tch: Khi dng cng vi saquinavir hay mt s khng protease khc
nh ritonavir, amprenavir, nng sildenafil trong huyt tng c th tng ng
k, gy ra h huyt p nghim trng, c th dn ti t vong. C ch l cc khng
protease c ch s chuyn ho ca sildenafil thng qua CYP3A4.
X l: Vi ngi bnh dng saquinavir hay cc khng protease khc, vic
s dng sildenafil phi rt thn trng, vi liu ban u thp, khng qu 25mg
trong 48 gi.

Interleukin
Phn tch: Interleulin dng cng saquinavir hay cc khng protease, lm tng
nng cc khng protease trong huyt tng, gy tng c tnh. C ch l
interleukin c ch s chuyn ho cc khng protease, thng qua CYP3A4.
X l: Phi hiu chnh liu cc khng protease khi bt u dng v khi
ngng interleukin.
Nevirapin
Phn tch: Dng ng thi, nevirapin lm gim nng cc khng protease
trong huyt tng, nn lm gim tc dng iu tr, do c th lm tng s chuyn
ho cc thuc ny gan, thng qua CYP3A4.
X l: Theo di cht ch nng cc khng protease trong huyt tng khi
bt u dng v khi ngng nevirapin. Hiu chnh liu cc khng protease khi cn.
Phn tch: Ketoconazol c ch chuyn ho saquinavir gan, nn lm tng
nng saquinavir trong huyt tng (tng 1,5 ln) v tng c tnh ca thuc
ny.
X l: Nu liu lng khng vt qu 200 mg/ ngy i vi ketoconazol v
1,8g/ ngy i vi saquinavir, khng cn thay i liu lng saquinavir. Trng
hp tri li, phi gim liu lng saquinavir.

Benzodiazepin
Phn tch: Do cnh tranh khu cytochrom P450, saquinavir c th lm gim
chuyn ho benzodiazepin, nn lm tng nng trong huyt tng v tng c
tnh ca cc thuc ( c m t vi triazolam v midazolam).
X l: Theo di ngi bnh cht ch v cc tc dng c.
Quinidin hoc dn cht; dihydropyridin; diltiazem; verapamil
Phn tch: Do cnh tranh khu cytochrom P450, saquinavir c th lm gim
chuyn ho cc thuc ny, nn lm tng nng trong huyt tng v tng c
tnh ca cc thuc .
731
X l: Theo di ngi bnh cht ch v cc tc dng c.
SERMORELIN
Sermorelin l mt peptid tng hp, gm 29 acid amin, c cu trc tng t vi
GRF
(yu t gii phng hormon tng trng), dng nh gi chc nng cc t bo
hng thn ca thu trc tuyn yn v chn on trng hp
thiu ht hormon tng trng
CC THUC TRONG NHM

SERMORELIN ng bt ng kh 50 mcg
Gerel ng bt ng kh 50 mcg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: V thn trng.
Thi k mang thai: Do tc dng ca thuc trn thai nhi.
732
SOTALOL
L thuc chn beta, cn c tc dng chng lon nhp tim
v thuc nhm III ca Vaugham - Williams
CC THUC TRONG NHM

SOTALOL vin nn 80 mg; 160 mg
Darob vin nn 80 mg; 160 mg
Sotahexal vin nn 80 mg; 160 mg
Sotalex vin nn 80 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Ngi bnh cao tui: Chng ch nh tuyt i ngi bnh cao tui c cc hi
chng sau: Bloc nh-tht khng lp my to nhp, suy tim sung huyt khng ki m sot
c, hen, bnh phi v ph qun mn tnh nng c tc nghn, nhp tim chm nng,
bnh Raynaud, sc do tim, bnh xoang (nt Keith - Flack), u t bo a crm khng iu
tr, huyt p thp, au tht Prinzmetal.
Cc trng hp khc: Tng huyt p do u t bo a crm: dng thuc phi thn
trng. Qu mn vi cc thuc chn beta.
Cn nhc li ch/ nguy c: mc 3

Thi k cho con b: Thuc qua c sa m. Trnh s dng
Suy tim: Tt c cc thuc chn beta u lm gim tn s v lu lng tim. iu
ny l ngun gc ca nhiu tai bin tim mch (nhp tim qu chm, l nh cc u chi,
mt b trng hp suy tim, suy tim sung huyt), ni chung c lin quan n bnh tim
c.
Suy h hp, hen: Nguy c cn hen nng ngi c t bm. Cn theo di ngi
bnh vim ph qun mn tnh tc nghn.
Cc trng hp khc: Bloc-nh tht khng lp my to nhp, suy tim sung huyt
khng kim sot c, nhp tim chm nng, bnh Raynaud, sc do tim, bnh xoang
(nt Keith Flack), u t bo a crm khng iu tr, h huyt p, au tht Prinzmetal.

Suy thn: Na i ca thuc chn beta b ko di, nht l khi thuc chuyn ho
chm v o thi qua thn, nh trng hp ny. Hiu chnh li liu lng cho thch
hp.
733
Cn theo di: mc 1
Tiu ng: Cc thuc chn beta che lp cc du hiu h glucose mu (tr i
khi tot m hi). thy nhng tai bin nghim trng km theo hn m ng i bnh
tiu ng iu tr bng cc thuc ung h glucose mu hay bng insulin.
Thi k mang thai: Cc thuc chn beta hnh nh khng gy qui thai v c th
dng iu tr tng huyt p do mang thai. Him c tai bin cho thai nhi (nhp tim chm,
suy dinh dng, h glucose mu) do gan cha trng thnh.
TNG TC THUC

Benzamid
Phn tch: Trong nhm benzamid, ch c sultoprid (Barnetil*) c th gy
nguy c. Tt c cc thuc c tc dng hng c m tnh (cht gy chm nhp
tim) c th lm tng nguy c lon nhp tht, c bit xon nh do cng thm cc
tnh cht in sinh l ca sultoprid.
X l: Chng ch nh v phi cm phi hp thuc ny.
Bretylium; vincamin
Phn tch: Tng nguy c xon nh do tc dng hip ng. H kali mu,
nhp tim chm, v khong QT di c t trc (ch c th thy trn in tm ) l
nhng yu t thun li cho xut hin cc xon nh.
X l: Chng ch nh v khng c k n phi hp thuc c kh nng
gy t vong ny.
Cisaprid
Phn tch: Kt hp vi sotalol hay nhiu thuc chng lon nhp khc c th
tng nguy c lon nhp tim e do tnh mng, bao gm xon nh. Nguyn nhn
c th do hip ng ko di khong QT.
X l: Chng ch nh dng cisaprid cho ngi bnh ang dng cc thuc
chng lon nhp loi Ia v III.
Cht cn quang c iod
Phn tch: Nu gp d ng, cc cht chn beta (k c dng thuc nh mt)
lm gim b tim mch, c bit trong trng hp h huyt p hay sc. S ti t
adrenalin cho php c th c mt p ng sinh l bnh thng trong trng hp
sc phn v. Chnh p ng ny b phong b.
X l: Hi tin s bnh tt. C phi y l ln u m ngi bnh c
dng thuc cn quang c iod. Khi b sc, c ch b b gim c th nguy him, v
phi chng ch nh phi hp ny. Khng k n cho nhng ngi bnh c tin
s d ng.
734
Floctafenin
Phn tch: Nu c phn ng d ng, cc cht chn beta lm gim b tim
mch, c bit trong trng hp h huyt p hay sc.
X l: Hi tin s bnh tt. C phi y l ln u m ngi bnh dng
floctafenin khng. Trong trng hp sc, s gim c ch b c th nguy him, v
phi chng ch nh phi hp thuc ny. Khng x l cho ngi bnh c tin s
d ng.
Phn tch: Tng tc ny ch mi c m t vi astemizol (Hismanal*), l
khng histamin H1 c coi l khng c tnh cht an thn: tng nguy c xut hin
xon nh.
X l: Chng ch nh phi hp cc thuc ny. Chn mt khng histamin
khng c tc dng an thn khc, khng gy xon nh (cetirizin, loratadin).
Macrolid
Phn tch: Tng nguy c xon nh do tc dng hip ng. Vn ny ch
c m t vi erythromycin tim tnh mch. H kali mu, nhp tim chm v
khong QT di c t trc (ch nhn thy trn in tm ) l nhng yu t thun
li cho xut hin xon nh. Trong nhm macrolid, ch c erythromycin, c bi t
di dng tim tnh mch l c th gy ri lon nhp tim (ko di khong QT,
ngoi tm thu tht, xon nh, bloc nh-tht).
X l: Chng ch nh v khng c k n phi hp thuc c tim nng
gy t vong ny. Ngay khi dng n c, erythromycin tim tnh mch cng c th
gy lon nhp tim. Khng nn tim thuc nhanh, m phi truyn tnh mch nh
git lin tc hay cch qung, thi gian truyn thuc mi ln phi ko di t nht 60
pht.
Sparfloxacin
X l: Chng ch nh phi hp ny. Cn chn hoc mt fluoroquinolon
khc, hoc mt thuc khc, ty theo mc ch iu tr. Nu phi hp thuc ny
tuyt i cn thit, bt buc phi theo di in tm v lm sng, c bit ch
ngi c t bm cng vi khong QT di.
Phn tch: Phi hp thuc khng hp l. i khng dc l, dng trong
trng hp qu liu cc thuc chn beta. Cng thy tng tc ny khi dng thuc
nh mt c cha cc thuc chn beta.
X l: Ch c th qun l c phi hp ny ti bnh vin, c lu phn
bit cc thuc chn beta c hot tnh cng giao cm vi cc thuc chn beta
khng c hot tnh cng giao cm.
735
Ziprasidon
Phn tch: Kt hp vi sotalol hay nhiu thuc chng lon nhp khc, tng
nguy c lon nhp tim e do tnh mng, bao gm xon nh. C th do hip
ng ko di khong QT.
X l: Chng ch nh ziprasidon vi ngi bnh dng sotalol hay nhiu
thuc chng lon nhp khc.

Amiodaron
Phn tch: Amiodaron lm nng thm chng nhp tim chm do thuc chn
beta gy ra. C th xut hin ri lon nhp xoang v bloc nh-tht, c bi t v i
nhng ngi bnh c tin s ri lon nhp xoang.
X l: Nu buc phi phi hp thuc, iu quan trng l phi gim liu v
theo di in tm . Cn nh l amiodaron c na i l 28 ngy, nn tc d ng
ca tng tc c th tn ti nhiu tun sau khi ngng iu tr.
Corticoid khong
Phn tch: Nguy c xon nh khi dng phi hp thuc ny. H kali mu,
nhp tim chm v khong QT di c t trc (ch nhn thy trn in tm ) l
nhng yu t to iu kin xut hin xon nh.
X l: Cn trnh phi hp ny, v dng nhng thuc khng gy xon nh.
Nu cn phi hp thuc ny, phi theo di lin tc khong QT v nh lng u
n kali mu. Cn ch n cc du hiu lm sng bo trc gim kali mu nh
mt mi, yu c, chut rt.
Flecainid hoc thuc tng t; propafenon
Phn tch: Phi hp cc thuc chng lon nhp thuc cc nhm khc nhau
c th dn ti tng nguy c tc dng ph v tim ( khu tnh t ng, dn truyn
tim, nhp tim v tnh hng c).
X l: Theo di cht ch lm sng v in tm .
Phn tch: Guanethidin l cht phong b gii phng noradrenalin
sau hch. Tt c cc cht c tnh cht chn alpha, chn beta, nu phi hp vi
guanethidin, c th lm tng xut hin h huyt p th ng v nhp tim chm.
X l: Tng cng theo di huyt p. Nhn mnh n vic tun th iu tr,
gi gic ung thuc, t khi bt u dng phi hp hai thuc. Cn ch vi ngi
bnh cao tui.
Halofantrin; pentamidin; quinidin hoc dn cht
Phn tch: Dng phi hp thuc ny c nguy c xut hin cc xon nh,
nht l khi h kali mu. H kali mu, nhp tim chm v khong QT di c t trc
(ch thy trn in tm ) l nhng yu t thun li cho xut hin xon nh.
736
X l: Nn trnh phi hp thuc ny, v dng nhng thuc khng gy xon

nh. Nu cn phi hp thuc ny, phi theo di lin tc (khong QT v nh
lng u n kali mu). C th c cc du hiu bo trc h kali mu nh mt
mi, yu c, chut rt.
Prazosin
Phn tch: Kt hp vi sotalol hay nhiu thuc chn beta khc, nguy c h
huyt p th ng s tng. C ch cn cha r.
X l: Cn cnh bo cho ngi bnh bit l c th xut hin cc triu
chng h huyt p th ng nhng thi gian u khi kt hp thuc.
Reserpin
Phn tch: S gim st catecholamin do reserpin gy ra c th lm tng tc
dng ca thuc chn beta (nhp tim chm v h huyt p).
X l: Tng tc ny c th xy ra, v mt dc l, nhng cha c m
t trn lm sng. Phi thn trng v khi c iu g bt thng cn thng bo v
Phn tch: i khng dc l (cc thuc cng giao cm c dng trong
trng hp qu liu cc thuc chn beta).
X l: S i khng dc l ny, nu khng c theo di lin tc (in tm
v huyt p) c th gy tng huyt p, nhp tim chm nng km theo sc tim.
Phi lu n cc dng thuc (dng dng ti ch, ung hay tim), nh gi
nguy c.

Amphotericin B
Phn tch: Nguy c xon nh khi phi hp vi amphotericin B di dng
tim. H kali mu, nhp tim chm v khong QT di c t trc (ch nhn thy
trn in tm ) l nhng yu t thun li cho xut hin xon nh.
X l: Nu cn phi hp thuc ny vi amphotericin B tim, phi phng
gim kali mu bng cch tng cng theo di cht ch v kim tra in tm .
Trong trng hp xut hin xon nh, khng dng cc thuc chng lon nhp.
Khuyn ngi bnh gp li bc s khi thy mt mi, yu c, chut rt.
Baclofen
X l: Theo di huyt p v hiu chnh liu thuc chng tng huyt p
trong khi iu tr v sau khi ngng phi hp thuc, c bit thn tr ng ng i
bnh cao tui.
737
Bepridil
Phn tch: V tc dng hng c m tnh r rt ca cc thuc ny, c nguy
c chm nhp tim qu ng, ngng xoang, ri lon dn truyn xoang, nh-tht v
suy tim.
X l: Ch c th phi hp thuc nu theo di c in tm u n,
c bit ngi bnh cao tui v lc bt u iu tr. Cn ch khi ngng hai
thuc i vi ngi bnh ng mch vnh.
Butyrophenon
Phn tch: Tng tc dng h huyt p ca cc thuc.
X l: Nu cn phi hp thuc, tng cng theo di huyt p trong khi iu
tr v khi ngng mt trong hai thuc. C khi phi hiu chnh liu lng cho thch
hp. Nhn mnh k hoch iu tr v yu cu tun th. Cn c bit thn trng
khi s dng ngi bnh cao tui.
X l: Theo di huyt p sut thi gian phi hp thuc. Tu theo thuc, h
huyt p c th nng hay nh. Hiu chnh liu lng ca mt hay hai thuc khi
cn. Thit lp mt k hoch dng thuc u n. Tng cng theo di nhng
ngi bnh cao tui (nguy c ng) v khuyn chuyn dn dn t t th nm
hoc ngi sang t th ng, khuyn ngi bnh gp li bc s iu chnh liu
lng, nu thy chng mt khi bt u iu tr.
Clonidin hoc thuc tng t; methyldopa
Phn tch: Phi hp hai thuc chng tng huyt p, mt phi hp c th
thc hin c v mt dc l v iu tr. Cn ch sotalol hay c dng lm
thuc chng lon nhp tim hn l thuc chng tng huyt p.
X l: Nu cn phi hp thuc, phi tng cng theo di huyt p trong khi
iu tr v khi ngng mt trong hai thuc. Cn thn khng ngng t ngt
clonidin, v nguy c tng p lc trong s v kh nng chy mu no. Nu cn,
ngng clonidin rt t t. Tin hnh hiu chnh liu lng cho thch hp, khi cn.
Nhn mnh vi ngi bnh v k hoch dng thuc v yu cu tun th. Cn
c bit cnh gic khi s dng ngi bnh cao tui.
Clozapin
X l: Theo di huyt p, v hiu chnh liu lng thuc chng tng huyt
p trong khi iu tr v sau khi ngng clozapin.
Dextropropoxyphen
Phn tch: Dextropropoxyphen c tc dng h huyt p nh. Phi hp vi
cc thuc h huyt p khc, s tng tc dng h huyt p v tng nguy c h
huyt p t th ng.
738
X l: Cn phi theo di huyt p khi phi hp thuc (trong khi iu tr v

sau khi ngng mt trong hai thuc). H huyt p nng hay nh tu thuc thuc
dng. Khi cn, iu chnh liu lng mt hoc hai thuc cho thch hp. Lp mt
k hoch dng thuc u n. Tng cng theo di khi s dng ngi bnh
cao tui (nguy c ng), v khuyn nn chuyn dn dn t t th nm hoc ngi
sang t th ng. Khuyn ngi bnh gp li bc s iu chnh liu lng, khi
thy chng mt lc bt u iu tr.
Phn tch: V tc dng hng c m tnh r rt ca cc thuc ny, c nguy
c chm r rt nhp tim, ngng xoang, ri lon dn truyn xoang, nh-tht v suy
tim.
X l: Ch phi hp thuc nu theo di c u n in tm , c bit
khi dng ngi bnh cao tui v lc bt u iu tr. Cn thn trng khi ngng
hai thuc ngi bnh ng mch vnh.
Disopyramid
Phn tch: Tng tc dng ca cc thuc chn beta. Nguy c xut hin ri
lon tnh co c, lm chm tn s tim v gim dn truyn tim.
X l: Cn tng cng theo di lm sng v theo di in tm khi phi
hp thuc.
Phn tch: y l trng hp phi hp hai thuc co mch ngoi bin. Phi
hp ny gp trong trng hp au na u dai dng. Mt s him trng hp
thiu mu cc b ngoi bin nghim trng, km theo phi ct ct chi c m
t. Cn phi theo di tht cht nhng phi hp vi propanolol, oxprenolol;
methylsergid cng c th k trong s .
X l: C th thc hin phi hp thuc ny, nhng phi theo di lm sng,
nht l theo di xut hin tc dng ph lc bt u v trong nhng tun iu tr
u tin. Ngng iu tr ngay lp tc khi thy bt k du hiu bo ng nh no.
Hi ngi bnh thng xuyn v nhng cm gic c th c u cc chi do tun
hon km.
Phn tch: Nguy c xon nh khi phi hp cc thuc ny. H kali mu, nhp
tim chm v khong QT di c t trc (ch nhn thy trn in tm ) l
nhng yu t to iu kin xut hin xon nh.
X l: Nu cn phi hp thuc, phi phng h kali mu thng qua theo
di cht ch ngi bnh, v theo di in tm . Khi xut hin xon nh, khng
dng thuc chng lon nhp tim. Khuyn ngi bnh gp li bc s khi thy mt
mi, yu c, chut rt.
739
Glucagon
Phn tch: Glucagon lm tng tn s tim, v tng tnh co c tim (iu tr qu
liu thuc chn beta). Ngoi ra, p ng tng glucose mu mong i bng cch
iu tr vi glucagon s gim ngi bnh ang dng thuc chn beta.
X l: Tt c ph thuc vo mc ch iu tr. Phi hp thuc c th c
thc hin, thm ch c khuyn ngh trong trng hp th nht (iu tr qu liu
thuc chn beta), nhng khng c khuyn ngh vi trng hp th hai.
Glucocorticoid
Phn tch: Nguy c xut hin xon nh khi phi hp cc thuc ny. H kali
mu, nhp tim chm v khong QT di c t trc (ch nhn bit c trn
in tm ) l nhng yu t to iu kin xut hin xon nh.
X l: Nu cn phi hp sotalol vi cc glucocorticoid, cn d phng h kali
mu thng qua tng cng theo di ngi bnh v theo di in tm . Khi c
xon nh, khng dng thuc chng lon nhp tim. Khuyn ngi bnh gp l i
bc s khi thy mt mi, yu c, chut rt.
Glycosid tr tim
Phn tch: C th s dng hai thuc ny, nhng cn tranh ci ty theo thuc
chn beta c dng, v sinh l bnh hc ca ngi bnh. Tng nguy c nhp tim
chm. Sotalol l thuc chn beta thng c dng nh thuc chng lon nhp
tim.
X l: Phi hp thuc ny dnh cho bc s chuyn khoa trong mt s ch
nh r rng, vi iu kin c th theo di c nhng tc dng ca phi hp hai
thuc ny (in tm ).
Insulin; sulfamid chng tiu ng
Phn tch: Thuc chn beta c th che lp triu chng h glucose mu, v
lm tng tc dng ca cc sulfamid chng tiu ng v ca insulin trong tiu
ng. iu ny c th dn ti hn m h glucose mu m khng c nhng du
hiu bo trc.
X l: Nu cn phi hp thuc, thng bo cho ngi bnh bit v nguy c
c th xut hin nhng du hiu h glucose mu (nhp tim nhanh, tot m hi,
run, hi hp, cm gic i, lo u...). iu tr tng huyt p ngi tiu ng,
nn chn cc thuc c ch enzym chuyn dng angiotensin.
Phn tch: Phi hp vi cc thuc chng tng huyt p c th lm tng
X l: Theo di huyt p trong khi dng v khi ngng mt trong hai thuc,
c bit ch i vi ngi bnh cao tui.
740
Phenothiazin
mt tc dng khng mong mun quan trng ca cc thuc an thn kinh dn xut
ca phenothiazin.
X l: Mc du sotalol c k n nh mt thuc chng lon nhp tim,
hn l mt thuc h huyt p; nu cn phi hp thuc ny vn phi tng cng
theo di huyt p trong v khi ngng iu tr mt trong hai thuc. Khi cn, hi u
chnh liu lng cho thch hp. Nhn mnh n k hoch dng thuc v s tun
th trong iu tr. Cn cnh gic c bit khi s dng ngi bnh cao tui.
Phn tch: Dng ng thi hai thuc ny c th dn ti nhng bin ng
quan trng v huyt p.
X l: Cc thuc c ch MAO him khi c s dng, tng tc rt nhiu,
do him c nhng n ghi thuc ny, nn c t nhn xt v cnh gic thuc.
Cng vn nn thn trng sau khi ngng thuc, phi i mt thi gian t 2 n 3
tun l mi dng cc thuc c ch MAO.
Tacrin
Phn tch: Tc dng gy chm nhp tim ca tacrin c nguy c cng thm
vo vi tc dng ca cc cht chn beta.
X l: Nu phi hp thuc ny, phi theo di lm sng v in tm u
n. Khuyn ngi bnh bo cho bc s khi c cm gic kh chu v tim.
Tetracosactid
Phn tch: Nguy c xut hin xon nh khi phi hp cc thuc ny. H kali
mu, chm nhp tim, v khong QT di c t trc (ch nhn bit c trn
in tm ) l nhng yu t to iu kin xut hin xon nh.
X l: Nu cn phi hp gia tetracosactid v sotalol, phi d phng h kali
mu bng tng cng theo di, v kim tra in tm . Khi c xon nh, khng
dng thuc chng lon nhp. Khuyn ngi bnh gp li bc s khi thy mt mi,
yu c, chut rt.
Phn tch: c ch phosphodiesterase do theophylin v cc dn cht ca n
s ko theo kch thch cc th th beta adrenergic, do c tc dng i khng.
X l: Theo di tc dng i khng c th xy ra khi bt u, khi ang v
khi ngng iu tr. Hi ngi bnh khi cp pht li n thuc. Tng tc ny
c m t, nhng cn cn thu thp thm ti liu. Bc s k n v ng i pht
thuc cn lun lun cnh gic. Chuyn v Trung tm cnh gic thuc nhng
nhn xt thu thp c.
Phn tch: Tng tc dng h huyt p ca cc thuc ny.
741
X l: Nu cn phi hp thuc, tng cng theo di huyt p trong khi iu

tr, v khi ngng mt trong hai thuc. Hiu chnh liu lng cho thch hp khi cn.
Nhn mnh n k hoch dng thuc v tun th iu tr. Cn c bit cnh
gic khi s dng ngi bnh cao tui.
Phn tch: C th ko di tnh trng h huyt p, v lm mt phn x p
ng ca tim do cm ng cc th th beta - adrenergic. Nhc im ny c th
khc phc bng cch dng dobutamin, dopamin hay isoproterenol... mt cch rt
thn trng.
X l: Bc s gy m phi theo di y (my theo di lin tc) c th
can thip bt k lc no.
Thuc gy m cc loi
Phn tch: Tng tc ty thuc tc dng i vi tim v gy chm nhp tim
ca mt s thuc chn beta.
X l: Khi phi phu thut, khuyn ngi bnh thng bo cho bc s gy m
bit cc thuc dng.
X l: Cn hiu chnh liu lng cho thch hp; xy dng k hoch dng
thuc v nhn mnh ngi bnh phi tun th. Khi bt u iu tr, khuyn ngi
bnh o (hay nh o) u n huyt p cho ti khi t c cn bng trong iu
tr.
Thuc khng acid ung hoc than hot tnh
Phn tch: Thuc khng acid lm gim hp thu qua ng tiu ho v gy
gim tc dng ca thuc phi hp. Tng tc ny xut hin khi dng atenolol,
metoprolol, propranolol.
X l: Dng thuc khng acid v thuc phi hp phi cch nhau t nht 2
gi. Cn nh cc thuc khng acid thng c dng 1 gi 30 pht sau ba n,
v n l nguyn nhn tng tit dch v.
Thuc li tiu gi kali
Phn tch: Tng tc dng h huyt p. Thng sotalol ch dng lm thuc
chng lon nhp.
X l: Cn phi hiu chnh liu cho thch hp; xy dng mt k hoch dng
thuc, v yu cu ngi bnh tun th. Lc bt u iu tr, khuyn ngi bnh o
(hay nh o) huyt p u n cho n khi c cn bng trong iu tr.
Phn tch: Nguy c xut hin xon nh (ri lon nhp tht) khi phi hp mt
thuc li tiu thi kali vi thuc chng lon nhp. H kali mu, nhp tim chm v
742
khong QT di c t trc (ch nhn thy trn in tm ) l nhng yu t

to iu kin xut hin xon nh.
X l: Nu cn phi hp mt thuc li tiu thi kali vi thuc chng lon
nhp tim ny, phi d phng h kali mu bng cch b sung kali v khi
cn th phi lm in tm . Khi xut hin xon nh, khng dng thuc chng
lon nhp. khuyn ngi bnh gp li bc s nu thy mt mi, yu c, chut rt.
Phn tch: Thuc nhun trng lm trn dng lu di c th dn ti h kali
mu, do tng nguy c xut hin xon nh khi phi hp vi sotalol. H kali
mu, nhp tim chm, khong QT di c t trc (ch nhn bit c trn in
tm ) l nhng yu t to iu kin xut hin xon nh.
X l: Phi theo di khi phi hp thuc ny. Tt nht hoc ngng thuc
nhun trng, hoc dng cc thuc khng gy xon nh.
Phn tch: C nguy c xut hin xon nh khi phi hp cc thuc ny.
Gim kali mu, nhp tim chm v khong QT di c t trc (ch nhn bit
c trn in tm ) l nhng yu t to iu kin xut hin xon nh.
X l: Tt hn ht l ngng dng thuc nhun trng. Nu cn phi hp,
phi d phng h kali mu thng qua tng cng theo di, v theo di in tm
. Nu xut hin xon nh, khng dng thuc chng lon nhp tim. Khuyn
ngi bnh gp li bc s khi thy mt mi, yu c, chut rt.

Phn tch: Tng tc dc lc; tng tc dng alpha adrenergic vi cc hu
qu nh h huyt p, nhp tim chm v c th bloc tim.
X l: Hiu chnh liu lng cho thch hp v theo di cht ch huyt p.
Khuyn ngi bnh t theo di huyt p.
Dihydropyridin
Phn tch: Tng tc dng h huyt p. Nhng sotalol thng c dng lm
thuc chng lon nhp tim hn l thuc chng tng huyt p. C th phi hp
dihydropyridin vi cc thuc chn beta vi iu kin phi chn ng thuc
dihydropyridin, v c ch nh ng.
X l: Him khi sotalol c dng lm thu c ch ng tng huy t p, nh ng
mc ch iu tr c th l cha ng th i tng huy t p v lo n nh p tim.
Trong trng hp ny, cn lp k hoch dng thu c v yu c u tun th . Khi
bt u iu tr, khuyn ng i bnh o (hay nh o) huy t p u n cho
n khi c kt qu n nh trong i u tr. Hi u ch nh li u l ng, n u c n.
743
Indometacin hoc dn cht pyrazol; salicylat; thuc chng vim khng

steroid
Phn tch: Gim tc dng chng tng huyt p. Cc thuc chng vim
khng steroid c ch tng hp thn prostaglandin gy gin mch v/ hoc ko
theo gi nc v natri. C nguy c suy thn cp ngi bnh mt nc.
X l: Phi lu tng tc ny khi k n, c bit vi indometacin v cc
salicylat liu cao. m bo cung cp nc y cho ngi bnh. Theo di chc
nng thn ( thanh lc creatinin). Xc nh tnh n nh ca huyt p, c bi t
khi bt u iu tr. Khuyn ngi bnh thng xuyn t theo di huyt p.
mt tc dng khng mong mun ca cc thuc chng trm cm ba vng.
X l: Nu cn phi hp thuc, phi tng cng theo di huyt p trong v
khi ngng iu tr mt trong hai thuc. Hiu chnh liu lng khi cn. Nhn mnh
v k hoch dng thuc v s tun th iu tr. Cn c bit cnh gic khi dng
ngi bnh cao tui.
Phn tch: Dng ng thi cc thuc chng tng huyt p hay thuc c th
gy h huyt p vi cc thuc gy m barbituric c th gy h huyt p nng.
X l: Ch s dng cc thuc gy m bnh vin v c theo di ngi
bnh cht ch. Khi khm trc phu thut, bc s gy m phi lu cc t ng
tc ni trn tnh liu thuc gy m cn thit.
744
SPARFLOXACIN
Khng sinh thuc nhm fluoroquinolon
CC THUC TRONG NHM

MOXIFLOXACIN
Avelox vin bao phin 400 mg
GREPAFLOXACIN
Raxar
SPARFLOXACIN vin nn 200 mg; vin nn bao phim 200 mg
Flospar vin nn bc 200 mg
Genspar vin nn bc 200 mg
Omniflox vin nn bc 200 mg
Sparbact vin nn bc 200 mg
Spardac vin nn bc 200 mg
Spartin vin nn bc 200 mg
CH KHI CH NH THUC

Thi k cho con b: Cc quinolon qua c sa m.
Thiu ht G6PD: Cc quinolon gy cc cn tan mu cp tnh trong trng hp
thiu ht G6PD trong hng cu.
Tr nh - tr cn b: Tc dng trn sn ni.
Thi k mang thai: Khng c dng cc quinolon cho ngi mang thai. V
khng chng minh c cc quinolon ch c tc dng hn ch trn ADN ca vi khun,
nn cn trnh dng trong khi mang thai.
Cc trng hp khc: Qu mn vi nhm thuc ny. Phi nng hay chiu tia t
ngoi: c tnh nng vi nh sng. Tin s bnh v gn.
Cn theo di: mc 1
ng kinh: Acid nalidixic c th gy cc cn co git.
Suy gan: Do chm bt hot thuc.
Suy thn: Do cc quinolon o thi ch yu qua thn.
TNG TC THUC
745

Amiodaron
X l: Cm phi hp hai thuc ny. Cn chn mt thuc chng lon nhp
tim khc, hay mt fluoroquinolon khc.
Benzamid; bretylium; disopyramid; halofantrin; pentamidin; procainamid;
quinidin hoc dn cht; sotalol; vincamin;
X l: Nn trnh phi hp thuc. Nn chn mt fluoroquinolon khc, hoc
mt thuc khc, tu mc tiu iu tr. Nu phi hp thuc tht s cn thit, th
bt buc phi theo di lm sng v in tm , c bit ngi c yu t bm
sinh vi khong QT di.
Bepridil
Phn tch: Kt hp vi mt s quinolon nh sparfloxacin, grepafloxacin,
nguy c c lon nhp nng c th gy t vong, k c xon nh s tng. C ch
cha r.
X l: Sparfloxacin chng ch nh ngi bnh iu tr vi nhng thuc
ko di khong QT, nh bepridil. Tng t, grepafloxacin cng chng ch nh
trong trng hp ny, tr khi c theo di chc nng tim lin tc (trong bnh vin).
Cc quinolon khc khng ko di khong QT hay khng b CYP 3A4 chuyn ho c
th dng thay th.
Cisaprid
Phn tch: Cc tc dng ph v tim mch ca cisaprid tng v tc dng
dc l ca sparfloxacin cng tng khi kt hp hai thuc ny. C ch: Tc hp
thu sparfloxacin tng khi kt hp hai thuc.
X l: Chng ch nh sparfloxacin vi ngi bnh ang dng cc thuc c
tc dng ko di khong QT, hoc cc thuc bit trc l c th gy xon
nh nh cisaprid. Nguy c gy cc tc dng ph v tim mch c bit cn lu
ngi bnh c bnh tim t trc, c khong QT ko di, c lon nhp hay mt
cn bng in gii.
Phenothiazin
Phn tch: Vic phi hp vi sparfloxacin, grepafloxacin lm tng nguy c
lon nhp e do tnh mng bao gm xon nh. C ch cn cha r.
X l: Chng ch nh sparfloxacin, grepafloxacin ngi bnh ang dng
cc thuc ko di khong QT hoc khng b chuyn ho bi isoenzym CYP3A4.
Phn tch: Vic phi hp vi sparfloxacin hay mt vi quinolon khc
(grepafloxacin) lm tng nguy c lon nhp nng, k c xon nh c th dn n
t vong. C ch cn cha r.
746
X l: Chng ch nh sparfloxacin, grefloxacin ngi bnh dng cc

thuc ko di khong QT, nh cc thuc chng trm cm ba vng. Nhng
quinolon khng c tc dng ko di khong QT hoc khng b chuyn ho bi
isoenzym CYP3A4 c th dng thay th sparfloxacin, grepafloxacin.
Phn tch: Tng tc ny mi ch c m t vi mt khng histamin H 1 l
astemizol (Hismanal). Tng nguy c xon nh.
X l: Cn trnh phi hp thuc. Nn chn mt fluoroquinolon khc, hoc l
mt khng histamin khng an thn khc khng gy xon nh (cetirizin, loratadin).
Ziprasidon
Phn tch: Dng kt hp vi sparfloxacin, moxifloxacin th nguy c lon nhp
e do tnh mng bao gm c xon nh. C th l do hip ng cc tc d ng
ko di khong QT.
X l: Chng ch nh dng ziprasidon ngi bnh ang dng sparfloxacin
hay moxifloxacin.

Amphotericin B; corticoid - khong; glucocorticoid; thuc li tiu thi kali;
thuc nhun trng kch thch; tetracosactid
Phn tch: Phi hp thuc ny lm tng nguy c xon nh. H kali mu,
nhp tim chm v khong QT di c t trc (ch nhn thy trn in tm )
l nhng yu t to iu kin xut hin xon nh.
X l: Nn trnh phi hp thuc. Nn dng nhng thuc khng gy xon
n kali mu. Khuyn ngi bnh gp li bc s khi thy mt mi, yu c, chut
rt.
Furosemid
Phn tch: Ch thy tng tc ny khi phi hp vi sparfloxacin (Zagam *):
Tng nguy c xon nh do hip ng cc tc dng in sinh l. H kali mu,
nhp tim chm v khong QT di c t trc (ch nhn thy trn in tm )
l nhng yu t to iu kin xut hin xon nh.
X l: Nn trnh phi hp thuc ny. Nn dng cc thuc khng gy xon
n kali mu. Khuyn ngi bnh gp li bc s khi thy mt mi, yu c, chut
rt.
Macrolid
Phn tch: Ch thy tng tc ny khi phi hp vi sparfloxacin (Zagam*).
Tng nguy c xon nh do hip ng cc tc dng in sinh l khi dng cng vi
erythromycin tim tnh mch (cha c ti liu ni ti cc macrolid khc). H kali
mu, nhp tim chm v khong QT di c t trc (ch nhn thy trn in tm
) l nhng yu t to iu kin cho xon nh.
747
X l: Nn trnh phi hp ny. Nn dng cc thuc khng gy xon nh.

Nu cn phi hp thuc ny, phi theo di lin tc khong QT v phi kim tra
u n kali mu. Khuyn ngi bnh gp li bc s khi thy mt mi, yu c,
chut rt.

Didanosid
Phn tch: Tng pH d dy, do c cht khng acid trong vin nn
didanosid, c th lm gim hp thu theo ng tiu ho.
X l: Tng tc ny c th gy tht bi trong iu tr bng khng sinh tr
liu nu hai thuc c dng ng thi. Khuyn ngi bnh nn dng hai thuc
ny cch nhau 2 gi.
St
Phn tch: Cc quinolon ni chung v cc fluoroquinolon ni ring, khi ung s
to phc vi cc cation ho tr 2 v 3 nh nhm, magnesi, calci, st v km v.v...
Tn trng trit khong cch trn 2 gi gia cc ln ung hai thuc.
X l: Phi lu n tng tc v khuyn ngi bnh tn trng khong
cch gia ung hai thuc t nht 2 gi.
Sucralfat
Phn tch: Dng quinolon cng sucralfat, tc dng dc l ca cc quinolon,
nh sparfloxacin s gim, do s hp thu ng tiu ho gim.
X l: Nu khng trnh c kt hp hai thuc ny, th dng sucralfat t
nht 6 gi k t lc dng quinolon.
Theophylin hoc cc dn cht
Phn tch: Tng na i ca theophylin, c th do c ch cnh tranh v tr
lin kt vi cytochrom P450 (c bit vi ciprofloxacin, enoxacin, norfloxacin,
pefloxacin). Tng nng trong huyt thanh v c tnh vi thn kinh ca
xanthin.
X l: Theo di lm sng, v nu cn, hiu chnh liu lng theo nng
theophylin trong huyt thanh trong khi dng v khi ngng dng cc quinolon ni
trn. Cng c th thay i chin lc iu tr vi khng sinh theo nguy c qu liu
theophylin.
Phn tch: Cc quinolon ni chung v cc fluoroquinolon ni ring khi ung
s to phc vi cc cation ho tr 2 hay 3, nh nhm, magnesi, calci, st v km
v.v... lm gim hp thu thuc.
X l: Cn cch nhau t nht 2 gi gia ln ung thuc khng acid vi ln
ung thuc ny. Nh l thuc khng acid thng c ung 1 gi 30 pht sau
ba n, v n l nguyn nhn ca tng tit dch v.
748
STEROID GY NG HO, ALKYL HO C17

Dn cht androgen, trn l thuyt t tc dng nam ho,
ng thi gy ng ho mnh
CC THUC TRONG NHM

MESTEROLON
Provironum vin nn 25 mg
NANDROLON ng tim 10 mg/1mL; 20 mg/2mL; 25 mg/1mL
Durabolin ng tim 10 mg/1mL
Extraboline ng tim 20 mg/2mL
Metabol 25 ng tim 25 mg/1mL
NANDROLON DECANOAT ng tim 50 mg/1mL; 25 mg/1mL
Deca - Durabolin ng tim 50 mg/1mL
Matader 25 ng tim 25 mg/1mL
TESTOSTERON
Androgel gel bi da 50 mg/5g
TESTOSTERON DECANOAT ng tim 250 mg/1mL
Sustanon 250 ng tim 250 mg/1mL
TESTOSTERON UNDECANOAT
Andriol nang 40 mg
TESTOSTERON heptylat ng tim 50 mg/1mL; 100 mg/1mL; 250 mg/1mL
Heptylat de testosteron ng tim 50 mg/1mL; 100 mg/1mL; 250 mg/1 mL
TESTOSTERON ENANTHAT ng tim 250 mg/1mL
Testosteron enanthate ng tim 250 mg/1mL
Testoviron Depot ng tim 250 mg/1mL
CH KHI CH NH THUC

Thi k cho con b: Do cc steroid qua c sa m.
Tr em: Vic dng cc thuc gy ng ha cho tr nh l vn cn ang tranh
ci. Ngoi nhng tc dng nam ha, thuc c th gy nhng ri lon nghim tr ng v
vnh vin v tng trng. i vi tr em gi cha n tui dy th, tuyt i chng ch
nh loi thuc ny.
749
Thi k mang thai: Thuc ng ho gy nam ha thai nhi n, c th gy tnh i nam

i n gi cc mc khc nhau, ty thi gian bt u dng thuc.
Ph i tuyn tin lit; u tuyn tin lit : Chng ch nh kinh in, v
testosteron kch thch tng sinh cc khi u tuyn tin lit c t trc.
Suy gan: Thuc ng ha c vi gan, c th gy vng da do mt trong gan.
Cn theo di: mc 1
Suy tim: Thuc ng ho c th gy ph n, gi natri v nc, phi trnh s
dng nhng ngi suy tim.
Suy thn: Thuc ng ho c th gy ph n, gi natri v nc, phi trnh s
dng nhng ngi suy thn.
TNG TC THUC

Corticoid - khong; glucocorticoid; tetracosactid
Phn tch: Dng ng thi hai thuc s lm tng nguy c xut hin ph n.
Tng tc dc lc.
X l: Cn nhc xem c cn ghi n c hai thuc khng? Hiu chnh liu
lng cho thch hp v theo di ion . Cn ch n vic s dng "giu dim"
cc steroid ng ho ( nhng vn ng vin).
Cyclosporin
Phn tch: Tng nng cyclosporin trong huyt tng do tng hp thu
hoc do c ch chuyn ho gan.
X l: Do c khc nhau ln gia cc c th, cho nn lc u ch dng na
liu (50% liu dng), v thng xuyn hiu chnh liu cyclosporin khi bt u,
trong khi v khi ngng dng cht ng ho.
Phn tch: Tc dng chng ng mu tng do mt c ch cha c gii
thch r rng. C th do gim lng cc tin yu t ng mu, hay do d ho v
do tng i lc ca cc th th vi cht chng ng mu.
X l: Hiu chnh liu lng lc bt u, trong v sau khi iu tr, ch n
trnh t thi gian dng mi th thuc. Theo di ngi bnh bng o t l chun
ha quc t (INR) hay t l prothrombin (TP).

Phn tch: Steroid ng ho c th lm h glucose mu. Tng tc ny
c xc nhn vi mt s steroid ng ho.
X l: Cn tng cng theo di glucose mu, thng bo cho ng i bnh
bit nguy c (du hiu h glucose mu) v hiu chnh liu cho thch hp. Cc du
750
hiu h glucose mu bao gm: cc du hiu do tit qu nhiu adrenalin nh m

hi, run ry, nhp tim nhanh, lo u, i; cc du hiu do lon chc nng h thn
kinh trung ng nh cm gic kh chu, nhc u, ri lon th gic, gim s sc
so v tr tu, l ln, ng x bt thng, co git, mt thc.
751
SUCCINIMID
Thuc khng oxalat niu (lm gim o thi acid oxalic ra nc tiu)
CC THUC TRONG NHM

SUCCINIMID gi bt ung 3g
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai: Khng dng cho ngi mang thai hay nghi ng mang thai.
SUCRALFAT
Cht chng lot, tc dng ch yu l bo v cc nim mc
ng tiu ho b tn thng
CC THUC TRONG NHM

SUCRALFAT vin nn 1g; hn dch ung 1g; gi bt 1g
Sucrabes vin nn 1g
Sucrace vin nn; hn dch ung 1g
Ulcar gi bt; vin nn 1g
Sucrafar 1g
Sucrat gel 1g
CH KHI CH NH THUC
Cn theo di: mc 1
Suy thn: Nguy c tch ly nhm trong cc m (bnh no) trong trng hp suy
thn ko di.
Cc trng hp khc: Trnh dng lu di trong cng tuyn cn gip v bnh
ci xng lon dng.
TNG TC THUC

Glycosid tr tim
Phn tch: Gim hp thu digoxin.
X l: Khuyn ngi bnh phi tn trng ung mi thuc cch nhau 2 gi.
752
Khng sinh nhm quinolon

Phn tch: Gim hp thu, c m t vi ciprofloxacin, norfloxacin v
lomefloxacin.
Penicilamin
Phn tch: Dng cng vi sucralfat th hiu qu ca penicilamin gim thiu
hoc mt i. C th l do sucralfat gi i phng mt l ng nh ion nhm t do
trong d dy, s to phc vi penicilamin v ngn cn s hp thu ca cht ny.
X l: Dng hai thuc cch xa nhau. Nu cn dng ng thi, phi hiu chnh
liu penicilamin.
Phenytoin; vitamin nhm D
Phn tch: Gim hp thu cc thuc ny khi c mt sucralfat, do tng tc
dc ng hc v hp thu thuc.
X l: Tn trng khong cch 2 gi gia hai ln ung hai thuc ny. Cht
khng acid tt nht c ung sau ba n (c tng tit acid khi n).
Phn tch: Phi hp thuc ny c th c li, tuy nhin vic dng ng thi
hai thuc s lm gim lin kt gia sucralfat vi nim mc.
X l: Phi c mt khong cch t nht 2 gi gia hai ln ung cht khng
acid v ln ung thuc. Nh l cc thuc khng acid thng c dng 1 gi 30
pht sau ba n, v n-ung l nguyn nhn tng tit dch v.
Phn tch: Gim hp thu thyroxin lm gim hot tnh ca n. Tng tc
dc ng hc v hp thu thuc.
X l: Khuyn ngi bnh ung mi thuc cch nhau 2 gi.
Phn tch: Gim hp thu cc thuc ny khi c mt sucralfat (tng tc dc
ng hc v hp thu thuc).
Vitamin A
Phn tch: Dng ng thi cc thuc ny lm gim hp thu v gim hot
tnh ca cc thuc do tng tc dc ng hc v hp thu thuc.
X l: Khuyn ngi bnh trnh dng hai thuc ny ng thi, dng vitamin
A hai gi trc hoc bn gi sau khi dng sucralfat.
753
SULFAMID CHNG TIU NG

Sulfamid kch thch tit insulin ni sinh
CC THUC TRONG NHM

CLORPROPAMID vin nn 250 mg
Apo- Chlorpropamide vin nn 250 mg
Diabinese vin nn 250 mg
GLIBENCLAMID vin nn 3,5 mg; vin nn 5 mg
Apo-Glyburide vin nn 5mg
Betanase vin nn 5 mg
Clamide vin nn 5 mg
Daonil vin nn 5 mg
Glibenclamide vin nn 5 mg
Glibenhexal vin nn 3,5 mg
Maninil vin nn 1,75 mg; 3,5 mg; 5mg
GLICLAZID vin nn 80 mg
Clibite vin nn 80 mg
Diamicron vin nn 80 mg
Glidabet vin nn 80 mg
Predian vin nn 80 mg
Reclide vin nn 80 mg
Zidenol vin nn 80 mg
GLIPIZID vin nn tc dng chm 5 mg; vin nn 5 mg
Dibizide vin nn 5 mg
Glucotrol XL vin nn tc dng chm 5 mg
Glibenese vin nn 5 mg
Minidiab vin nn 2,5 mg; 5 mg
GLIQUIDON vin nn 30 mg
Glurenorm vin nn 30 mg
TOLBUTAMID vin nn 500 mg
Tolbutamid vin nn 500 mg
CH KHI CH NH THUC
754
Chng ch nh: mc 4
Thi k cho con b: C nguy c thuc qua c sa m (c m t vi
clorpropamid), c th gy h glucose mu tr b m.
Thi k mang thai: Sulfamid h glucose mu gy qui thai mt s loi ng vt
v c coi l nguyn nhn gy sy thai v cc d tt. Ph n trong tui sinh c
bnh tiu ng ph thuc insulin hay tr thnh tiu ng trong lc mang thai, bt
buc phi iu tr bng insulin.

Tr em: Bnh tiu ng tp I tr em hoc thiu nin khng phi l mt ch
nh ca cc sulfamid chng tiu ng.
Suy gan, suy thn: Dng liu thp.
Cc trng hp khc: Qu mn cm vi sulfamid.
Cn theo di: mc 1
Ung ru: Bn thn ru c tnh cht h glucose mu, nn lm tng tc dng
ca cc sulfamid chng tiu ng.
Ngi bnh cao tui: Ngi bnh cao tui c bit nhy cm vi cc tai bin
do h glucose mu, v tnh trng qu liu thng hay gp.
755
TNG TC THUC

Probenecid
Phn tch: Probenecid c ch bi tit cc sulfamid qua thn. Tng tc ny
c th c s dng gim liu lng cc sulfamid, nhng c tnh ca bn
thn sulfamid lm cho liu php nguy him, khi v phi hp thuc (nguy c h
glucose mu).
X l: S dng probenecid lm chm o thi nhiu thuc c th v
c thc hin lm gim liu lng mt s thuc. Vn l phi rt cnh
gic v nguy c tim tng ca bin php v c tnh ca thuc phi hp. Cn
xem xt bi cnh sinh l bnh hc c th.
Phn tch: Tng ng k tc dng h glucose mu do cc dn cht imidazol
c ch cytochrom P450. Theo di glucose mu. Tng tc ny ch yu c m t
vi miconazol v fluconazol.
X l: Nu cn phi hp thuc, phi bo trc cho ngi bnh nguy c h
glucose mu tng cng t theo di. Hiu chnh liu lng cho thch hp, lc
bt u, trong v sau khi iu tr.

Danazol
Phn tch: Danazol lm tng glucose mu v tng s khng insulin.
X l: Khi phi hp thuc, cn theo di cht ch nng glucose mu.
Khuyn ngi bnh tng cng t theo di v khi cn, hiu chnh liu lng cho
thch hp bt u, khi ang v khi ngng iu tr vi danazol.
Glucagon
Phn tch: Tng tc dc lc hc. Glucagon to iu kin ng thi cho
s tn to glucose v s thy phn glycogen, bng cch cm ng adenylcyclase
sinh AMP vng. Hu qu l tng nng glucose trong huyt tng.
X l: Phi hp glucagon vi cc thuc h glucose mu l khng hp l, tr
trng hp cn i khng dc l.
Glucocorticoid
Phn tch: Gim tc dng ca cc sulfamid chng tiu ng do tnh cht
tng glucose mu gin tip ca thuc ny. Gim tnh dung np glucid do corticoid
v c nguy c nhim ceton.
X l: Phi tnh ti tc dng ca cc corticoid khi iu tr vi cc thuc
chng tiu ng. Cn lp cn bng nng glucose trong mu lc bt u, lc
ang v sau khi iu tr vi corticoid. Thng bo cho ngi bnh v nhng bin
ng glucose mu, v lp k hoch dng thuc.
756
Methenamin
Phn tch: Trong nc tiu acid, methenamin ging ho thnh formol gy
nguy c kt ta cc sulfamid t ho tan, c th dn n tinh th niu v si thn.
X l: Tt hn l nn thay i thuc.
Pyrazol
Phn tch: Cc prostaglandin tham gia c ch iu ho glucose mu, do
lm tng nguy c h glucose mu. Ngoi ra, cc thuc chng vim khng steroid
lin kt mnh vi cc protein huyt tng, nn c nguy c y sulfamid khi lin
kt vi protein huyt tng.
X l: C th thy nhng bin ng nh glucose mu, i hi phi hiu
chnh liu lng lc bt u, trong khi v sau khi ngng iu tr vi cc pyrazol.
Thng bo cho ngi bnh tng cng t theo di v lp mt chng trnh
dng thuc u n.
Ritonavir
Phn tch: Ritonavir c i lc mnh vi isoenzym 3A4 ca cytochrom P450. C
nguy c quan trng trong cnh tranh gia ritonavir vi cc thuc b chuyn ho
bi isoenzym ny. S cnh tranh ny gy gim chuyn ho cc thuc , v c
nguy c gy tng ng k nng ca chng trong huyt tng. Nguy c h
glucose mu c th dn ti hn m do h glucose mu ( c m t vi
tolbutamid). Tng tc dc ng hc v chuyn ho thuc.
X l: o u n glucose mu, v nu cn th gim liu lng sulfamid
chng tiu ng.
Ru
Phn tch: Ru lm tng tc dng h glucose mu ca cc thuc chng
tiu ng do mt c ch cha hon ton sng t. C th s tn to glucose
gan b ru c ch. Vi clorpropamid (Diabinese*) v mc thp hn, vi
tolbutamid (Dolipol*), glibenclamid (Daonil*, Euglucan*), glipizid (Glibenese*,
Minidiab*), c nguy c gy tc dng antabuse (kiu disulfiram) do c tng tc vi
c ch ca ru: c mt t l bt thng acetaldehyd tch ly m (c ch
enzym) ko theo mt s du hiu lm sng, nh cc cn vn mch, gin mch
mnh, nhp tim nhanh, nhit cao, bun nn, nn, pht ban ngoi da, i khi h
huyt p v try tim mch. Cc triu chng ny nng hay nh ty lng ru
ung.
X l: mt s ngi, rt kh kim sot lng ru ung. Cn lm cho h
c thc cnh gic trc nguy c h glucose mu, v hn ch n mc ti a
lng ru ung. c bit trnh ung ru lc i. Nu bit ngi bnh ung
ru th trnh khng dng clorpropamid (Diabinese*). Chn mt sulfonylur khc.
Tetracosactid
Phn tch: Gim tc dng ca insulin do tnh cht kch thch bi tit corticoid
lm tng glucose mu gin tip. Gim dung np glucid do corticoid v c nguy c
nhim ceton.
757
X l: Cn tnh ti cc tc dng ca tetracosactid lm tng corticoid khi iu

tr vi cc thuc chng tiu ng. Cn thit lp cn bng glucose mu
lc bt u, trong khi v sau khi iu tr vi tetracosactid. Thng bo cho
ngi bnh cc nguy c v bin ng glucose mu v lp k hoch dng thuc
u n.
Thuc kim ho nc tiu
Phn tch: Cc thuc c tc dng kim ho nc tiu lm tng s o thi
clorpropamid (Diabinese). C ch l do khi pH ca nc tiu tng, th s thanh
lc clorpropamid qua thn cng tng.
X l: Vic kim ho nc tiu l c ch iu tr nhim c clorpropamid.
Nhng khi ngi bnh dng clorpropamid bnh thng, li dng thm thuc c tc
dng kim ho nc tiu nh natribicarbonat, th phi theo di nng glucose
mu, v nu cn, phi tng liu clorpromamid.
Thuc li tiu thiazid
Phn tch: Thuc li tiu thiazid lm tng glucose mu khi i v lm gim
tc dng h glucose mu ca sulfonylur. Tc dng ny xut hin cng hin
tng h natri mu sau khi ung thuc li tiu thiazid vi ngy n
vi thng. C ch cc thuc li tiu thiazid lm gim tnh nhy cm ca m vi
insulin, lm gim tit insulin hoc lm tng o thi kali, gy tng glucose mu.
X l: Theo di cht ch glucose mu ngi bnh c glucose mu tng
cao, c th tng liu sulfonylurea.
Thuc c ch monoamino oxidase (MAOI)
Phn tch: Cc thuc c ch MAO lm tng tc dng h glucose mu ca
sulfonylurea. C ch cha r.
X l: Nu bt buc phi kt hp sulfonylurea vi cc thuc c ch MAO,
phi theo di cn thn ngi bnh. Nu glucose mu b h qu thp, phi hiu
chnh liu cc thuc.

Phn tch: Alopurinol c th c ch clopropamid tit qua ng thn, dn ti
nguy c h glucose mu nghim trng do tng na i ca clorpropamid.
X l: c bit cnh gic khi s dng nhng thuc ny ngi suy thn
khi dng hai thuc ny. Theo di cht ch glucose mu lc bt u, trong khi v
sau khi ngng iu tr alopurinol. Tng tc ny mi ch c m t vi
clorpropamid v khng ni ti cc sulfamid chng tiu ng khc. Nh vy, tt
hn nn dng mt thuc chng tiu ng khc nu c th.
Asparaginase
Phn tch: Asparaginase c th lm ri lon cn bng glucose mu do tnh
cht gy tng glucose mu.
758
X l: Theo di glucose mu, c bit nhng ngi bnh tiu ng,

trong v sau khi iu tr vi asparaginase.
Cholestyramin
Phn tch: Lm gim hp thu sulfamid chng tiu ng qua ng tiu ho.
X l: Nu cn k n c hai thuc, khuyn nn ung sulfamid chng tiu
ng hoc hai gi trc, hoc bn gi sau khi dng cholestyramin
Diazoxyd
Phn tch: Tng tc dc lc gia mt thuc h glucose mu vi mt
thuc tng glucose mu. C i khng dc l.
X l: Chng ch nh phi hp hai thuc ny, trong trng hp bnh tiu
ng khng cn bng hoc cn bng khng tt. Vic s dng diazoxyd thng
ch thc hin c s chuyn khoa c kh nng theo di lin tc.
Phn tch: C th c nhng bin ng bt thng v glucose mu, do tnh
cht tng glucose mu nh ca loi thuc ny; ghi nhn c s gim tc dng ca
insulin.
X l: Thng bo cho ngi bnh v kh nng c bin ng glucose mu.
Hiu chnh liu lng insulin, theo p ng sinh hc.
Fibrat
Phn tch: Nguy c tng tc dng h glucose mu do y thuc chng tiu
ng khi cc lin kt vi protein huyt tng. C kh nng tng na i ca
thuc chng tiu ng ( c m t vi clorpropamid), v gim tnh khng
insulin.
X l: Phi hp thuc ny i hi phi nh lng u n glucose mu khi
bt u iu tr vi thuc chng tiu ng hay fibrat, trong khi iu tr v khi
ngng iu tr bng fibrat. Trnh t thi gian dng thuc l quan trng hiu cc
bin ng v glucose mu xy ra, v hiu chnh liu lng thuc chng tiu
ng cho thch hp. Nhc nh ngi bnh tng cng t theo di bnh.
759

Phn tch: Cc thuc li tiu quai c th, trong mt s him trng hp lm
tng glucose mu hoc cn tr tc dng h glucose mu ca thuc chng tiu
ng.
X l: Khi kh cn bng glucose mu, phi tnh ti kh nng c tng tc
ny. Nhc nh ngi bnh tng cng t theo di; hiu chnh liu trong khi iu
tr v khi ngng iu tr vi thuc li tiu quai.
Phn tch: Aminogluthetimid tc dng nh mt cht gy cm ng enzym c
th lm tng chuyn ho cc sulfamid chng tiu ng v lm cho iu tr chng
tiu ng mt cn bng.
X l: Hiu chnh liu trong v sau khi iu tr vi aminogluthetimid. Thng
bo cho ngi bnh cn tng cng t theo di khi phi hp hai thuc. Lp mt
k hoch dng thuc chnh xc.
Phn tch: Guanethidin c th lm tng tc dng ca cc thuc h glucose
mu bng cch y chng ra khi lin kt vi protein huyt tng.
X l: Thng bo cho ngi bnh tng cng t theo di, v nu cn,
hiu chnh liu lng lc bt u v khi ngng thuc guanethidin da theo
glucose mu.
Hormon tuyn gip
Phn tch: Dng hormon tuyn gip c th lm mt cn bng trong iu tr
bnh tiu ng do tng nhu cu insulin hay tng nhu cu thuc h glucose mu.
X l: Phi hp thuc ny i hi phi hiu chnh liu lng. Thng bo cho
ngi bnh cn phi tng cng t theo di khi thay i liu lng cc hormon
tuyn gip.
Indometacin hoc dn cht; salicylat; thuc chng vim khng steroid
nn tng nguy c h glucose mu.
X l: Trong khi iu tr vi cc thuc chng vim c th c bin ng tm
thi glucose mu. Thng bo cho ngi bnh tng cng t theo di.
Octreotid
Phn tch: Dng cc thuc chng tiu ng trong khi ang iu tr vi
octreotid c th gy h glucose mu hay tng glucose mu.
X l: Do cch s dng v ch nh ca octreotid, iu tr thng phi tin
hnh c s chuyn khoa. Vi ngi bnh tiu ng c iu tr, cn theo di
glucose mu cn thn v t , hiu chnh liu lng cho thch hp.
760
Phenicol
Phn tch: Tng tc c xc nh r vi tolbutamid v clorpropamid.
Tc dng chng tiu ng tng ln, c th do cloramphenicol c ch chuyn
ho gan. Cc ngi bnh u t nhiu nhy cm vi phi hp thuc ny, v
hu qu c th t nhiu quan trng.
X l: C nguy c h glucose mu. Nhng bin ng gia cc c th ngi
bnh bt buc bc s phi theo di glucose mu v thng bo cho ngi bnh
cn tng cng t theo di.
Phenothiazin
Phn tch: Vi liu cao (100 mg/ ngy), clorpromazin gy tng glucose mu
do gim gii phng insulin.
X l: Hiu chnh liu lng lc bt u, trong khi iu tr v sau khi ngng
dng clorpromazin. Thng bo cho ngi bnh tng cng t theo di khi iu tr
vi clorpromazin.
Phn tch: Cc dng liu cao progestogen c tnh cht gy tiu ng v c
th i khng vi cc thuc chng tiu ng.
X l: Thng bo cho ngi bnh nguy c v nhng bin ng glucose
mu. Khuyn tng cng t theo di. Ty theo kt qu, hi u chnh liu l ng
cho thch hp lc bt u v sau khi iu tr vi cc cht progestogen. Lp mt
k hoch dng thuc u n. Khi c vn , khuyn ngi bnh i khm li.
Rifampicin
Phn tch: Tng tc c m t vi tolbutamid. Gim nng
tolbutamid trong huyt tng do cm ng enzym trn cytochrom P450. Tng tc
X l: Cn tng liu tolbutamid. T theo di glucose mu thc hin trong khi
iu tr v sau khi ngng thuc.
Sotalol
Phn tch: Cht chn beta c th che lp nhng triu chng h glucose
mu v lm tng tc dng ca cc sulfamid chng tiu ng v ca insulin trong
bnh tiu ng. iu ny c th dn ti hn m do h glucose mu m khng
c du hiu bo trc.
X l: Nu cn phi hp thuc ny, phi thng bo cho ngi bnh v nguy
c c th thy nhng du hiu h glucose mu (nhp tim nhanh, tot m hi, run,
nh trng ngc, cm gic i, lo u...). Trong vic iu tr tng huyt p ngi
tiu ng, nn chn cc thuc c ch enzym chuyn dng angiotensin.
Phn tch: Sulfamid y thuc ny khi nhng lin kt vi protein huyt
tng v/ hoc c ch d ho, lm tng na i v nng thuc trong huyt
thanh.
761
X l: Cn thit phi hiu chnh liu lng trong khi v sau khi iu tr vi
sulfasalazin. Khuyn ngi bnh tng cng t theo di bnh tiu ng, nu
cn.
Thuc acid ho nc tiu
Phn tch: Vic dng cc thuc acid ho nc tiu nh amoni clorid, natri
hay kali dihydrophosphat s lm tng sinh kh dng ca clorpropamid
(Diabinese), nn tc dng h glucose mu c tng cng. C ch l do khi pH
ca nc tiu gim, s thanh lc ca clorpropamid qua chuyn ho s vt tri
s thanh lc qua thn.
X l: Nu ngi bnh dng kt hp thuc, phi theo di thng xuyn
glucose mu. Nu nng glucose mu h nhiu, c th phi gi m li u
clorpropamid.
Thuc chn beta
Phn tch: Thuc chn beta (k c dng thuc nh mt) c th che lp cc
triu chng h glucose mu, v lm tng tc dng ca cc sulfamid h glucose
mu trong bnh tiu ng. iu ny c th dn ti hn m do h glucose mu
khng c du hiu bo trc.
X l: Nu cn phi hp, phi thng bo cho ngi bnh ch n nhng
du hiu h glucose mu c th xut hin (nhp tim nhanh, tot m hi, run, hi
hp, cm gic i, lo u...). Trong iu tr tng huyt p, i vi ngi bnh tiu
ng, nn chn cc thuc c ch enzym chuyn i.
762

Phn tch: Gim tc dng ca cc thuc chng tiu ng ni chung do
tnh cht tng glucose mu ca cc thuc cng giao cm beta (c bit r vi
ephedrin).
X l: Theo di cht ch glucose mu, v thng bo cho ngi bnh bit
nguy c. Lp mt k hoch dng thuc u n.
Phn tch: Tng tc c m t vi captopril v enalapril. Hn hu phi
hp thuc ny c th gy h glucose mu ngi bnh tiu ng iu tr bng
insulin hay bng sulfamid chng tiu ng.
X l: Phi hp ny kinh in, v chn dng cc thuc c ch enzym
chuyn dng angiotensin cho ngi bnh tiu ng l thng thng. Hn hu
c kh chu do h glucose mu. Thng bo cho ngi bnh nu cn, h t
theo di glucose mu.

Desmopressin
Phn tch: Tc dng cha c sng t: gim tc dng chng li niu khi
phi hp vi glibenclamid, tng tc dng chng li tiu khi phi hp vi
clorpropamid.
X l: Theo di lm sng v hiu chnh liu lng desmopressin theo cc
kt qu lm sng v sinh hc.
Phn tch: Steroid ng ho c th gy h glucose mu. Tng tc ny
c xc nh vi mt s steroid ng ho.
X l: Cn tng cng theo di glucose mu, thng bo cho ng i bnh
nguy c ny (nhng du hiu h glucose mu) v hiu chnh liu lng cho thch
hp.
Phn tch: Do lin kt mnh vi protein huyt tng, thuc phi hp c th
y cc thuc khng vitamin K ra khi lin kt vi protein-huyt tng. C nguy
c chy mu. Cng nhn thy tng nguy c h glucose mu, c th dn n hn
m do h glucose mu. iu ny c m t vi cc cht: dicoumarol v
tolbutamid (Dolipol*); dicoumarol v clorpropamid (Diabinese*), acenocoumarol
(Sintrom*) v clorpropamid (Diabinese*) warfarin (Coumadine*) v glibenclamid
(Daonil).
X l: Theo di t l prothrombin v t l chun ho quc t - INR, v hiu
chnh liu lng cho thch hp lc bt u, trong khi iu tr v trong vng 8 ngy
sau khi ngng thuc.
763
SULFAMID KHNG KHUN

Thuc khng khun - Trong s c nhng thuc t hoc khng c hp thu
ng tiu ho, v c s dng iu tr nhim khun ng rut
CC THUC TRONG NHM

SULFACETAMID (NATRI) dung dch nh mt; dung dch nh mi
Meko-sulfableu dung dch nh mt
Sulfableu dung dch nh mt
Sunfarin dung dch nh mi
Sulfadiazin bc kem bi da
Silvirin kem bi da
SULFAGUANIDIN vin nn 500 mg
Ganidan vin nn 500 mg
Guanidine vin nn 500 mg
Sulfaguanidin vin nn 0,5 g
SULFAMETHOXAZOL phi hp vi trimethoprim vin nn 480 mg; vin nn 960
mg
Biseptol vin nn 480 mg
Cotrim fort vin nn 960 mg
Co- trimoxazol vin nn 480 mg; 960 mg
Trimazol vin nn 480 mg
Trimexazol vin nn 480 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai: Chng ch nh dng sulfamid cho ngi mang thai, v nguy
c gy qui thai v do gan thai nhi cha trng thnh vo cui thai k.
Cc trng hp khc: Qu mn vi thuc ny.

Thi k cho con b: Sulfamid qua c sa m v c th y bilirubin khi cc
v tr lin kt vi protein ca huyt tng.
Thiu ht G6PD: Sulfamid gy thiu mu tan mu ngi bnh thiu ht G6PD.
764
Tr em: Sulfamid c th y bilirubin khi cc v tr lin kt vi protein ca huyt

tng. Tng nguy c vng da nhn no tr non v tr mi sinh, do gan v hng
ro mu - no cha trng thnh. Bilirubin c tnh c, s gn vo nhng nhn no
xm trung tm.
Suy gan: Sulfamid b bt hot bng cch acetyl ho gan. Phi gim liu lng
ngi suy gan.
Suy thn: Sulfamid c th l nguyn nhn ca vim cu thn hay vim k. Ngoi
ra khi suy thn, nhng dn cht acetyl ho do chm o thi s gy ra tch lu v nguy
c kt tinh, dn n si thn, c th trnh nh tng lng nc tiu v kim ho nc
tiu.
Thn trng: mc 2
Si thn: Nguy c kt tinh v lm bnh si thn nng ln. Khuyn nn tng
lng nc tiu bng cch ung nhiu nc v gi nc tiu kim.
TNG TC THUC

Acid ascorbic
Phn tch: Nguy c kt ta ng tit niu khi dng vitamin C liu cao
(vt qu 2g). Tng tc l ho hc v l thuyt; cn phi chng minh trong thc
t.
X l: Trong mt vi hon cnh iu tr, theo di pH nc tiu l c ch. o
pH bng giy ch th kim tra tnh acid hay tnh kim ca nc tiu. Tt c
ph thuc vo mc ch iu tr. Nu mong mun nc tiu c tnh kim, nn
trnh dng ng thi vi vitamin C. Thng bo ngi bnh bit, khng t dng
vitamin C liu cao khi iu tr bng sulfamid.
Probenecid
Phn tch: c ch bi tit sulfamid qua thn do probenecid. C th s dng
phi hp thuc ny gim liu lng sulfamid, nhng sulfamid c c tnh nn
bin php ny tr nn nguy him, khi v phi hp.
X l: S dng probenecid lm chm o thi nhiu loi thuc c
v c th c thc hin gim liu lng. Cn phi rt cnh gic v nhng
nguy c tim tng, tng c tnh ca thuc phi hp. Phi xem xt bi cnh sinh
l bnh hc c th.
Thuc acid ho nc tiu
Phn tch: Qua phn ng ho - l, c th gii thch c nguy c kt tinh
sulfamid ti ng thn, gy tn thng thc th thn. Kt ta ny li cng r
rng khi pH vo khong 5. Tng tc ny ni ring c thng bo trong y vn
khi phi hp vi methenamin.
X l: Trnh phi hp thuc. Nu bt buc phi hp phi theo di pH nc
tiu bng giy ch th.
765

Cyclosporin
Phn tch: Vic kt hp cyclosporin vi cc sulfamid khng khun lm gim
tc dng ca cyclosporin, ng thi lm tng nguy c c vi thn ca sulfamid
dng ng ung. C ch cn cha r.
X l: Nu khng th trnh c kt hp thuc ny, phi thng xuyn kim
tra nng cyclosporin trong huyt tng, v hiu chnh liu dng cyclosporin nu
cn, ng thi kim tra nng creatinin trong huyt thanh.
Methenamin
Phn tch: Trong nc tiu acid, methenamin ging ho thnh formol gy
nguy c kt ta vi cc sulfamid t ho tan, dn n tinh th niu v si thn.
X l: Tt nht, thay i thuc.
Methotrexat
Phn tch: Tng tc dng c vi mu ca methotrexat do y cht ny
khi cc v tr lin kt vi protein huyt tng.
X l: Nu cn, nh lng nng methotrexat trong huyt thanh. Hiu
chnh liu trong khi v lc ngng dng sulfamid khng khun.
Penicilin
Phn tch: Tc dng km khun ca sulfamid khng khu n c th i
khng vi tc dng dit khun ca penicilin. Tc d ng di t khu n ny th hi n
cc vi khun trong giai on pht tri n theo hm m. Tnh i khng ny c
th c hi trong iu tr vim mng no, khi c n can thi p nhanh v m nh.
X l: Tnh ti nguy c ny tu theo tnh hnh sinh l bnh c th, c th
phi hp thuc tu theo tng loi thuc v loi vi khun gy bnh (c lu t i
nng ti thiu c ch-MIC).
Phenytoin
Phn tch: Tng tc dc ng hc: Tng nng phenytoin trong huyt
tng do c ch enzym v do y khi nhng lin kt vi protein huyt tng, c
th gy ra nhng du hiu qu liu.
X l: Chn mt thuc khc khng thuc nhm sulfamid. Nu cn phi hp,
phi qun l cht ch liu lng phenytoin.
Sulfonylurea
Phn tch: Vic dng kt hp sulfonylurea chng tiu ng vi sulfamid
khng khun c th lm tng na i ca sulfonylurea h glucose mu
c th xy ra. C ch c th do cc sulfamid cn tr chuyn ho cc sulfonylurea
gan.
766
X l: Theo di glucose mu. C th cn phi gim liu sulfonylurea.

Glyburid khng c tng tc ny v c th dng thay th loi sulfonylurea
ang dng.

Didanosin
Phn tch: Hip ng cc tc dng khng mong mun: tng nguy c vim
tu do thuc.
X l: Theo di lm sng, v nu cn, trc cm gic au ng tiu ho,
phi xt nghim sinh hc chc nng tuyn tu (xc nh amylase mu v amylase
trong nc tiu).
y cc thuc khng vitamin K, c bit l warfarin (Coumadine) khi cc lin kt
vi protein huyt tng. C nguy c chy mu. C ch cn cha r, cng c th
do gim tng hp vitamin K rut do sulfamid gy ra.
X l: Theo di t l prothrombin hay t l chun ha quc t -INR, v hiu
chnh liu lng cho thch hp lc bt u, lc ang iu tr v trong 8 ngy sau
khi ngng iu tr.
Zidovudin
Phn tch: C th phi hp thuc. Tng c tnh vi mu do hip ng tc
dng c ch dihydrofolat reductase (ch vi trimethoprim).
X l: Tng cng theo di ngi bnh v huyt hc, v xem xt tnh hnh
sinh l bnh hc c th.
SULFASALAZIN
Sulfamid ng rut, khi thu phn gii phng acid 5-aminosalicylic v
sulfapyridin. Dng trong cc bnh vim ng tiu ho
CC THUC TRONG NHM

SULFASALAZIN vin nn 500 mg
Salazopyrine vin nn 500 mg
CH KHI CH NH THUC
767

Thi k cho con b: Sulfapyridin qua c sa m vi lng thp, ch gy
nhng phin phc nu tr mi sinh b thiu ht G6PD.
Thiu ht G6PD: Nguy c tan mu.
Tr em, tr cn b: Ch vi tr di 2 tui, do cha trng thnh v mt enzym,
c nguy c vng da nhn no.
Thi k mang thai: Gim liu lng, nhng khng ngng iu tr, do nguy c c
nhng cn vim i-trc trng.
Cc trng hp khc: Qu mn vi cc sulfamid v vi cc salicylat.
Cn theo di: mc 1
Suy gan: Do chuyn ho thuc gan ( m t cc trng hp vim gan).
Suy thn: Nguy c gim o thi thuc.
TNG TC THUC

Probenecid
Phn tch: Probenecid c ch bi tit sulfamid qua thn. C th dng tng
tc ny gim liu lng sulfamid, nhng do c tnh ca sulfamid nn phi
hp thuc s tr thnh nguy him, nu v dng.
X l: Dng probenecid lm chm o thi nhiu thuc c th v
c thc hin gim bt liu lng. Nhng phi rt cnh gic vi nhng nguy
c tim tng do c tnh ca phi hp thuc. Phi nghin cu tnh hnh sinh l
bnh c th ca mi trng hp.
Cn nhc nguy c/ li ich: mc 3

Methenamin
Phn tch: Trong nc tiu c tnh acid, methenamin ging ho thnh
formol, gy nguy c to ta vi sulfamid t ho tan, dn n tinh th niu v si
thn.
X l: Tt hn l nn thay th thuc.

Phn tch: Salazosulfapyridin lm gim hp thu acid folic (khong mt phn
ba). m t cc du hiu thiu ht folat, nh t l folat thp trong huyt thanh,
thiu mu nguyn hng cu khng l v chng i hng cu v chng tng hng
cu li. C ch c th do c ch hp thu folat rut.
X l: Nu thy thiu ht folat, v mt lm sng hay sinh hc, cn b sung
cho ngi bnh acid folic hay acid folinic.
768
Glycosid tr tim
Phn tch: Tng tc dc ng hc ch ring vi cht digoxin.
Salazosulfapyridin lm gim hp thu digoxin, ko theo gim nng cht ny
trong huyt thanh, c th ti 50%.
X l: Nu cn phi hp, iu quan trng l phi hiu chnh liu lng theo
nng digoxin trong mu khi iu tr v khi ngng sulfasalazin.
Methotrexat; phenytoin
Phn tch: Sulfamid y cc thuc ny khi cc lin kt vi protein huyt
tng v/ hoc c ch d ho, lm tng na i v nng cc thuc trong
huyt thanh.
X l: Cn phi hiu chnh liu lng trong v sau khi iu tr bng sulfasalazin.
Phn tch: Dng sulfajalazin ng thi vi sulfonylurea c th lm tng na
i ca sulfonylurea v h glucose mu c th xy ra. C ch do sulfasalazin c
th cn tr chuyn ho ca sulfonylurea gan hoc y chng ra khi lin kt
vi protein huyt tng.
X l: Theo di glucose mu. C th phi gim liu ca sulfonylurea. Glyburid
c th l thuc thay th khng b nh hng ca tng tc.
y cc cht khng vitamin K, c bit l acenocoumarol (Sintrom) ra khi lin kt
vi protein huyt tng. C nguy c chy mu.
X l: Theo di t l prothrombin hay t l chun ha quc t- (INR) v hiu
chnh liu cho thch hp lc bt u, trong khi iu tr v trong vng tm ngy sau
khi iu tr.
SUMATRIPTAN
Thuc co mch, ch vn c hiu v chn lc ca cc th th 5HT1
vi serotonin, v dng trong iu tr cp cn au na u,
hoc trong iu tr cp cn au do mch mt
CC THUC TRONG NHM

SUMATRIPTAN
Imigrane dung dch tim di da 6 mg
Imitrex vin nn 100 mg
CH KHI CH NH THUC
769
Chng ch nh: mc 4
Tr em; ngi bnh cao tui: Do khng c thng tin.
Tng huyt p: Tng huyt p khng kim sot c.
Suy tim: Tin s nhi mu c tim.
Suy mch vnh: au tht ngc do gng sc v/hoc lc ngh (kiu Prinzmetal).
Cc trng hp khc: Qu mn vi thuc hoc vi sulfamid (d ng cho). Hi
chng hay bnh Raynaud. Tin s nhi mu no.

Thi k cho con b: Thuc qua c sa ng vt m.
Thi k mang thai: Do cha c ti liu.
TNG TC THUC

Citalopram; paroxetin
Phn tch: Tng tc dc lc do hip ng cc tc dng serotoninergic c
th gy tng huyt p v co ng mch vnh.
X l: Trnh phi hp thuc ny. Nu cn phi hp, phi m bo mt
khong cch 7 ngy t lc ngng dng thuc chng trm cm n khi dng
sumatriptan.
Phn tch: Hai thuc ny c th k n ring r khi au na u dai dng.
Ngi bnh au na u c th v tnh dng hai thuc ny trn vi nhau v gy
tng tc dc l v y l phi hp hai thuc co mch mnh, nht l khi
sumatriptan li dng theo ng tim.
X l: Cm phi hp hai thuc ny, do nguy c co ng mch vnh (au
ngc) v/ hoc ng mch phi. Thay i chin lc iu tr. Nhc ngi bnh
khng c t phi hp thuc.
Fluoxetin; fluvoxamin
Phn tch: Nguy c tng huyt p v co tht mch vnh.
X l: m bo mt khong cch 5 tun l k t lc ngng dng fluoxetin
hay fluvoxamin n lc dng sumatriptan.
Phn tch: Tng tc dc lc do hip ng cc tc dng serotoninergic vi
nguy c xut hin l ln, kch ng, nhit cao, co git, co tht mch v tng
huyt p nng.
770
X l: Do nguy c dc l, khng nn phi hp hai thuc ny v phi i t

nht 2 tun l, t lc ngng dng thuc c ch MAO khng chn lc n lc
dng sumatriptan.
Thuc c ch MAO typ A hoc typ B
Phn tch: Tng tc dc lc do hip ng cc tc dng serotoninergic vi
nguy c xut hin l ln, kch ng, nhit cao, co git, co tht mch v tng
huyt p nng.
X l: Do nguy c dc l, khng nn phi hp cc thuc ny v phi i
t nht 24 gi, k t lc ngng dng thuc c ch MAO n lc dng sumatriptan.
SYNERGISTIN
Thuc khng sinh km khun
CC THUC TRONG NHM

PRISTINAMYCIN vin nn 500 mg
Pyostacine vin nn 500 mg
VIRGINIAMYCIN vin nn 250 mg; gi bt ung 100 mg
Staphylomycine vin nn 250 mg
CH KHI CH NH THUC

Cc trng hp khc: Qu mn vi cc synergistin.
Cn theo di: mc 1
Thi k cho con b: Khi nhim khun v vi nhng dng thuc dng ti ch,
do tr b c th c nguy c a b hp thu cht ny. Ngoi ra thuc dng ton thn
cn qua c sa m.
TNG TC THUC

Cephalosporin c nhn thiomethyltetrazol; cephalosporin hoc thuc tng
t; penicillin; phenicol
Phn tch: Tc dng km khun ca cc synergistin c th i khng tc
dng dit khun ca cc thuc ny. Tc dng dit khun ny th hin vi khun
771
giai on to thnh vch t bo vi khun pht trin theo hm m. S i khng

ny c th c hi trong iu tr vim mng no, cn can thip nhanh v mnh.
X l: Tnh ti nguy c ny theo tnh hnh sinh l bnh c th. S phi hp
thuc c th thc hin tu theo thuc dng v vi khun gy bnh (nng t i
thiu c ch-MIC).

Ciclosporin
Phn tch: Tng tc ny c m t vi pristinamycin. Tng nng
ciclosporin trong huyt thanh, c th do c ch d ho ciclosporin gan.
X l: Theo di chc nng thn qua thanh lc creatinin. Hiu chnh liu
lng cho thch hp trong v sau khi iu tr pristinamycin.
TACRIN
Thuc dng trong iu tr bnh Alzheimer,
c nhng tnh cht gn ging acetylcholin
CC THUC TRONG NHM

TACRIN nang 10 mg; 20 mg; 30 mg; 40 mg
Cognex nang 10 mg; 20 mg; 30 mg; 40 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai: Cn c bin php nga thai khi dng thuc.

Suy gan: Nguy c tng transaminase.
Lot d dy - t trng; vim d dy: Lot khng iu tr l mt chng ch nh
do tnh cht ging acetylcholin ca thuc.
Cc trng hp khc: Qu mn vi tacrin.
TNG TC THUC

Azathioprin; carmustin hoc dn cht; dantrolen; estrogen hoc thuc
nga thai estroprogestogen; furosemid hoc thuc tng t; griseofulvin;
isoniazid hoc thuc tng t; macrolid; mercaptopurin; methotrexat; natri
valproat hoc dn cht; niridazol; noramidopyrin hoc dn cht; paracetamol;
ru; thuc chng ng kinh khng barbituric
772
Phn tch: C nguy c tng c tnh vi gan.

X l: Nu cn, tng cng theo di gan. Trnh cc phi hp thuc c nguy
hi cho ngi bnh cao tui.
Fluvoxamn
Phn tch: Dng kt hp vi fluvoxamin, nng tacrin trong huyt tng
tng, do tc dng dc l cng vi cc tc dng ph cng tng. C ch c th
do fluvoxamin c ch chuyn ho tacrin thng qua cytochrom P450 1A2.
X l: Nu khng th trnh c phi hp thuc ny, cn phi theo di cht
ch s xut hin cc tc dng ph, trong c c tnh vi gan, khi ngi bnh
ang dng tacrin bt u dng thm fluvoxamin, hoc khi bt u dng ng thi
c hai thuc. Cht c ch chn lc ti nhp serotonin khc l fluoxetin khng b
cytochrom P450 1A2 chuyn ho c th dng thay th trong trng hp ny.
Phn tch: Tc dng i khng dc l.
X l: Nu c th, hon k n thuc khng cholinergic phi hp vi tacrin.
Nguy c iu tr tht bi hon ton.

Phn tch: Tc dng lm chm nhp tim ca tacrin c th cng thm vi tc
dng ny ca cc cht chn beta.
X l: Theo di in tm v lm sng u n nu cn phi hp thuc.
Mexiletin; propafenon; quinidin hoc dn cht
Phn tch: Nguy c nhp tim chm qu sc, do hip ng cc tc dng lm
chm nhp tim.

Cc cht cholinergic
Phn tch: Tng tc dc lc. C hip ng tc dng cholinergic.
X l: Tng cc tc dng khng mong mun, v nu c th hon k n
cht cholinergic phi hp vi tacrin.
Phn tch: Tng tc dc l, gim thanh lc theophylin huyt tng,
ko theo nguy c qu liu.
X l: Nu cn phi hp thuc, phi theo di nng theophylin trong mu
v gim liu lng cht ny; theo di lm sng.
773
Phn tch: Tng nng tacrin trong huyt tng, c th do c ch chuyn

ho ca n.
X l: Chn mt thuc khng H2 khc.
TACROLIMUS
Cht c ch min dch mnh, dng sau ghp c quan
CC THUC TRONG NHM

TACROLIMUS nang 1 mg; 5 mg
Prograf nang 0,5 mg; 1 mg; 5 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: Do khng c thng tin.
Thi k mang thai: Gy qui thai sc vt.
Cc trng hp khc: Qu mn vi cc macrolid hay vi thuc ny.

Suy tim/ suy gan/ suy thn: V cc tc dng ph.
TNG TC THUC

Ciclosporin
Phn tch: Theo mt s cng trnh nghin cu, c tng nng ciclosporin
hay tacrolimus trong huyt tng do c ch chuyn ho ca chng rut hay
gan. C th thuc n lm chm chuyn ho thuc kia. Ngoi ra c tc dng hip
ng c vi thn ca hai thuc.
X l: Cm phi hp hai thuc ny, nu khng s xut hin nhng du hiu
quan trng c vi thn. Khuyn ngh nn i t nht 24 gi sau liu ciclosporin
cui cng mi dng liu tacrolimus u tin.

Macrolid
hp
Phn tch: Tng nng tacrolimus v creatinin trong huyt thanh khi phi
tacrolimus
vi
erythromycin,
clarithromycin,
josamycin
(v
774
triacetyloleandomycin), c th do c ch chuyn ho tacrolimus gan v rut.

X l: Nn gim liu lng ca tacrolimus v theo di chc nng thn qua
nh lng creatinin trong mu. Theo di nng tacrolimus trong huyt tng
trong khi iu tr v sau khi ngng thuc.
Mycophenolat mofetil
Phn tch: Dng cng vi tacrolimus, nng mycophenolat trong huyt
tng tng, lm tng nguy c xut hin cc tc dng ph. C ch cha r.
X l: Theo di nng mycophenolat trong huyt tng, hiu chnh liu
dng thuc ny nu cn.
Ritonavir
nn c nguy c cnh tranh quan trng gia ritonavir vi cc thuc b isoenzym
ny chuyn ho. S cnh tranh ny lm cc thuc gim chuyn ho, v tng
nng trong huyt tng mt cch ng k. C nguy c tng c tnh vi thn
ca hai thuc ny. C nguy c c ch min dch qu mc, dn n nhim khun
nghim trng. C nguy c thiu mu, gim tiu cu do tacrolimus. Tng tc
X l: Theo di iu tr thng qua nh lng thuc c ch min dch, c khi
phi gim liu lng thuc c ch min dch ty theo nng ca n trong huyt
tng.
Phn tch: C th lm gim nng tacrolimus, do tnh khng bn vng
ca tacrolimus trong mi trng kim hoc do hin tng hp ph, v iu ny
xy ra trong vng hai gi. Tng tc dc ng hc v hp thu thuc, c m
t vi thuc c mui nhm (hydroxyd hay oxyd). S kim ho cng xy ra khi
dng thuc c mui calci v magnesi.
X l: Nn trnh phi hp thuc ny.
Thuc li tiu gi kali; kali

Phn tch: Nguy c tng kali mu c th gy t vong, do hip ng cc tc
dng tng kali mu ca hai thuc (c bit trong trng hp suy thn. Cn cn
thn vi ngi bnh cao tui). Tng tc dc lc.
X l: Nu khng th trnh c phi hp thuc ny, phi theo di u n
kali mu.
Vaccin sng gim c lc
Phn tch: Nguy c pht trin nhim khun tng ng vi vaccin do
tacrolimus c ch min dch.
775
X l: Hai thuc phi dng cch nhau t 3 thng n mt nm; khong cch
ny di ngn tu thuc vo mc c ch min dch.

Barbituric
Phn tch: Ko di tc dng ca thuc, ch thy vi pentobarbital, khi iu
tr di ngy vi tacrolimus, do c ch cn cha r. C th do tacrolimus c ch
chuyn ho pentobarbital.
X l: Cn gim liu lng ca tacrolimus v theo di chc nng thn thng
qua nh lng creatinin mu. Theo di nng tacrolimus trong huyt tng
trong v sau khi ngng iu tr.
Benzodiazepin
Phn tch: Tng nng tacrolimus trong huyt tng, thy ring vi
midazolam (Hypnovel*) in vitro. Tng tc dc ng hc v chuyn ho thuc.
X l: Nn gim liu lng tacrolimus v theo di chc nng thn thng qua
nh lng creatinin mu. Theo di nng tacrolimus trong huyt tng trong v
sau khi ngng iu tr.
Danazol
Phn tch: Tng nng tacrolimus trong huyt thanh, km theo run v tng
nng creatinin trong huyt thanh; c th do c ch chuyn ho tacrolimus.
Tng tc dc ng v chuyn ho thuc.
X l: Cn gim liu tacrolimus v theo di chc nng thn thng qua nh
lng creatinin mu. Theo di nng tacrolimus trong huyt tng trong v sau
khi ngng iu tr.
Dihydropyridin
Phn tch: C kh nng c ch chuyn ho tacrolimus gan lm nng
thuc trong huyt tng tng (tng tc dc ng v chuyn ho thuc). Tng
tc ny c m t vi nicardipin v nifedipin, tuy nhin cng vn phi quan
tm xt n khi dng cc dihydropyridin khc.
khi ngng iu tr.
Phn tch: C kh nng c ch chuyn ho tacrolimus gan (tng tc
dc ng hc v chuyn ho thuc).
khi ngng iu tr.
776
Doxorubicin hoc dn cht; vincristin hoc thuc tng t

Phn tch: Tng nng thuc chng ung th trong ni bo v tng tc
dng ca n, do c ch glycoprotein G. Glycoprotein G lc thng lm cho t bo
c kh nng khng li iu tr, c tc dng nh mt bm, ph thuc ATP, c th
loi thuc ra ngoi t bo. Tc dng ny c quan st in vitro, v cha c
khai thc trn lm sng.
X l: Tng tc ny hnh nh cha mang li li ch trc mt trn lm
sng, nhng cn phi tnh ti khi khng thuc.
Griseofulvin
Phn tch: Gim nng tacrolimus trong huyt thanh do kch thch d ho
bng enzym.
X l: Nu cn phi hp, phi theo di cht ch nng tacrolimus trong
huyt thanh, v hiu chnh liu lng cho thch hp lc bt u v sau khi ngng
iu tr vi griseofulvin.
Omeprazol
Phn tch: C th nng tacrolimus trong huyt tng tng, do c ch
chuyn ho thng qua cc cytochrom P450. Tng tc dc ng hc v chuyn
ho thuc.
khi ngng iu tr.
Phenytoin
Phn tch: Tng nng phenytoin trong huyt tng, do y phenytoin
khi v tr lin kt vi albumin huyt tng. Tng tc dc ng v phn b
thuc.
X l: Cn theo di nng phenytoin trong huyt tng trong thi gian
iu tr vi tacrolimus v khi ngng dng thuc ny.
Primidon hoc dn cht
Phn tch: Gim nng tacrolimus trong huyt thanh do kch thch d ho
bng enzym.
X l: Nu cn phi hp thuc, phi theo di nng tacrolimus trong
huyt thanh, v hiu chnh liu lng cho thch hp lc bt u iu tr v sau khi
ngng iu tr vi primidon hay dn cht.
Rifampicin
Phn tch: Gim nng tacrolimus trong huyt tng, do cm ng enzym
trn cytochrom P450. Tng tc dc ng v chuyn ho thuc.
X l: Cn tng liu tacrolimus. Theo di nng tacrolimus trong huyt
tng trong khi iu tr v sau khi ngng thuc.
777

Phn tch: Tng nng tacrolimus trong huyt tng do c ch chuyn
ho tacrolimus gan v/ hoc rut. Tng tc ny c m t vi
clotrimazol, fluconazol, miconazol v ketoconazol. Vi chuyn ho rut, sinh kh
dng ca tacrolimus tng, nhng loi tng tc ny s khng xy ra khi cht
chng nm c dng theo ng tnh mch. Ngoi ra, i vi fluconazol tng
tc ny ph thuc liu lng.
lng creatinin trong mu. Theo di nng tacrolimus trong huyt tng trong
khi iu tr v sau khi ngng thuc.
778

Phn tch: Tng nguy c c vi thn khi phi hp hai cht c c tnh tim
tng vi thn. Hip ng cc tc dng khng mong mun.
X l: Loi phi hp ny thng gp bnh vin; mc du cch dng mt
ln c nht trong ngy s hn ch c tnh vi tai v vi thn, nhng khi cn
phi hp thuc, vn nn hiu chnh liu lng cho thch hp theo thanh l c
creatinin (cng thc Cockroft v Gault). Theo di c bit ngi bnh cao tui.
Amphotericin B
Phn tch: Tng creatinin niu. Hip ng cc tc dng c vi thn.
X l: Phi lu tng tc ny, khi cn phi hp hai thuc. Phi theo di
cht ch thanh lc creatinin v ion .
Cc globulin min dch khng lympho bo
Phn tch: Phi hp hai cht c ch min dch, c th dn ti pht trin u
limpho bo gi. Dng liu cao, c nguy c c vi thn.
X l: Phi tnh ti nguy c ny trong trng thi sinh l bnh ca ngi bnh.
TAMOXIFEN
Thuc khng estrogen khng steroid dng trong iu tr ung th biu m v
CC THUC TRONG NHM

TAMOXIFEN vin nn 10 mg; 20 mg
Nolvadex vin nn 10 mg
Nolvadex D vin nn 20 mg
Tamofen vin nn 10 mg; 20 mg
Tamoxifen Ebewe vin nn 10; 20 mg
Tamoxifen Citrate vin nn 10 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: Do ung th v, khng c cho b
Thi k mang thai: Phi loi tr kh nng mang thai trc khi k n thuc v
n 2 thng sau khi iu tr
779
Cn theo di: mc 1
Suy gan: Theo di chc nng gan
TNG TC THUC

Phn tch: i khng dc l gia mt liu php khng estrogen vi mt
estrogen.
X l: Tamoxifen thng c dng mt c s chuyn khoa. V iu tr,
phi hp ny khng hp l.
Rifamycin
Phn tch: Cc rifamycin nh rifabutin, rifampicin khi dng ng thi vi
tamoxifen, lm gim nng tamoxifen trong huyt tng, lm gim tc dng
khng estrogen ca thuc. C ch do rifamycin gy cm ng CYP 3A4, lm tng
cng chuyn ho tamoxifen.
X l: Theo di p ng lm sng ca ngi bnh. C th phi tng liu
tamoxifen khi dng ng thi vi rifamycin.

Phn tch: Tng ng k nguy c chy mu.
X l: Theo di u n thi gian Quick v/ hoc t l chun ha quc t(INR), c bit lc bt u, trong khi v lc ngng phi hp thuc ny. Hiu chnh
liu lng theo cc kt qu th sinh hc.
TEICOPLANIN
Khng sinh glycopeptid
CC THUC TRONG NHM

TEICOPLANIN l bt ng kh pha tim 200 mg; 400 mg
Targocid l bt ng kh pha tim 200 mg; 400 mg
CH KHI CH NH THUC
780

Thi k cho con b: Trnh dng thuc ny cho ph n ang thi k cho con b
Tr em: Do thn trng, v cha c thng tin.
Thi k mang thai: thy phi cht khi nghin cu trn ng vt. ngi hin
cha t liu.
Cc trng hp khc: Qu mn vi teicoplanin

Suy thn, ngi bnh cao tui: Cn hiu chnh liu cho thch hp.
TERBINAFIN
Thuc chng nm dng trong iu tr bnh nm ngoi da
v nm mng chn tay
CC THUC TRONG NHM

TERBINAFIN vin nn 125 mg; 250 mg; kem 1%
Exifine vin nn 125 mg; 250 mg
Exifine kem 1 %
Lamisil kem bi da 1%
Lamisil vin nn 125 mg; 250 mg
CH KHI CH NH THUC

Thi k cho con b: Thuc qua c sa m
Thi k mang thai: Do thn trng v thiu thng tin.
Suy gan: Bt u iu tr vi liu thp hn
Suy thn: Bt u iu tr vi liu thp hn. Trnh dng khi suy thn nng, do
thuc o thi chm hn.
Cn theo di: mc 1
Tr em: Do thn trng v thiu thng tin.
781
TETRACOSACTID
Cht corticostimulin (ACTH) tng hp
CC THUC TRONG NHM

TETRACOSACTID ng tim 0,25 mg; 0,5 mg; 1 mg
Synacthene ng tim 0,25 mg
Synacthene retard ng tim 0,5 mg; 1 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai: Do tc dng ca cc glucocorticoid
Suy tim: Do cc tc dng khng mong mun
Suy h hp-hen: Hen ph qun.
Lot d dy-t trng; vim d dy: Cc corticoid c tc dng gy lot (tng tit
acid clohydric d dy, gim sc chng ca nim mc, c th bc l mt vt lot
tim n ng tiu ho, hoc lm nng thm mt vt lot c sn). Liu php corticoid
di ngy i hi phi pht hin c h thng cc vt lot v i khi c n ph i k n
ng thi cc thuc chng lot.
Cc trng hp khc: Qu mn vi ACTH, bnh nhim khun, bnh Cushing,
hi chng thng thn - sinh dc, suy v tuyn thng thn, lon tm thn cp.

Thi k cho con b: Trnh cho con b trong thi gian iu tr (nguy c chm
pht trin).
Tiu ng: Cc glucocorticoid tng tn to glucose gan. iu ny lm tng
glucose mu, gim nhy cm vi insulin v xut hin trng thi tin tiu ng ngi
bnh thng. Do phi tng cng theo di v tng liu cc thuc h glucose mu
ngi tiu ng.
Tng huyt p: Gi nc v natri do tc dng corticoid - khong ca cc
glucocorticoid lm nng thm bnh tng huyt p sn c. ngi tng huyt p, phi
hp thuc li tiu vi ch king mui c th c ch.
TNG TC THUC
782

Benzamid
Phn tch: Nguy c xut hin xon nh khi phi hp thuc ny. Ch l
tng tc mi ch c m t vi sultoprid( Barnetil), trong nhm cc benzamid.
H kali mu, nhp tim chm v khong QT di c t trc (ch nhn thy trn in
tm ) l nhng yu t to iu kin xut hin xon nh. Cc thuc gy h kali
mu to iu kin xut hin xon nh khi dng cng cc thuc khng chng lon
nhp tim.
X l: Cn trnh phi hp. Dng cc thuc khng gy xon nh. Nu cn phi
hp thuc ny, phi theo di lin tc khong QT v kim tra u n kali mu.
Khuyn ngi bnh gp li bc s khi thy mi mt,yu c, chut rt.
Bepridil; pentamidin
Phn tch: Nguy c xon nh khi phi hp thuc. H kali mu, nhp tim
chm v khong QT di c t trc (ch nhn thy trn in tm ) l nhng
yu t to iu kin xut hin xon nh, c th pht trin thnh rung tht.
X l: Cn trnh phi hp thuc. Dng cc thuc khng gy xon nh.
Nu cn phi hp, phi theo di lin tc khong QT v ki m tra u n kali
mu. Khuyn ngi bnh gp li bc s khi thy mi mt, yu c, chut rt.
Biguanid
Phn tch: Gim tc dng ca biguanid do tc dng tng glucose mu gin
tip ca thuc. Gim tnh dung np vi glucid do corticoid v nguy c nhim
ceton.
X l: Phi lu n tc dng ca corticoid khi iu tr bng cc thuc
chng tiu ng. Cn cn bng glucose mu khi bt u, trong v sau khi iu
tr bng corticoid. Thng bo cho ngi bnh nguy c bin ng glucose mu, v
lp mt k hoch dng thuc.
Halofantrin
Phn tch: Nguy c xut hin xon nh khi phi hp thuc, nht l khi h
kali mu. H kali mu, nhp tim chm v khong QT di c t trc (ch nhn thy
c trn in tm ) l nhng yu t thun li cho s xut hin xon nh.
X l: Cn trnh phi hp thuc ny. Dng cc thuc khng gy xon nh.
Nu cn phi hp thuc, phi theo di lin tc khong QT v kim tra u n
kali mu. Khuyn ngi bnh gp li bc s khi thy mi mt, yu c, chut rt.
Heparin
Phn tch: Phi hp mt corticoid c tnh gy lot vi mt thuc chng ng
mu hay mt thuc chng kt tp tiu cu lm tng nguy c chy mu ng
tiu ho.
X l: Hi ngi bnh v tin s lot d dy. Nu c, phi trnh phi hp
thuc. Nu c th phi hp thuc phi theo di bng nhng xt nghim ng
783
mu thch hp (thi gian Howell v thi gian cephalin-kaolin). Tuy nhin, nn chn
mt liu php khc thay th.
Phn tch: Gim tc dng ca insulin do tc dng tng glucose mu gin
tip ca cc corticoid. Gim tnh dung np glucid do corticoid, v nguy c nhim
ceton.
X l: Phi tnh n cc tc dng ca corticoid khi iu tr bng cc thuc
h glucose mu. Phi cn bng glucose mu lc bt u, trong v sau khi iu tr
vi corticoid. Thng bo cho ngi bnh bit nhng bin ng v glucose mu v
lp mt k hoch s dng thuc.
Phn tch: Tng tc ch c ghi nhn vi mt thuc khng histamin
khng an thn l astemisol (Hismanal). H kali mu (v c tiu chy ko di c
th gy mt nc v in gii) l yu t thun li cho xon nh. Nguy c tng
khi cc thuc h kali mu c phi hp vi cc thuc khc c th gy xon
nh.
X l: Nn trnh phi hp. Cn thay i chin lc iu tr v chn cc
thuc khng gy xon nh. Nu cn phi hp thuc ny, phi theo di kali mu,
v b sung kali.
Macrolid
Phn tch: Tng nguy c xon nh do hip ng cc tc dng.Tng tc
mi ch c m t vi erythromycin tim tnh mch. H kali mu, nhp tim chm
v khong QT di c t trc (ch nhn bit c trn in tm ) l nhng yu
t to thun li xut hin xon nh. Trong nhm macrolid, ch c erythromycin,
c bit dng tim tnh mch c th gy lon nhp tim (ko di khong QT, ngoi
tm thu tht, xon nh, bloc nh-tht).
X l: Phi hp thuc c tim nng gy t vong ny l chng ch nh v
khng c k n. Ngay c khi dng n c, erythromycin tim tnh mch c
th gy lon nhp tim. Thuc ny khng c tim c liu mt lc, m phi tim
truyn tnh mch lin tc hoc gin on, vi thi gian truyn mi ln t nht l 60
pht.
Sparfloxacin
Phn tch: Ch thy tng tc khi phi hp vi mt fluoroquinolon l
sparfloxacin (Zagam*). Tng nguy c xut hin xon nh khi phi hp thuc. H
kali mu, nhp tim chm v khong QT di c t trc (ch nhn thy c
trn in tm ) l nhng yu t to thun li cho xut hin xon nh.
Nu cn phi hp thuc, phi theo di lin tc khong QT v kim tra u n
kali mu. Khuyn ngi bnh gp li bc s khi thy mt mi, yu c, chut rt.
784
Vaccin sng gim c lc

Phn tch: Nguy c pht trin nhim khun do chng ca vaccin v tc dng
c ch min dch ca thuc phi hp.
X l: Dng hai thuc cch nhau t 3 thng n mt nm, khong cch ny
di ngn tu thuc vo mc c ch min dch.
Vincamin
Phn tch: Nguy c xut hin xon nh khi dng phi hp cc thuc ny.
H kali mu, nhp tim chm v khong QT di c t trc (ch nhn bit c
trn in tm ) l nhng yu t to thun li xut hin xon nh. C th pht
trin thnh rung tht gy t vong.
Nu cn phi hp thuc, phi theo di lin tc khong QT v kim tra thng
xuyn kali mu. Khuyn ngi bnh gp li bc s khi thy mi mt, yu c,
chut rt.

Amiodaron
Phn tch: Nguy c xon nh d xy ra khi h kali mu. H kali mu, nhp
tim chm v khong QT di c t trc (ch nhn bit c trn in tm )
l nhng yu t to thun li cho xut hin xon nh.
X l: Nu cn phi hp cc thuc c th gy h kali mu vi amiodaron,
phi d phng h kali mu bng cch tng cng theo di cht ch v kim tra
in tm . Trong trng hp xut hin xon nh, khng dng thuc chng
lon nhp. Khuyn ngi bnh gp li bc s khi thy mi mt, yu c, chut rt.
Amphotericin B
Phn tch: Tc dng h kali mu tng khi dng dng tim. Amphotericin B
rt t c hp thu khi dng theo ng ung hay dng ti ch, trong iu ki n
bnh thng.
X l: Theo di kali mu. Phi nh gi nhng nguy c tng tc thuc theo
ng dng amphotericin B
Asparaginase
Phn tch: Tc dng tng glucose mu gia tng v c nguy c bnh thn
kinh v ri lon to hng cu.
X l: Ch bc s chuyn khoa mi thc hin phi hp thuc ny v ti bnh
vin. c tnh s gim nu dng asparaginase sau corticoid, so vi dng tr c
hay dng cng.
Barbituric; carbamazepin; phenytoin; rifampicin
Phn tch: Tng d ho adrenocorticoid do cc thuc cm ng enzym
(barbituric). Cm ng enzym ch biu hin sau nhiu ngy, k t lc bt u iu
tr.
785
X l: Cm ng enzym khng phi l mt hin tng tc th. Khi iu tr vi

mt thuc cm ng enzym di hn hay trung hn phi tnh ti nguy c gim tc
dng iu tr. Hiu chnh liu lng trong khi iu tr v sau khi ngng cht cm
ng enzym.
Cc thuc loi cura
Phn tch: Nguy c tng phong b thn kinh-c do gim kali mu, nht l
vi cc thuc curar khng kh cc.
X l: C th cn phi nh lng kali trc khi dng mt thuc curar khng
kh cc.
Phn tch: Hiu qu ca thuc chng tng huyt p b gim, c th do tc
dng gi natri ca steroid.
X l: Nu cn phi hp thuc, phi tng cng theo di huyt p trong
iu tr v khi ngng dng mt trong hai thuc. C khi phi hiu chnh liu lng.
Nhn mnh k hoch dng thuc, v yu cu tun th trong iu tr. Cn c
bit cnh gic khi dng ngi bnh cao tui.
Corticoid khong; furosemid hoc thuc tng t; glucocorticoid; thuc li
tiu thi kali
Phn tch: Phi hp hai thuc thi kali, gy tng nguy c h kali mu v
xut hin xon nh.
X l: Theo di kali mu v khi cn iu chnh bng b sung mui kali. H
kali mu c biu hin trn lm sng qua mt mi, thm ch chut rt, v i khi
lon nhp tim. Cn ch n hin tng mt nc qu mc (khi gng sc, hoc
qu nng hoc tiu chy dai dng), lm tng thm mt kali.
Disopyramid
Phn tch: Nguy c xon nh khi phi hp hai thuc ny. H kali mu, nhp
tim chm v khong QT di c t trc (ch nhn bit c trn in tm ) l
nhng yu t thun li cho xon nh.
X l: Khi cn phi hp thuc, phi d phng h kali mu bng tng cng
theo di v kim tra in tm . Trong trng hp xon nh, khng dng thuc
chng lon nhp. Khuyn ngi bnh gp li bc s khi thy mi mt, yu c ,
thm ch chut rt.
786

Phn tch: Estrogen c th lm ri lon s chuyn ho v s lin kt vi
protein huyt tng ca cc glucocorticoid, gy tng thi gian bn thi v tng tc
dng iu tr cng tc dng c ca cc glucocorticoid
X l: Cn phi khng nh tng tc dc ng hc ny bng nhng quan
st trn lm sng. Bc s k n phi cnh gic v liu lng cc glucocorticoid
v nh gi nguy c theo liu lng estrogen dng.
Glycosid tr tim
Phn tch: Tetracosatid gy h kali mu, ko theo yu c c th lm tng
tc dng ca cc cht cura khng kh cc (l nhng cht phong b ch ni thn
kinh - c) v lm tng c tnh thuc digitalis. Cc glycosid tr tim c ch Na +/ K+
ATPase, enzym ny tham gia vo vn chuyn cc ion Na+ v K+ qua mng t bo
c tim. C ch chnh xc vn cha c r hon ton, cha c nhng cng trnh
trong y vn nhm khng nh gi thuyt dc l ny.
H kali mu nng c th gy ngoi tm thu tht hay nh, lon nhp nhanh tht hay
nh, v nhng ri lon quan trng trong dn truyn nh - tht; ngi bnh dng
digitalis cng thy nhng ri lon tng t khi kali mu gim t hn.
X l: Trc khi bt u iu tr ng thi cc thuc ny, cn phi nh
lng nng kali trong huyt thanh, phi iu tr h kali mu nu c, v phi
theo di kali mu thng xuyn. Tng tc ny da vo nhng chng c dc l
hc. Khi thc hin phi hp thuc, ngi k n v ngi cp thuc cn tp
trung theo di, khi c hon cnh, thu thp nhng nhn xt lm sng cho php
khng nh gi thuyt ny. Cn ch l v lm sng, h kali mu c th bt u
bng yu c, chut rt v dn n nhng triu chng nghim trng hn nh lon
nhp tim v lit h hp. Cn d chng h kali mu do ra qu nhiu m hi v tiu
chy dai dng, kh cha.
steroid
Phn tch: Nguy c gy lot chy mu tng. Nhng trong mt s dng vim
khp, phi hp thuc c th c li.
X l: Cn nhc nguy c/ li ch, trc khi k n phi hp thuc. Thng
bo cho ngi bnh bit nguy c v theo di lm sng
Phn tch: Nguy c tng chuyn ho isoniazid gan, lm gim tc dng ca
n. Cng gim tc dng ca corticoid.
X l: Nguy c tht bi trong iu tr vi isoniazid, nu iu tr vi
tetracosatid ko di. Trong trng hp ny, phi tnh ti hu qu trong iu tr do
tng tc gy ra tip tc phi hp thuc hay ngng li. Vi cc corticoid khc,
vn cn phi cnh gic.
787
Primidon hoc dn cht

Phn tch: Tng d ho thuc phi hp do primidon gy cm ng enzym.
Cm ng enzym ch th hin sau 10 n 12 ngy, k t lc bt u iu tr.
X l: Cm ng enzym khng phi l mt hin tng tc th. Vic iu tr
vi mt thuc cm ng enzym di hn hay trung hn i hi phi tnh n nguy
c gim hiu qu ca thuc phi hp. Hiu chnh liu lng trong khi iu tr v
sau khi ngng cht cm ng enzym.
Quinidin hoc dn cht
Phn tch: Nguy c xut hin xon nh khi phi hp mt thuc h kali mu
vi mt thuc chng lon nhp thuc nhm I ca Vaughan - Williams. H kali
in tm ) l nhng yu t thun li cho xon nh.
X l: Nu cn phi hp corticoid vi thuc ny, phi d phng h kali mu
bng cch b sung mt lng kali c tnh ton, v nu cn th lm in tm
. Khi c xon nh, khng dng thuc chng lon nhp. Khuyn ngi bnh gp
li bc s khi thy mi mt, yu c, thm ch chut rt.
Sotalol
Phn tch: Nguy c xut hin xon nh khi phi hp hai thuc ny. H kali
in tm ) l nhng yu t thun li cho xon nh.
X l: Nu phi hp tetracosactid vi thuc ny, phi d phng h kali mu
bng tng cng theo di v kim tra in tm . Trong trng hp xut hin
xon nh, khng c dng thuc chng lon nhp. Khuyn ngi bnh gp li
bc s khi thy mi mt, yu c, chut rt.
Thuc ng ho steroid, alkyl ho C17
Phn tch: S dng ng thi hai thuc c th lm tng nguy c ph n.
Tng tc dc lc.
X l: Cn nhc xem c cn phi k n hai thuc khng, v nu cn, hiu
chnh liu lng v theo di ion . Cn phi ch n vic s dng du dim
cc thuc ng ho steroid (vn ng vin th thao) v cho ngi bnh bit nguy
c xy ra nu dng hai thuc ng thi.
Phn tch: Thuc khng acid lm gim hp thu ng tiu ho, nn lm
X l: Phi ung hai thuc cch nhau 1 n 2 gi. Nh l cc thuc khng
acid thng c dng sau ba n 1 gi 30 pht, v n l nguyn nhn tng tit
dch v.
Phn tch: Phi hp hai thuc h kali mu lm tng thm nguy c h kali
mu, nht l khi thuc nhun trng dng lu di.
788
X l: Theo di kali mu, v nu cn iu chnh bng b sung mui kali. H

kali mu th hin trn lm sng qua mt mi, thm ch chut rt v i khi lon
nhp tim. Cn ch n mt nc nhiu (khi gng sc, hoc qu nng hoc tiu
chy dai dng), lm mt kali nng thm.
Phn tch: Tc dng gy lot ca corticoid lm tng nguy c lot chy mu,
nht l ngi bnh cao tui.
X l: Hi ngi bnh v tin s lot d dy, v tng cng theo di lm
sng v sinh hc nu phi hp thuc.

Dihydropyridin
Phn tch: Gim tc dng chng tng huyt p. Cc thuc chng vim c
ch tng hp thn cc prostaglandin gy gin mch v / hoc ko theo gi
nc v natri. Nguy c suy thn cp ngi bnh b mt nc.
X l: Phi m bo ngi bnh c cung cp nc tt. Theo di chc
nng thn ( thanh lc creatinin). Kim tra tnh n nh ca huyt p, c bi t
lc bt u iu tr. Khuyn ngi bnh theo di u n huyt p.
789
Guanethidin hoc dn cht; reserpin; thuc gin mch chng tng huyt
p; thuc c ch enzym chuyn dng angiotensin
Phn tch: Tc dng chng tng huyt p c th b gim do cc glucocorticoid
gy gi nc v natri.
X l: Hiu chnh liu lng trong v sau khi iu tr bng cc corticoid. Lp
mt k hoch dng thuc u n v yu cu tun th. Khuyn ngi bnh tng
cng t theo di trong qu trnh iu tr vi corticoid v nu c nhng bin ng
quan trng v huyt p, khuyn ngi bnh gp li bc s iu tr.
prednison, v cng c gi tr vi cc corticoid khc. C ch cha r.
X l: Cn phi tnh ti s gim tc dng ny trc khi k n phi hp
thuc. Cn nhc nguy c / li ch v gi thnh / hiu qu.
Methyldopa
Phn tch: Tc dng chng tng huyt p c th b gim do cc glucocorticoid
gy gi nc v natri.
X l: iu chnh liu lng trong v sau khi iu tr bng corticoid. Thng
tin cho ngi bnh tng cng t theo di trong thi gian iu tr corticoid. Lp
mt k hoch dng thuc u n v yu cu tun th trong khi iu tr. Nu c
bin ng quan trng v huyt p, khuyn ngi bnh gp li bc s iu tr.
TETRACYCLIN
Cc khng sinh km khun hot ph rng
CC THUC TRONG NHM

DOXYCYCLIN nang 50 mg; 100 mg; vin nn 100 mg; dung dch tim 100 mg/5 ml
Apo-Doxy nang 100 mg
Doxat nang 100 mg
Doxi nang 100 mg
Doxycyclin Domesco nang 100 mg
Lyka Lydox nang 100 mg
Medomycin nang 100 mg
Unidox nang 100 mg
TETRACYCLIN vin nn bc ng 250 mg; 500 mg
Polycyclin
790
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k cho con b: Cc tetracyclin rt a lipid, qua c sa m, nn cn trnh
dng, ngay c khi chng to vi calci trong sa cc phc cht t c hp thu.
Tr em: Cc tetracyclin c th lm cho rng vng nu, v ng li di dng mui
phc cht nhng vng ngm khong ca rng sa cng nh rng vnh vin. V vy,
cn trnh dng cho tr em di chn tui.
Thi k mang thai: Cc tetracyclin c th lm cho rng ca tr nh c mu vng
nu nu ngi m dng thuc ny trong thai k (to mt mui phc calci vng ng m
khong ca rng), v lm chm ct ho tm thi do gn vo xng.

Cc trng hp khc: Qu mn vi cc cyclin. Trnh nh nng v tia t ngoi
Thn trng: mc 2
Cng tuyn gip: Trnh iu tr lu di vi cc tetracyclin ngi c ri lon
chc nng tuyn gip.
Nhc c: Nguy c lm nng thm nhng triu chng nhc c nghim trng.
Cn theo di: mc 1
Suy gan: ngi bnh suy gan, cc tetracyclin c th tch lu v gy thoi ho
m gan.
Suy thn: Tetracyclin o thi qua thn, tr clortetracyclin v doxycyclin o thi
theo ng mt - tiu ho l ch yu. Tt c cc trng hp lon chc nng thn u
lm tng nguy c gy bin chng gan do chm o thi.
TNG TC THUC

Digoxin
Phn tch: Vic s dng ng thi tetracyclin vi digoxin c th gy tng
nng digoxin trong mu mt s t ngi bnh (khong 10%). Tc dng c
c th xy ra v ko di nhiu thng sau khi ngng tetracyclin. C ch: khong
10% s ngi bnh, mt lng ln digoxin c vi khun rut chuyn ho thnh
sn phm kh khng c hot tnh. Tetracyclin tc ng trn vi khun rut nn
ngn cn s chuyn ho ny, lm cho c nhiu digoxin c hp thu hn v
nng digoxin trong huyt thanh tng.
X l: Theo di ngi bnh v s tng nng digoxin v nhng du hiu
c tnh. C th cn phi gim liu digoxin, hoc dng ch phm nang c tc
dng gim thiu s to thnh sn phm kh do lm tng sinh kh dng.
791

Phn tch: Phi hp hai thuc c th lm xut hin nhc u, chng mt,
ri lon th gic do tng p lc ni s (hip ng tc dng tng p lc ni s ca
mi thuc).
X l: Chng ch nh phi hp thuc ny, v phi tm mt liu php dng
khng sinh khc (xem vi mt s macrolid)
Methoxyfluran
Phn tch: Dng cng vi tetracyclin, th c tnh vi thn tng ln. C ch: c
th do tetracyclin kch thch s bin i sinh hc methoxyfluran thnh cc cht
chuyn ho c v c ch s bi tit cc cht chuyn ho qua thn.
X l: Khng phi hp hai thuc ny v chn cc thuc thay th.

Cephalosporin c nhn thiomethyltetrazol; cephalosporin hoc thuc tng
t; penicillin
Phn tch: Tc dng km khun ca cc tetracyclin c th i khng vi tc
dng dit khun ca cc cephalosporin v cc penicilin. Tc dng dit khun ny
th hin trn nhng vi khun giai on pht trin theo hm m. Tng tc ny
c th c hi trong iu tr vim mng no m ta cn can thip nhanh v mnh
X l: Phi tnh ti nguy c ny trong tnh hnh sinh l bnh hc c th. Phi
hp ny c th thc hin ty theo thuc dng v mm gy bnh (ch t i nng
ti thiu c ch-MIC).
Thuc kim ho nc tiu
Phn tch: Phi hp tetracyclin vi cc thuc kim ho nc tiu lm tng
s o thi tetracyclin v h thp nng thuc trong huyt thanh. Do hiu
qu iu tr c th gim. Mt s bo co khc li mu thun. C ch: c th do
s ti hp thu tetracyclin qua cc tiu qun thn b gim khi nc tiu mang tnh
kim. ng thi khi pH dch v tng cng lm cho tetracyclin kh hp thu.
X l: Dng hai loi thuc trn cch nhau 3 n 4 gi. Tuy nhin, nu pH
nc tiu tng cao do cc thuc kim ho nc tiu th s khng c hiu qu
gim thiu tng tc. C th cn phi tng liu tetracyclin.
Vitamin A
Phn tch: Tng nguy c tng p lc ni s lnh tnh (nhc u, gim th
lc) ging nguy c chnh khi tng tc vi cc retinoid.
X l: Cha thy c thng k v nguy c i vi vitamin A, nhng do ging
nhau v mt dc l, cn phi rt thn trng.

Barbituric; carbamazepin; gluthetimid hoc thuc tng t; phenytoin;
primidon hoc dn cht
792
Phn tch: Tng d ho doxycyclin gan do cm ng enzym. Mc du hin

tng ny cha c xc lp vi cc tetracyclin khng o thi qua nc tiu,
nhng vn cn thn trng.
X l: Tng tc ny i hi phi iu tr nhiu ngy mi c th c c
cm ng enzym. Nguy c tht bi trong iu tr s xy ra nu nng ti thiu
c ch ca khng sinh khng i vi vi khun ang xt. Cn ch n nguy
c ny v khi cn, chn mt phc dng khng sinh khc.
Calci; st; magnesi; km
Phn tch: Tng tc l ho. To phc gia cc cation vi cc tetracyclin,
ko theo gim hp thu tetracyclin v c nguy c tht bi trong iu tr (Fe, Al, Ca,
Zn)
X l: Nguy c ny ln hn vi cc tetracyclin th h 1 (terramycin...), gim
hp thu ti 75%. Vi cc tetracyclin th h 2 gim hp thu khong 20% v c th
khng c ngha lm sng.
Cholestyramin
Phn tch: Gim hp thu cc tetracyclin theo ng tiu ho.
X l: Nu hai thuc ny c k n, khuyn nn dng tetracyclin hai gi
trc, hoc bn gi sau khi dng cholestyramin.
Didanosin
Phn tch: Citrat trong thnh phn t dc ca thuc didanosin dng ung,
lm gim hp thu thuc phi hp, lm gim hiu qu ca chng.
X l: Dng thuc phi hp hai gi trc khi dng didanosin hoc su gi
sau.
Phn tch: Liu php khng sinh lm gim h vi khun ng rut (gi
thuyt), nn c th lm gim ti hp thu cc steroid chu trnh gan - rut. C
nguy c khng thng xuyn v gim tc dng ca estroprogestogen. Cha c
th a ra nhng iu d bo.
X l: Nguy c ny tu thuc thi gian iu tr v mc tn hi n h vi
khun ng rut. iu quan trng l phi xem ngi ph n dng cc
estroprogestogen c b tiu chy khng.
Furosemid hoc thuc tng t; thuc li tiu gi kali; thuc li tiu thi
kali
Phn tch: Nguy c tng ure mu ngi suy thn, do mt c ch cn cha
r. Ch ring tetracyclin cng c th gy tng ure mu. ngha lm sng ca
tng tc ny khng ln.
X l: Tng ure c th do mt thuc, hoc c hai thuc.
793

Phn tch: Thuc khng acid lm gim hp thu ng tiu ho nn lm
X l: Thuc khng acid v thuc phi hp phi ung cch nhau t nht 1
n 2 gi. Nh rng cc thuc khng acid thng c ung sau ba n 1 gi 30
pht, v n l nguyn nhn tng tit dch v.
Phn tch: Nguy c chy mu theo mt c ch cha r. Tng tc ny c
ni rt t trong y vn.
X l: Theo di thi gian prothrombin v t l chun ha quc t (INR), v
hiu chnh liu lng lc bt u, trong khi iu tr v trong vng tm ngy k t
khi ngng iu tr.
THEOPHYLIN HOC DN CHT

Dn cht xanthin, gin ph qun v hi sc h hp
CC THUC TRONG NHM

AMINOPHYLLIN dung dch tim 25 mg/mL; dung dch tim tnh mch 4,8%
Aminophylline dung dch tim 25 mg/mL
Diaphyllin dung dch tim tnh mch 4,8% x 5mL
THEOPHYLLIN nang 100 mg ; 200 mg ; siro 1% x 200 mL ; vin nn 100 mg; 175
mg; vin nn gii phng chm 100 mg
Asmacort vin nn 65mg (phi hp vi dexamethason v phenobarbital)
Dilatrane nang 100 mg ; 200 mg ; siro 1% x 200 mL
Theolair LP vin nn 100 mg; 175 mg
Theostat vin nn gii phng chm 100 mg
CH KHI CH NH THUC

Thi k cho con b: Theophylin qua c sa; tr em b sa s nhn c
10% n 15% liu dng ca ngi m, nn c th b kch thch v mt ng.
794
Tr em: Theophylin c phm vi iu tr hp v tai bin qu liu hay gp l tng

kch thch, vt v, co git, nn, c th li nhng di chng thn kinh vnh vin. Trnh
dng cho tr di 30 thng tui, tr trng hp dng d phng cn ngng th
nguyn pht ca tr s sinh thiu thng.
Cc trng hp khc: Qu mn vi theophylin.
Thn trng: mc 2
n ung - ru: Khi ng c ru, na i ca theophylin s tng do c ch
enzym.
Thi k mang thai: C th dng theophylin cho ngi mang thai, nhng nu dng
cui thai k, c th thy nhp tim nhanh, kch thch tr mi sinh.
Ph i tuyn tin lit; u tuyn tin lit: Nguy c b tiu tin.
Cn theo di: mc 1
ng kinh: Do nguy c co git khi qu liu
Tng nng tuyn gip: Do ri lon tim mch (nhp tim nhanh) khi qu liu.
Suy tim: Suy tim lm tng na i v lm gim tc o thi theophylin, v vy
cn gim liu.
Suy mch vnh: Do ri lon tim mch (nhp tim nhanh) khi qu liu.
Suy gan: Theophylin chuyn ho gan (kh metyl v oxy ho, ch yu to thnh
acid dimethyl 1 - 3 uric). Cn lu n tnh trng chc nng gan n nh liu lng.
Suy thn: Suy thn i hi phi gim liu lng trnh nguy c qu liu.
Ngi bnh cao tui: Cn theo di iu tr chnh xc, v phm vi iu tr hp v
nguy c tng cc tc dng ph.
Lot d dy - t trng; vim d dy: ng vt, theophylin kch thch tit dch v.
Dng thuc ny cho ngi lot d dy phi thn trng.
TNG TC THUC

Acyclovir
Phn tch: Phi hp vi acyclovir, nng theophylin trong huyt tng
tng ln, lm tng tc dng dc l v cc tc dng ph. C th l acyclovir c
ch s chuyn ho oxy ho ca theophylin.
X l: Theo di cht nng theophylin trong huyt tng v cc tc dng
ph c th xy ra ngi bnh khi dng ng thi vi acyclovir. Nu cn th hiu
chnh liu dng theophylin.
Adenosin
Phn tch: Theophylin vi cc tc dng ca adenosin trn tim mch c ch
cha r, nhng ngi ta bit l theophylin i khng vi th th ca adenosin.
795
X l: Do hiu qu ca adenosin dng vi liu tiu chun trn iu tr nhp

nhanh tht b gim, nn cn nh gi p ng vi thuc v nu cn phi dng vi
liu cao hn.
Disulfiram
Phn tch: Disulfiram lm tng tc dng dc l v c tnh ca theophylin
thng qua vic c ch qu trnh hydroxyl ho v kh methyl trong chuyn ho
theophylin.
X l: Vi ngi bnh ang dng theophylin, khi bt u dng v khi thi
dng disulfiram, phi theo di nng theophylin trong huyt tng v s gim
tc dng ca theophylin. Cn iu chnh li liu lng theophylin.
796
Hormon tuyn gip

Phn tch: ngi bnh thiu nng tuyn gip, thng c hin tng gim
thanh lc theophylin. S thanh lc ny tr v mc thng khi chc nng
tuyn gip bnh thng ho tr li. C mi tng quan dng tnh gia nng
thyroxin trong huyt tng vi s thanh lc theophylin. Nhng ngi bnh tng
nng hoc gim nng tuyn gip u b nh hng ca s thanh lc theophylin.
X l: a chc nng tuyn gip tr v bnh thng l cn kim sot
c s thanh lc theophylin. Theo di nng theophylin v hiu chnh liu nu
cn.
Macrolid
Phn tch: Tng nng theophylin trong mu, km nguy c qu liu, nht l
tr em (cha c ti liu vit v spiramycin, roxithromycin, clarithromycin,
azithromycin, midecamycin, dirithromycin).
X l: Hiu chnh liu lng theo kt qu nh lng theophylin. Nu khng,
phi thay i khng sinh.
Than hot tnh
Phn tch: Than hot tnh lm gim s hp th nhiu loi thuc, c th nh
theophylin v cn c kh nng loi bt cc thuc ra khi tun hon. Tu
bnh cnh, iu ny c th lm gim hiu qu hoc gim c tnh ca thuc.
X l: Trong nhim c, dng 30-100g than hot cng sm cng tt. Nu
y hi, tiu chy m c dng theophylin, thay than hot bng thuc khc.
Thuc gin c khng kh cc
Phn tch: Tc dng gia loi thuc ny vi theophylin c i khng.
X l: Khi dng phi hp vi theophylin, cn phi dng cc thuc gin c
khng kh cc vi liu cao hn bnh thng.
Thuc khng gip trng (thioamin)
Phn tch: Dng cng vi theophylin, thuc khng gip trng c nh hng
n s thanh lc ca thuc ny. C ch: do s thanh lc theophylin tng ngi
bnh tng nng tuyn gip. Khi chc nng tuyn gip tr v mc bnh thng, s
thanh lc cng tr li gi tr thng l. C mi tng quan dng tnh gia nng
thyroxin trong huyt tng vi thanh lc theophylin.
X l: a chc nng tuyn gip v trng thi bnh thng l iu c bn
kim sot s thanh lc theophylin. Theo di nng theophylin trong huyt
tng, hiu chnh liu nu cn.
Thuc nga thai ung
Phn tch: Thuc nga thai dng ng ung lm gim s thoi bin oxy
ho ca theophylin thng qua cytochrom P448. Do c th xy ra trng hp ng
c theophylin do gim thi thuc.
797
X l: i vi ngi bnh dng ng thi hai thuc ny, phi theo di v

lm sng v nh k nh lng theophylin trong huyt thanh. Hiu chnh li liu
theophylin nu cn.
Ritonavir
Phn tch: Gim din tch di ng cong (AUC) ca theophylin, km theo
gim hiu qu iu tr.
X l: nh lng u n theophylin trong huyt tng, v nu cn, tng
liu lng.
Viloxazin
Phn tch: Nguy c tng nng theophylin trong huyt thanh do gim d
ho theophylin gan.
X l: Tng cng theo di lm sng v theo di c bit nng
theophylin trong mu. Hiu chnh liu lng theophylin khi cn, nu iu tr bng
viloxazin khng th ngng hay thay i c. Du hiu lm sng v nhim c
theophylin gm c: bun nn, nn, au vng thng v; nhc u, kch thch, mt
ng; nhp tim nhanh. Co git thng l mt du hiu khng nh nhim c,
nhng cng c th l du hiu u tin (c bit vi tr em). Khuyn ngi bnh
gp li bc s khi thy du hiu nhim c. Cn nh theophylin l thuc c phm
vi iu tr hp.

Phn tch: iu tr bng alopurinol liu cao (t nht 600 mg/ ngy) cng vi
theophylin gy gim thanh lc theophylin qua thn, v tng nng theophylin
trong huyt thanh.
X l: Cn theo di cht nng theophylin trong huyt thanh v da vo
, hiu chnh liu lng. Cc du hiu ng c theophylin trn lm sng gm:
bun nn, nn, au thng v; nhc u, trng hp kch thch mt ng; nhp tim
nhanh. Co git thng l du hiu khng nh ng c thuc ny, nhng cng c
th l du hiu u tin (c bit tr em). Khuyn ngi bnh gp li bc s khi
thy du hiu ng c. Cn nh theophylin l thuc c phm vi iu tr hp.
Phn tch: Cn thn trng trong phi hp amantadin vi cc thuc kch thch
tm thn, nhm trnh cc tc dng hng thn kiu kch ng, mt ng, thm ch
lon nhp tim.
X l: Cn thn trng v cnh gic vi phi hp thuc ny, cn chuyn cc
nhn xt n cc Trung tm cnh gic thuc.
Phn tch: Phi hp vi mt thuc cm ng enzym nh k trn. Sau 10 n
12 ngy, cht cm ng kch thch chuyn ho theophylin gan, lm gim nng
theophylin trong huyt tng v do lm gim tc dng iu tr.
798
Benzodiazepin
Phn tch: Theophylin i khng vi tc dng an thn ca cc
benzodiazepin. Tc dng i khng ny c th l do cnh tranh lin kt vi cc
th th adenosin trong no.
X l: Theo di tnh trng ngi bnh trn lm sng v hiu chnh liu ca
benzodiazepin nu cn.
Diltiazem; mexiletin
Phn tch: Tng tc cn ang tranh lun. Hnh nh mexiletin v diltiazem
c th lm gim thanh lc v tng na i ca theophylin.
X l: Cn cnh gic. D ngha lm sng ca tng tc khng tht quan
trng, nhng na i ca theophylin c th tng ln. Nu iu tr di ngy, phi
theo di nng theophylin trong huyt thanh, v chuyn cc nhn xt n Trung
tm cnh gic thuc.
Fluvoxamin
Phn tch: Fluvoxamin c ch chuyn ho theophylin gan, c th gy ra
qu liu. Tng tc dc ng hc v chuyn ho thuc.
X l: Theo di lm sng, nu cn kim tra nng theophylin trong mu,
v hiu chnh liu lng trong v sau khi iu tr vi fluvoxamin.
799
Lansoprazol
Phn tch: Tng tc dc ng hc. Cn thn trng vi nhng thuc b
chuyn ho bi cytochrom P450, v c nguy c gim hot tnh ca chng do
lansoprazol gy cm ng enzym, c th dn ti tht bi trong iu tr.
X l: Lansoprazol l thuc tng i mi, nn cn thiu nhng nhn xt
lm sng. C th xy ra nhng tng tc, v nn chuyn nhng nhn xt lm
sng n Trung tm cnh gic thuc. Hiu chnh liu lng theo nng
theophylin trong mu khi bt u v khi ngng iu tr vi lansoprazol. Xem xt
nguy c trong bi cnh iu tr c th v thng bo cho ngi bnh bit. Khuyn
ngi bnh n khm li, nu khng .
Lithi
Phn tch: Tng tc dc ng hc. Tng o thi lithi qua nc tiu.
X l: Theo di lm sng. Nu cn, iu chnh liu lng theo nng lithi
trong mu.
Nicotin
Phn tch: Nicotin gy cm ng enzym; v vy c th kch thch chuyn ho
mt s cht, v lm gim hiu qu iu tr.
X l: Cn cnh gic vi nhng thuc c phm vi iu tr hp trong khi iu
tr bng nicotin, v nu cn xem li liu lng trong v sau khi iu tr. Cn nh
cm ng enzym l mt hin tng ch xut hin sau khong 10 ngy, khc vi c
ch enzym l hin tng tc th.
Nilutamid; verapamil
Phn tch: C th do tc dng c ch enzym ca thuc phi hp, m c
nguy c qu liu theophylin.
X l: Theo di lm sng v sinh hc (o nng theophylin trong huyt
thanh). Hiu chnh liu lng theo cc kt qu lm sng v / hoc sinh hc.
Khuyn ngi bnh gp li bc s nu thy du hiu ng c theophylin (bun
nn, nn, nhp tim nhanh, nhc u, nguy c co git).
Quinolon; sparfloxacin
Phn tch: Tng na i ca theophylin, c th do c ch cnh tranh v tr
lin kt trn cytochrom P450 (c bit vi ciprofloxacin, enoxacin, norfloxacin v
pefloxacin). Tng nng trong huyt thanh v tng c tnh vi thn kinh ca
xanthin.
X l: Theo di lm sng, v nu cn hiu chnh liu lng theo nng
theophylin trong huyt thanh, trong khi iu tr v khi ngng iu tr vi cc
quinolon k trn. Cng c th, ty theo nguy c qu liu theophylin m thay i
chin lc iu tr bng khng sinh.
800
Ticlopidin
Phn tch: Tng tc dc ng hc v o thi thuc. Tng nng
theophylin trong mu. Nguy c qu liu do gim thanh lc theophylin huyt
tng.
X l: Nguy c qu liu. Hiu chnh li liu theo nng theophylin hu
hiu trong mu. Nng ny nm trong khong 5 n 15 mg/lt. Da trn kt qu
phng th nghim o c hiu chnh liu lng. Cn nhc li nhng du hiu
lm sng v qu liu theophylin ngi ln l: co git, st cao, ng ng tim; tr
em l: kch ng, ni nhiu, l ln, nn lin tip, st cao, nhp tim nhanh, rung
tht, co git, h huyt p, ri lon h hp, sau suy h hp.
Phn tch: Theophylin v cc dn cht c ch enzym phosphodiesterase
dn n kch thch cc th th beta adrenergic, do c th gy tc dng i
khng.
X l: Theo di nhng tc dng i khng c th xy ra lc bt u, trong
khi v khi ngng iu tr. Tng tc ny c m t nhng cn cn thm ti
liu. Chuyn v Trung tm cnh gic thuc nhng nhn xt thu c.
Phn tch: Cimetidin l cht c ch cc enzym oxydase ca gan (cytochrom
P450) chu trch nhim chuyn ho mt s thuc. Ngoi ra, cn lm gim lu
lng mu qua gan. Do , nng mt s thuc trong huyt tng tng ln (c
nguy c qu liu). Do c ch c mt s chuyn ha sinh hc, cimetidin phong
b mt s c ch gii c.
X l: Theophylin l thuc c phm vi iu tr hp; khi c ch chuyn ho
ca n dn n nguy c qu liu. Phi tng cng theo di nng thuc trong
huyt tng khi du hiu qu liu xut hin, hoc phi i thuc chng lot.
Nhng du hiu lm sng khi qu liu theophylin ngi ln l: co git, st cao,
ngng tim; tr em l: vt v, ni nhiu, l ln tm thn, nn lin t c, s t cao,
nhp tim nhanh, rung tht, co git, h huyt p, ri lon h hp, th nhiu sau
suy h hp.
Phn tch: Tng cc tc dng hng thn, c th dn n kch ng, mt
ng, v him hn l co git v lon nhp tim.
X l: Nu cn phi hp thuc, ch yu phi theo di lm sng. nh gi
nguy c theo dng bo ch ca thuc.
Phn tch: Tng nguy c lon nhp tim, c bit vi halothan.
X l: Phi hp thuc ny c thc hin c s bnh vin. Nhc nh
ngi bnh thng bo cho bc s gy m nhng thuc mnh dng. Bc s gy m
phi lu nguy c ny v phi theo di nhp tim ngi bnh.
801
Thuc gy m cc loi
dng an thn.
X l: Khuyn ngi bnh sp phu thut thng bo cho bc s gy m
nhng th thuc mnh dng.
Vaccin sng gim c lc
Phn tch: C th c tng tc c hiu vi vaccin chng cm. C ch tc
dng cn c xc nhn v mt sinh ho v dc ng hc ca chuyn ho
theophylin. Mc du cn tranh lun v tng tc ny, ngi ta cho rng vaccin
chng cm lm gim o thi cc thuc b cytochrom P 450 chuyn ho gan, v
lm tng nng v na i ca theophylin v cc dn cht trong huyt thanh.
Cng c kin cho rng tng tc ny khng xy ra vi cc vaccin c tinh
khit cao, lm cho ta ngh n vai tr ca mt tp cht no trong mt s
vaccin.
X l: Nh vy, cn phi thn trng nu phi tin hnh iu tr song song
hai thuc ny, mc du cha c tai bin iu tr thc s no c cng b trn y
vn. Vi s hiu bit hin ti ca chng ta, c th c hai thi : Gim liu
theophylin khong 50% trong 24 gi sau khi tim; chng hng ti dng cc
vaccin c tinh khit cao. Nu nhng thay i dc ng hc ca thuc biu
th ra nhng du hiu ng c trn lm sng, nn chuyn cc nhn xt v Trung
tm cnh gic thuc.

Tacrin
Phn tch: Tng tc dc ng hc, lm gim thanh lc theophylin
trong huyt tng, ko theo nguy c qu liu.
X l: Nu cn phi hp thuc, phi theo di nng theophylin trong mu
v gim liu lng theophylin. Phi theo di lm sng.
Phn tch: Trong cc thuc chng nm dn cht ca imidazol, ch c
fluconazol c ghi nhn l lm gim thanh lc theophylin. Tng tc dc
ng hc.
X l: Nu cn phi hp thuc, phi lu n tng tc ny trc khi k
n theophylin, v phi hiu chnh li liu lng trong v sau khi iu tr. Theo di
lm sng v sinh hc (o nng theophylin trong mu).
THIOTEPA
Cht km t bo alcoyl ho
802
CC THUC TRONG NHM

THIOTEPA ng tim 15 mg
CH KHI CH NH THUC
S dng thuc ny i hi bc s k n phi c trnh chuyn khoa. Do ,
chng ch nh cn c xt ty theo tnh trng ca ngi bnh v phi c bc s
chuyn khoa nh gi.
TNG TC THUC
Cn nhc nguy c/ li ch; mc 3

Phn tch: Dng ng thi vi nhng cht c ch min dch lm tng nguy
c xut hin chng tiu c vn v suy thn.
X l: Mc du nhng trng hp c thng bo ch lin quan n
lovastatin, vn c nguy c tim tng vi simvastatin v pravastatin. Nn trnh phi
hp thuc ny.
Vaccin sng gim c lc
Phn tch: C nguy c pht trin nhim khun tng ng vi chng ca
vaccin do hot tnh c ch min dch ca thuc phi hp.
X l: Hai thuc ny phi dng cch nhau t 3 thng n 1 nm; khong
cch thi gian ny di ngn ny tu thuc vo mc c ch min dch.

Amphotericin B
Phn tch: Phi hp amphotericin B tim vi cc thuc c vi ty khc i
hi phi rt thn trng. C nguy c thiu mu v cc ri lon mu khc.
X l: Khi cn phi hp thuc, phi theo di cht ch huyt v khi cn,
phi gim liu lng.
803

cht; fluoro - 5 - uracil; ganciclovir; interferon alpha ti t hp ; levamisol;
melphalan; mercaptopurin; methotrexat; pentostatin; procarbazin; thuc khng ung
th cc loi; vincristin hoc thuc tng t
Phn tch: Nguy c tng c tnh vi mu v c ch ty xng do tc dng
hip ng, c th dn ti mt bch cu ht.
X l: Trnh phi hp thuc ny, nu c th. Nu cn phi hp thuc, phi
dng liu thp vi mi cht v theo di cn thn huyt . Phi hp thuc ny
phi do cc bc s chuyn khoa thc hin v cc phc i u tr thng c
nh r.
Ciclosporin
Phn tch: Phi hp hai thuc c ch min dch. Do c ch min dch qu
ln, nn c nguy c xut hin cc u lympho gi.
X l: Cn suy ngh k khi phi hp hai thuc c ch min dch, phi cn
nhc nguy c/ li ch theo mc ch iu tr. Ch c th tin hnh phi hp thuc
c s chuyn khoa, v phi theo di ngi bnh cht ch.
Clozapin
Phn tch: C nguy c tng c tnh vi mu do c ch ty xng do tc
dng hip ng, c th dn ti mt bch cu ht. Ch vi clozapin dng n c,
c th c hin tng mt bch cu ht nng, thm ch dn ti t vong (c tnh
min dch).
X l: Nu cn phi hp thuc, phi dng liu thp cho mi thuc. Khng
c g cho php tin on mt bch cu ht khi dng clozapin. Vic theo di c n
thn huyt , thc hin mt cch bnh thng khi dng mt thuc km t bo,
vn c gi tr. Tuy nhin, cn bo trc cho ngi bnh bit ch st nh, vim
hng, lot ming l phi ngng dng clozapin.
Colchicin hay dn cht
Phn tch: Dng ng thi mt cht km t bo vi mt thuc chng bnh
thng phong (gt) lm tng nng acid uric. Ngoi ra, cn tng nguy c gim
bch cu, gim tiu cu do hip ng cc tc dng khng mong mun.
X l: Tt nht l nn trnh dng hai thuc ng thi, v c th liu php
chng bnh thng phong tht bi. Nn dng alopurinol (cht c ch tng hp
acid uric), thay cho cc cht gy acid uric niu trnh bnh v thn.
Glycosid tr tim
Phn tch: Phi hp vi mt cht km t bo lm gim hp thu cc thuc
digitalis khong 50%, do tn thng nim mc rut hi phc c.
X l: Theo di cht ch nng cc thuc digitalis trong huyt thanh sut
thi gian iu tr.
804
Phn tch: Phi hp hai cht c ch ty xng.
X l: Ch c dng interleukin ti c s chuyn khoa, do tnh nghim trng
ca bnh l. Cc tng tc lc phi cn nhc, v tt c cc chc nng ca c
th u cn theo di lin tc. Theo di huyt bao gi cng bt buc.
Phenicol
Phn tch: Nguy c tng c tnh vi mu do c ch ty xng do hip
ng tc dng, c th dn ti mt bch cu ht. Ch vi cc phenicol dng n
c, c th mt bch cu ht nng, thm ch t vong (c tnh min dch).
X l: Nu cn phi hp thuc, phi dng mi thuc vi liu lng thp.
Khng c g bo trc mt bch cu ht vi cc phenicol. Vic theo di cht ch
huyt , thc hin bnh thng khi dng mt cht km t bo, vn c gi tr .
Nhng ngi bnh cn c bo trc l nu ch st nh, vim hng, lot ming,
th phi ngng dng phenicol.
Vng
Phn tch: Nguy c tng h hi cc dng t bo mu (bt sn ty).
X l: Phi hp thuc i hi phi theo di sinh hc (huyt hc) nhng
ngi bnh c nguy c.
Zidovudin
Phn tch: Phi hp zidovudin vi cc cht c vi ty khc i hi phi rt
thn trng. Nguy c thiu mu hay cc ri lon khc v mu.
X l: Khi cn phi hp thuc, phi theo di cht ch huyt , v khi cn
phi gim liu lng.
THUC AN THN KINH CC LOI

Cc thioxanthen thuc nhm ny. Thuc dng iu tr cc chng ri lon tm
thn. Cn phn bit: cc thuc an thn kinh h benzamid, cc butyrophenon, cc thuc
an thn kinh h phenothiazin. Mi loi to thnh mt nhm ring
CC THUC TRONG NHM

FLUPENTIXOL vin nn 1 mg; 3 mg; ng tim 20 mg
Fluanxol vin nn 1 mg; 3 mg
Fluanxol LP ng tim 20 mg
LOXAPIN vin nn 25 mg; 50 mg; ng tim 50 mg
805
Loxapac vin nn 25 mg; 50 mg

Loxapac ng tim 50 mg
PIMOZID vin nn 1 mg; 4 mg; thuc ung git 45 mg/1mL
Orap vin nn 1 mg; 4 mg
Orap thuc ung git 45 mg/1mL
ZUCLOPENTIXOL vin nn 10 mg; 25 mg
Clopixol vin nn 10 mg; 25 mg
CH KHI CH NH THUC
Thn trng: mc 2
Glocom: Nguy c tng nhn p do khp gc.
Ph i tuyn tin lit - u tuyn tin lit : Nguy c b tiu tin lin quan n ri
lon niu o - tuyn tin lit.
Cn theo di: mc 1
n ung - ru: Ru lm tng tc dng an thn ca cc thuc an thn kinh.
Thi k cho con b: Cc thuc an thn kinh qua c sa m gy nguy c an
thn tr cn b.
Tr em - ngi bnh cao tui: Tr em v ngi bnh cao tui nhy cm hn vi
nhng tc dng khng mong mun (hi chng Parkinson gi, ri lon tim mch, h huyt
p th ng, l ln). Liu lng phi thp v tng dn.
ng kinh: Cc thuc an thn kinh lm gim ngng gy ng kinh v c th
khi ng mt cn ng kinh.
Thi k mang thai: Phi trnh dng cc thuc an thn kinh u thai k, cha
xc nh c tnh an ton s dng i vi phn ln cc thuc ny.
Suy gan - suy thn: c tnh ca cc thuc an thn kinh tng ngi suy gan
hoc suy thn. Liu lng phi gim.
TNG TC THUC

Levodopa
Phn tch: Phi hp levodopa vi mt s thuc c tc dng i khng
K n: Chng ch nh phi hp ny, ngoi tr tm kim mt s i
khng dc l (c tin hnh c s chuyn khoa).
Thuc c ch MAO typ B
dng ca levodopa, iu gii thch vic k n levodopa cng vi thuc c
806
ch MAO typ B. Phi hp thuc ny c cc tng tc thuc ging tng tc thuc

ca levodopa. Phi hp levodopa vi mt s thuc c tc dng i khng
dopaminergic c th dn n cc tc dng i khng.
X l: Chng ch nh phi hp levodopa v thuc c ch MAO typ B vi
thuc an thn kinh thuc h ny, ngoi tr tm kim mt s i khng dc l
(thc hin c s chuyn khoa).
Ritonavir
P450, lm gim bng cch cnh tranh, chuyn ho ca cc thuc c chuyn
ho mnh bi cc cytochrom P450. Nh vy, nng ca nhng thuc ny trong
huyt tng s tng v c nguy c tng c tnh ca chng. Nguy c tng c
tnh tim cng vi khong QT ko di v xut hin xon nh (ch m t duy nht
vi pimozid: Orap). Tng tc dc ng hc v chuyn ha thuc. Cn trnh
tng tc vi risperidon.

Phn tch: Tng tc dng c ch h thn kinh trung ng, dn n tng tc
X l: Lu tng tc ny iu chnh liu ca hai thuc. Ch n
gim tnh to ngi li xe v ngi vn hnh my. Khuyn khng ung ru,
khng dng cc ch phm c ru.
Phn tch: Gim tc dng chng tng huyt p do c ch ti nhp
guanethidin t bo thn kinh bi cc thuc an thn kinh cc loi.
X l: Thay i chin lc iu tr bng cch chn mt thuc chng tng
huyt p khc. Phi hp nn trnh.
Lithi
Phn tch: Tai bin c thn kinh thuc loi hi chng l ln nhng ngi
bnh dng phi hp ny c thng bo.
X l: Phi hp cn trnh. Thay i chin lc iu tr, ngoi tr ngi
bnh trong mt c s chuyn khoa, ti ngi bnh c theo di lin tc.
Methyldopa
Phn tch: Vi cc thuc an thn kinh ni chung, c nguy c lm gim tc
dng chng tng huyt p do chn ti nhp cc cht chuyn ho ca methyldopa
trong cc nrn adrenergic. Nguy c h huyt p t th ng cng gia tng vi
mi thuc an thn kinh.
X l: Khi mun cn bng huyt p, ngi k n phi lu nguy c bin
i huyt p vi cc thuc an thn kinh v chn cch iu tr. Thng tin cho ngi
807
bnh, nu cn phi hp, dng thuc u n vo gi nht nh v tng cng t

theo di. Nu khng, thay i chin lc iu tr. Khuyn ngi bnh n bc s
khm li nu thy bin i huyt p.
Ritonavir
Phn tch: Ritonavir c i lc cao vi isoenzym 3A4 ca cc cytochrom P450.
C nguy c quan trng cnh tranh gia ritonavir v cc thuc khc c chuyn
ho hoc nghi c chuyn ho bi isoenzym ny. S cnh tranh ny s gy
gim chuyn ho v nguy c tng ng k nng ca thuc an thn kinh phi
hp trong huyt tng. Nguy c h huyt p, an thn v tng cc tc dng ngoi
thp (m t vi risperidon, Risperdal, trong h ny). Tng tc dc ng hc v
chuyn ho. Phi cm phi hp vi pimozid.
X l: Theo di cht ch ngi bnh v s xut hin c tnh v gim liu
ca thuc an thn kinh, nu cn.
Ru
dng an thn bun ng. Mt s tc dng tm thn vn ng c th c
ghi nhn vi mt s thuc, nht l trong tun u iu tr. Tng tc kiu d c
lc.
X l: Tt nht khng dng thuc ny, v khng kim sot c vic ngi
bnh ung ru. Nguy c an thn bun ng nguy him nht l vi ngi li xe v
ngi iu khin my mc. Khuyn ngi bnh khng ung ru, khng dng
cc ch phm c ru.

Baclofen
X l: Lu nguy c ny iu chnh liu ca hai thuc nu cn phi
hp. Ngh n gim tnh to ngi li xe v ngi vn hnh my mc. Khuyn
Benzamid; butyrophenon; reserpin
Phn tch: Cng hp cc tc dng khng mong mun, th hin bng nguy
c cc tc dng ngoi thp nng ln.
Buspiron
dng an thn. Mt s tc dng tm thn vn ng c th c ghi nhn vi mt
s thuc, nht l trong tun u iu tr. Tng tc dc lc.
X l: Tt nht khng nn phi hp hai thuc, v ngi k n khng kim
sot c ngi bnh ung ru. Nguy c an thn bun ng nguy him nht i
808
vi ngi li xe v ngi vn hnh my mc. Khuyn ngi bnh khng ung

ru, khng dng cc ch phm c ru, khi iu tr.
Carbamat hoc thuc tng t; carbamazepin; dantrolen; interferon alpha
ti t hp; medifoxamin; paroxetin; primidon hoc dn cht; procarbazin; thuc
c ch h thn kinh trung ng cc loi;
X l: Ch n gim tnh to ngi li xe v ngi vn hnh my mc.
Khuyn khng ung ru , khng dng ch phm c ru.
Phn tch: Cn lu hai nguy c: tng tc dng chng tng huyt p (vn l
mt tc dng khng mong mun ca cc thuc an thn kinh); tng tc d ng c
ch h thn kinh trung ng dn n tng tc dng an thn. Tng tc kiu
dc lc. Nn nh rng rilmenidin, vi liu thng thng, khng lm tng cc tc
dng c ch h thn kinh trung ng ca nhng thuc ny.
X l: Lu nhng nguy c ny iu chnh liu ca hai thuc nu cn
phi hp. Ngh n s gim tnh to ngi li xe v ngi vn hnh my mc.
Khuyn khng ung ru, khng dng cc ch phm c ru.
Clozapin
X l: Theo di huyt p v iu chnh liu ca thuc phi hp trong v sau
khi ngng iu tr clozapin. Thn trng c bit ngi bnh cao tui.
Methadon
Phn tch: Tng nguy c c ch h thn kinh trung ng.
X l: Nguy c an thn bun ng nguy him nht l ngi li xe v ngi
vn hnh my; trnh phi hp thuc. Khuyn ngi bnh khng dng cc
ung hoc cc thuc c ru.
Phn tch: Natri valproat v cc dn cht, ngoi thm cc tc dng c ch
h thn kinh trung ng, cn lm tng hm lng trong huyt tng ca nhng
thuc an thn kinh (thioxanten), c l do c ch enzym v gim d ho ca chng.
X l: Nu cn phi hp, phi gim liu ca nhng thuc an thn kinh loi
thioxanten. Ngh n gim tnh to ngi li xe v ngi vn hnh my. Khuyn
khng ung ru v nu ngi bnh t dng thuc, kim tra t dc ca nhng
thuc ny khng c c ru.
Phenothiazin
Phn tch: Cc phenothiazin c th dng trong iu tr nh nhng thuc
khng histamin, hoc thuc an thn kinh. Dng lm thuc an thn kinh khi chng
c phi hp vi cc thuc an thn kinh khc, c cng hp cc tc dng khng
mong mun, th hin bng nguy c lm nng thm cc tc dng ngoi thp.
809

X l: Nu cn phi hp, phi tng cng theo di huyt p trong v sau
khi ngng iu tr bng mt trong hai thuc. iu chnh liu nu cn. Nhn mnh
v k hoch dng thuc v s tun th. c bit cnh gic khi dng ngi
bnh cao tui.
Thuc gy m bay hi cha halogen cc loi; thuc gy m
X l: Khuyn ngi bnh phi can thip ngoi khoa thng tin cho ngi
gy m nhng thuc m h dng.
Phn tch: Tng tc gy tng tc dng h huyt p ca nhng thuc c
tnh cht an thn kinh v gy th pht h huyt p.
X l: Nu cn phi hp, phi tng cng theo di huyt p trong v khi
ngng iu tr bng mt trong hai thuc. iu chnh liu nu cn. Nhn mnh v
k hoch dng thuc v s tun th. c bit cnh gic khi dng ngi bnh
cao tui.
Phn tch: Thuc khng acid ung lm gim hp thu ng tiu ho v
lm gim tc dng ca thuc c phi hp.
X l: Cn ung hai thuc cch nhau t nht t mt n hai gi. Nn nh
rng cc khng acid thng c ung 1 gi 30 pht sau ba n, v n ung l
Thuc li tiu thi kali mu
X l: Theo di huyt p trong khi phi hp. Ty theo thuc, huyt p c th
h nhiu hay t. iu chnh liu ca mt trong hai thuc nu cn. Xy d ng k
hoch dng thuc u n. Tng cng theo di ngi bnh cao tui (nguy c
ng), v khuyn chuyn dn dn t t th nm hoc ngi sang t th ng.
Khuyn ngi bnh gp li bc s iu chnh li liu, nu thy chng mt lc
u iu tr.
Phn tch: Tng tc gy tng tc dng gim huyt p ca cc thuc c
tnh an thn kinh v th pht gy h huyt p.
X l: Nu cn phi hp, phi tng cng theo di huyt p trong v sau
khi ngng iu tr bng mt trong hai thuc. iu chnh liu nu cn. Nhn mnh
810
v k hoch dng thuc v s tun th. c bit cnh gic khi dng ngi
bnh cao tui.

amphetamin.
Khuyn ngi bnh gp li bc s nu thy kt qu iu tr khng n nh.
Barbituric; fluoxetin; fluvoxamin; thuc khng histamin khng H1 - an thn;
thuc c ch MAO khng chn lc
Phn tch: Tng c ch h thn kinh trung ng, dn n tng an thn
X l: Lu tng tc ny iu chnh liu ca hai thuc. Ngh n gim
tnh to ngi li xe v ngi vn hnh my. Khuyn khng ung ru v cc
ch phm c ru.
Citalopram
Phn tch: Tng tc dng an thn ca cht c ch ti nhp serotonin.
X l: Ch khng ung ru cng, nht l ngi li xe v ngi vn
hnh my.
Oxaflozan; viloxazin; thuc ch vn morphin
Phn tch: Tng c ch h thn kinh trung ng, dn n tng tc dng an
X l: Lu nguy c ny iu chnh liu ca hai thuc nu cn phi hp
ny. Ch n gim tnh to ngi li xe v ngi vn hnh my. Khuyn
Phn tch: Tng c ch h thn kinh trung ng, c ch h hp v h
huyt p. Ngoi ra, nu c s ph thuc thuc, phi hp hai thuc c th lm
tng nguy c ph thuc thuc.
hp. Ngh n gim tnh to ngi li xe v ngi vn hnh my. Khuyn ngi
bnh khng ung ru v dng cc ch phm c ru.
Phn tch: Nguy c tng c ch h thn kinh trung ng.
X l: Nu cn phi hp hai thuc, lu nguy c ny khi gy m v l a
chn liu.
811

Phn tch: Tng cc tnh cht khng cholinergic ca phn ln cc thuc an
thn kinh do hip ng tc dng khng mong mun. Nhng tc d ng ny bi u
hin bng tng nguy c b tiu tin, kh ming v to bn.
X l: Cc tc dng khng mong mun ca loi thuc ny cn c lu .
Nu phi hp ny phi lm theo mc tiu iu tr, thng bo cho ngi bnh v
nhng tc dng khng mong mun c th c. Trnh phi hp thuc ngi c
bnh tuyn tin lit v ngi b tng nhn p.
THUC BO V CHNG NH SNG

L nhng cht bo v chng cc tia t ngoi A v B,
do tc dng lc hay phn x
CC THUC TRONG NHM

TITAN DIOXID kem bi da
Mastu S Forte thuc n
Mastu S thuc m
Sunplay kem bi da
CH KHI CH NH THUC
Cn theo di: mc 1
Cc trng thi khc: D ng vi acid paraaminobenzoic.
THUC CM NG GY RNG TRNG LOI CLOMIFEN

Cc cht tng hp cm ng gy rng trng
cc thuc trong nhm
CLOMIPHEN vin nn 50 mg
Clomhexal 50 vin nn 50 mg
Clostilbegyt 50 vin nn 50 mg
ch khi ch nh thuc
Thi k mang thai: Nghi ng c tc dng gy qui thai ph n mang thai.
Trc khi k n cn xc minh ngi bnh khng mang thai.
812
+++
Suy gan: Trnh s dng cho trng hp bnh gan nng hoc mi mc.
Trng hp khc: Ung th c quan sinh dc, u nang bung trng, ri lon th
gic, chy mu ph khoa khng r nguyn nhn.
813
Thuc cm mu
Cc ch phm dng p ti ch cm mu
Cc thuc trong nhm
bng gc ti ch
Urgo bng c nhn
Uniplas bng c nhn
PECTIN dung dch ung
Arhemapectine dung dch ung
Chng ch nh v thn trng khi s dng
Khng p trn nhng vt thng hoc cc hc b nhim khun. Trnh tip xc
vi mt.
Thuc chn alpha
L nhng cht c tc dng phong b th th alpha adrenergic
Cc thuc trong nhm
ALFUZOSIN vin nn bao phim 2,5 mg; 5 mg
Xatral vin nn bao phim 2,5 mg
Xatral SR vin nn bao phim 5 mg
IFENPRODIL vin nn bc 20 mg; ng tim 2 mL/ 5 mg
Vadilex vin nn bc 20 mg
Vadilex ng tim 2 mL/ 5 mg
INDORAMIN vin nn 25 mg
Wydora vin nn 25 mg
MOXISYLIT vin nn 30 mg; dung dch tim 10 mg; 20 mg
Carlytine vin nn 30 mg
Icavex dung dch tim 10 mg; 20 mg
NICERGOLIN nang 5 mg; 10 mg; ng tim 1 mL/4 mg
Sermion nang 5 mg; 10 mg
Sermion ng tim 1 mL/4 mg
RAUBASIN vin nn (phi hp vi dihydroergotamin) 0,6 mg; 1,2 mg; vin nn
(phi hp vi almitrin) 10 mg
Duxil: vin nn 10 mg (phi hp vi almitrin)
Iskedyl forte: vin nn 1,2 mg (phi hp vi dihydroergotamin)
Iskedyl vin nn 0,6 mg (phi hp vi dihydroergotamin)
814
URAPIDIL nang 30 mg; 60 mg

Mediatensyl nang 30 mg v 60 mg
YOHIMBIN vin nn 2 mg
Yohimbine Hond vin nn 2 mg
Ch khi ch nh thuc
Chng ch nh: mc 4
Suy gan: Trong nhm thuc ny, ch c lin quan n yohimbin v s kt hp
cn c theo di khi b suy gan.
Suy thn: Trong h thuc ny ch c lin quan n yohimbin v s kt hp cn
c theo di khi suy thn.
Thn trng: mc 2
Cc trng thi khc: Trng hp co tht mch mu no hoc vng mc. Huyt
p tm thu di 100 mmHg. Nguy c h huyt p t th ng. Phi theo di cht ch
huyt p, nht l trong giai on u iu tr.
Cn theo di: mc 1
Suy mch vnh: Nu cc cn li xut hin hoc nng ln, phi ngng iu tr.
Tng tc thuc
Phn tch: i khng dc l nn lm gim tc dng chng tng huyt p ca
clonidin (ging alpha adrenergic) v gim tc dng cc thuc cng giao cm alpha
(kt hp khng hp l).
X l: Khuyn khng nn dng phi hp ny, do tnh i khng dc l, c th
dn ti tht bi trong iu tr, nu mc ch chnh ca liu php l iu tr bnh tng
huyt p.
Bepridil; verapamil
Phn tch: Kt hp hai thuc chng tng huyt p, c th dn ti nhng nguy c
tt huyt p nghim trng.
X l: C th phi hp hai thuc chng tng huyt p, coi nh mt bin php th
hai. Thng bo cho ngi bnh v nguy c h huyt p v xut mt k hoch dng
thuc tri u trong ngy, c tnh ti dc ng hc ca cc thuc nu cn. Khuyn
ngi bnh t theo di u n khi dng thm thuc th hai, v khi ng ng dng mt
trong hai thuc.
Dihydropyridin; diltiazem
X l: Phi theo di huyt p trong khi kt hp hai thuc. Ty theo thuc phi
hp, h huyt p c th nghim trng t hay nhiu. C khi phi iu chnh liu ca mt
815
hay hai thuc. Lp mt chng trnh dng thuc u n. Khuyn ngi bnh g p li
bc s iu chnh li liu dng, nu thy chng mt khi bt u dng phi hp
thuc. Tng cng theo di ngi bnh cao tui (nguy c ng) v khuyn h chuyn
dn dn t th nm hay ngi sang t th ng.
Ru (ethanol)
Phn tch: Tng nguy c gim huyt p, c bit ngi thiu ht aldehyd
dehydrogenase (ngi b mt khi ung ru). Tng tc xy ra nhanh. C ch nghi
l h thn kinh giao cm b thuc chn alpha c ch, nn lm tng nguy c gim huyt
p do ru.
X l: Khuyn trnh ung ru khi dng thuc chn alpha.
Phn tch: C kh nng phong b tc dng tng huyt p ca cht cng giao
cm v ko theo h huyt p nghim trng tu theo liu dng.
X l: Trc khi iu tr bng thuc chn alpha-1, hy i lc tc dng dc l
ca thuc cng giao cm ht , tr khi mun c i khng gia hai thuc. Phi tnh
ti cc dng bo ch nh gi nguy c (dng ngoi, ung hoc tim). Nn nh l
cc dng thuc dng ngoi c th gy mt tc dng ton thn ty theo iu ki n v
hon cnh dng liu php.
Phn tch: Nguy c h huyt p nghim trng.
X l: Khuyn ngi bnh thng bo cho bc s gy m tn ca tt c cc thuc
dng trc khi phu thut.
Thuc gy m cc loi (ngoi barbituric v thuc gy m bay hi cha halogen)
Phn tch: C th gim tc dng co mch.
X l: Khuyn ngi bnh thng bo cho bc s gy m tn ca tt c cc thuc
dng trc khi phu thut.
Thuc li tiu
Phn tch: Tng tc dng h huyt p; tng nguy c h huyt p liu u tin ca
prazosin.
X l: Ngi suy tim xung huyt khi iu tr mnh bng thuc li tiu th phi
dng prazosin lc u tin vi liu thp nht (500 microgam, 2 hoc 3 ln mi ngy).
Thuc c ch enzym chuyn: enalapril + bunazosin
Phn tch: H huyt p nng xy ra khi cho liu u tin enalapril phi hp vi
bunazosin. Hip ng tc dng h huyt p.
X l: Cn thn trng khi phi hp, nht l khi cho li u u tin. C th cho
thuc lc i ng v phn ng h huyt p cp xut hin ng n. Cc thuc chn alpha
khc nh alfuzosin, doxazosin, prazosin, terazosin, trimazosin vi cc thuc c ch
enzym chuyn c th cng c nhng phn ng tng t.
thuc chn alpha - BETA
816
Chn alpha - beta

Cc thuc trong nhm
LABETALOL vin nn 200 mg; ng tim 100 mg/ 20 mL
Trandate ng tim 100 mg/ 20 mL
Trandate vin nn 200 mg
Tng tc thuc
Phn tch: Phi hp khng hp l. i khng dc l khi qu liu thuc chn beta
tr.
X l: y l i khng dc l m ta cn bit trc khi xy dng chin lc iu

thuc chn beta
Thuc i khng cnh tranh vi cc catecholamin th th beta adrenergic.

Thuc chng au tht ngc ch yu, chng tng huyt p, chng lon nhp tim
(nhm II ca Vaughan-Williams)
Cc thuc trong nhm
ACEBUTOLOL
Sectral vin nn 200 mg
ATENOLOL
Apo- Atenol vin nn 100 mg
Ateloc vin nn 100 mg
Atenolol 50 Stada vin nn 50 mg
Atenolol 100 Stada vin nn 100 mg
Atenova vin nn 100 mg
Bliconol vin nn 100 mg
Noten vin nn 50 mg
Tredol vin nn 50 mg; 100 mg
Tenolol vin nn 50 mg; 100 mg
Tenormin vin nn 50 mg
Tenoret vin nn 50 mg
Tenoretic vin nn 100 mg
Tenoric vin nn 100 mg vi 20 mg chlortalidon
BETAXOLOL
817
Betoptic S hn dch nh mt 0,25%

BISOPROLOL
Concor 5 vin nn bao 5 mg
CARVEDILOL
Carca vin nn 6,25 mg; 12,5mg
Cardivas vin nn 6,25 mg; 12,5mg
Dilatrend vin nn 25 mg
Talliton vin nn 6,25 mg; 12,5mg
LEVOBUNOLOL
Betagan dung dch nh mt 0,5%
METOPROLOL
Betaloc vin nn 50 mg; 100 mg
Cardiosel vin nn 50 mg
Metohexal vin nn 100 mg
Metoprolol 100 Stada vin nn 100 mg
Metoprolol 200 Stada vin nn 200 mg
Montebloc vin nn 100 mg
NADOLOL
Apo-Nadol vin nn 40 mg
PROPRANOLOL
Avlocardyl vin nn 40 mg
Avlocardyl ng tim 5 mg/5 mL
Avlocardyl LP nang 160 mg
Dorocardyl vin nn 40mg
Hopranolol vin nn 40 mg
Novo-pranol vin nn 40 mg
TERTATOLOL
Artex 5 vin nn bao 5 mg
TIMOLOL
Nyolol dung dch nh mt 0,5%; 0,25%
Ofan Timolol dung dch nh mt 2,5 mg/mL; 5 mg/mL
Nyolol gel nh mt 0,1%
Timolol dung dch nh mt 0,25%
818
Timolol dung dch nh mt 0,5%

Ch khi ch nh thuc
Suy tim: Tt c cc thuc chn beta u lm gim tn s v lu lng tim. iu
ny l ngun gc ca nhng s c tim mch (nhp tim chm qu mc, l nh u chi,
suy tim mt b, suy tim sung huyt) ni chung lin quan t i mt bnh tim c. Cc
chng bnh sau y c chng ch nh: bloc nh -tht, nhp tim chm quan trng, hi n
tng Raynaud, sc do tim, bnh nt xoang, au tht Prinzmetal.
Suy h hp; hen: Cc thuc chn beta kinh in chn cc th th ngoi vi ca
ph qun vi nguy c cn hen nng nhng ngi c c a. Vi cc thuc chn beta1 (acebutolol, atenolol, betaxolol, metoprolol) nguy c ny hu nh khng c, tr trng
hp qu liu.
Ngi bnh cao tui: Tn trng tuyt i nhng chng ch nh kinh in, nht
l nhng chng ch nh v tim v phi thn trng khi dng.
Trng hp khc: Tng huyt p do u t bo a crm: phi thn trng khi dng
thuc chn beta.
Thn trng: mc 2
Thi k cho con b: Cc thuc chn beta qua c sa m v c th biu hin
tc dng dc l trn tr s sinh.
Suy thn: Na i ca cc thuc chn beta ko di, nht l khi chng t b
chuyn ho v o thi qua ng thn (sotalol, atenolol). iu chnh liu.
Cn theo di : Mc 1
Tiu ng: Cc thuc chn beta lm mt cc du hiu bo hiu ca h
glucose mu, cc du hiu ny ph thuc vo catecholamin. Nhng tai bin h glucose
mu nghim trng gy hn m c m t nhng ngi tiu ng c iu tr
bng insulin hoc cc thuc ung h glucose mu.
Thai nghn: Cc thuc chn beta hnh nh khng sinh qui thai v c
th c dng iu tr tng huyt p do thai nghn. Him thy cc s c bo thai
(nhp tim chm, suy dinh dng, h glucose mu) do gan cha trng thnh.
Suy mch vnh: y l mt h thuc c k thng xuyn. Cn bo cho ngi
bnh khng c ngng iu tr mt cch t ngt, thm ch nn tip tc iu tr cho
ti khi can thip phu thut, nu c.
Tng tc thuc
Floctafenin
Phn tch: Floctafenin c th gy ra nhng phn ng qu mn, c th dn ti sc
phn v nng. Trong trng hp ny, cc thuc chn beta (k c dng thuc nh mt) lm
cho bnh cnh nng thm bng cch gim b tim mch (do adrenalin v noradrenalin), c
bit trong trng hp h huyt p hoc sc.
819
X l: Hi ngi bnh v tin s. Ngi bnh c dng floctafenin ln u tin

khng? Trong trng hp sc, s gim cc c ch b c th nguy him v phi chng
ch nh phi hp ny. Khng k thuc gim au ny cho nhng ngi bnh c tin
s d ng. Thay thuc gim au d hn thay thuc chn beta.
Thuc cn quang c iod
Phn tch: Trong trng hp phn ng d ng, cc thuc chn beta (k c dng
thuc nh mt) lm gim b tim mch, c bit khi h huyt p v sc. Bi tit
adrenalin cho php c th c p ng sinh l bnh thng trong trng hp chong
phn v, nhng khi phi hp vi thuc chn beta, p ng ny b chn.
X l: Hi ngi bnh v tin s. C phi y l ln u tin ngi bnh c
cho mt thuc cn quang c iod khng? Trong trng hp sc, s gim cc c ch b
tr c th nguy him v phi chng ch nh phi hp ny. Khng k thuc cho nhng
ngi bnh c tin s d ng.
Phn tch: Phi hp khng hp l. i khng dc l, s dng trong trng hp
qu liu thuc chn beta. Tng tc ny gp c khi dng thuc nh mt cha thuc
chn beta.
X l: Phi hp ny ch c th theo di c ti c s bnh vin, do c hay
khng c cng thn kinh giao cm ni ti ca thuc chn beta cc loi.
Amiodaron
Phn tch: Amiodaron c th lm nhp tim chm thm, do thuc chn beta gy ra
(k c dng thuc nh mt), diltiazem hoc verapamil. C th xut hin nhng ri lon
nhp xoang v bloc nh - tht, nht l ngi bnh c tin s ri lon nhp xoang.
X l: Nu phi phi hp, iu quan trng l phi gim liu v theo di in tm
. Cn nh rng amiodaron c na i l 28 ngy, nn nhng tc dng ca tng tc
c th biu hin nhiu tun sau khi ngng iu tr.
Phn tch: Guanethidin l thuc chn gii phng noradrenalin sau hch thn
kinh. Tt c cc thuc chn alpha, chn beta, nu phi hp vi guanethidin, c th dn
n tng h huyt p th ng v nhp tim chm.
X l: Tng cng theo di huyt p. Nhc nh ngi bnh tun th v thc hin
ng gi ung thuc nu iu tr bng hai liu php. Thn trng khi dng ngi bnh
cao tui.
Reserpin
Phn tch: Reserpin lm gim catecholamin, nn c th lm tng tc dng ca cc
thuc chn beta (nhp tim chm v h huyt p).
X l: V dc l hc, c th c tng tc ny, nhng v lm sng, cha c
m t. Do , phi thn trng v cn phi chuyn bo co cho Trung tm cnh gic
thuc, nu thy c s bt thng.
Thuc cng thn kinh giao cm alpha-beta
820
Phn tch: i khng dc l (cc thuc cng thn kinh giao cm c dng
trong trng hp qu liu thuc chn beta).
X l: i khng dc l ny, nu khng c theo di thng xuyn (in tm
v huyt p ng mch), c th dn n tng huyt p, nhp tim chm qu mc vi
kh nng sc tim. Lu dng bo ch nh gi nguy c (dng dng ti ch, ung
hoc tim).
Ampicilin
Phn tch: Tc dng chng tng huyt p v chng au tht ngc ca atenolol c
th b gim. Tng tc xy ra nhanh. C ch sinh kh dng ca atenolol c th b gim
do ampicilin lm gim hp thu atenolol qua ng tiu ho.
X l: Nu nghi ng c tng tc, cn nhc tng liu atenolol v gim st cht
ch huyt p. Chia ampicilin thnh liu thp v dng ri rc.
Baclofen
X l: Theo di huyt p v iu chnh liu ca thuc chng tng huyt p u
tin trong khi dng v sau khi ngng liu php phi hp. Thn trng c bit khi dng
ngi bnh cao tui.
Bepridil; diltiazem; verapamil
Phn tch: V cc thuc ny c tc dng gim co c tim r rt (i vi thuc chn
beta, k c dng thuc nh mt), nn c mt nguy c tht s: nhp tim chm qu mc,
ngng xoang, ri lon dn truyn xoang v nh - tht v suy tim.
X l: Ch c th k n phi hp nu theo di in tm u n, c bit
ngi bnh cao tui v lc bt u iu tr. Thn trng khi ngng hai liu php ngi
bnh mch vnh.
Butyrophenon
Phn tch: Tng tc dng chng tng huyt p ca cc thuc ny.
X l: Nu cn phi hp, tng cng theo di huyt p trong khi iu tr v khi
ngng dng mt trong hai thuc. Nu cn, tin hnh iu chnh liu. Nhn mnh v k
hoch dng thuc v tun th. c bit cnh gic khi s dng ngi bnh cao tui.
Phn tch: Phi hp hai thuc chng tng huyt p, c th c ch v mt dc l
v iu tr.
X l: Nu cn phi hp, tng cng theo di huyt p ng mch trong khi iu
tr v khi ngng dng mt trong hai loi thuc ny. Thn trng khng ngng t ngt
clonidin, v nguy c tng p lc ni s vi kh nng chy mu no. Nu cn, ng ng
clonidin rt t t. Tin hnh iu chnh liu, nu cn. Nhn mnh v k hoch u ng
thuc v tun th. c bit thn trng khi dng ngi bnh cao tui.
Clozapin
821
X l: Theo di huyt p ng mch v iu chnh liu thuc chng tng huyt

p la chn u tin trong khi iu tr v sau khi ngng clozapin.
Cyclosporin
Phn tch: Nng cyclosporin tng km theo nguy c nhim c (thn, h thn
kinh). Tng tc xy ra chm. C ch mt s thuc chn beta c th cn tr chuyn
ho ca cyclosporin.
X l: Gim st nng cyclosporin huyt tng v creatinin huyt thanh. Theo
di ngi bnh pht hin nhim c. iu chnh liu cyclosporin nu cn.
Dextropropoxyphen
Phn tch: Sinh kh dng ca metoprolol tng nhiu v sinh kh dng ca
propranolol tng t hn khi phi hp vi dextropropoxyphen. C ch: c th
dextropropoxyphen c ch chuyn ho gan ca cc thuc chn beta ny v cc
thuc ny o thi chm ra ngoi c th.
X l: Cn theo di huyt p khi ang dng metoprolol hoc propranolol m thm
dextropropoxyphen, tuy cho ti nay cha c tai bin no.
Disopyramid
Phn tch: Tng tc dng chn beta (k c dng thuc nh mt). Nguy c xut
hin ri lon tnh co bp, gim tn s v gim dn truyn tim.
X l: Khi dng phi hp ny, tng cng theo di lm sng v in tm .
Phn tch: y l hai thuc co mch ngoi bin. Phi hp c thy trong nhng
trng hp au na u kh cha. gp, tuy him nhng trng hp thiu mu cc
b ngoi bin nng phi ct ct. Phi theo di rt k nhng phi hp vi propranolol,
oxprenolol. Metylsergid cng c th lin quan.
X l: C th phi hp thuc, nhng phi theo di lm sng, nht l khi bt u
v trong nhng tun u iu tr. Ngng ngay iu tr h thy du hiu bo ng no,
d nh (th d nh lnh u chi). Thng xuyn hi ngi bnh.
Phn tch: C th c ch cc enzym tiu th gan, dn n gim tc dng qua gan
ln u ca mt s thuc chn beta c chuyn ho gan (acebutolol, alprenolol,
betaxolol, labetalol, metoprolol, oxprenolol, propranolol, timolol). Hnh nh cc thuc
chn beta khc tng tc t hn.
X l: Nguy c tng tc dng ca mt s thuc chn beta. Cn theo di lm sng
khi phi hp.
Flecainid hoc thuc tng t
Phn tch: Do gim cc c ch b tr ca h giao cm, thuc chn beta c th
dn n ri lon tnh co, tnh t ng v tnh dn truyn.
X l: Ch c bc s chuyn khoa c sn phng tin theo di in tm mi c
th k n phi hp ny. Tng cng theo di lm sng v in tm .
Glucagon
822
Phn tch: Glucagon tng tn s v tnh co c tim (iu tr qu liu thuc chn
beta). Ngoi ra, p ng tng glucose mu, mun c khi iu tr bng glucagon s gim
ngi bnh c iu tr bng thuc chn beta.
X l: Tt c ty thuc vo mc tiu iu tr. C th phi hp thm ch c
khuyn ngh trong trng hp u tin; khng c khuyn ngh trong trng hp th
hai, ni trn.
Glycosid tr tim
Phn tch: C th dng hai thuc, nhng cn tranh ci ty theo thuc chn beta
c s dng v sinh l bnh ca ngi bnh. Tng nguy c nhp tim chm. Sotalol l
thuc chn beta nhiu khi c dng lm thuc chng lon nhp tim.
X l: Phi hp ny dnh cho nhng bc s chuyn khoa trong mt s ch nh c
th, vi iu kin c th theo di nhng tc dng ca phi hp hai thuc (in tm ).
Insulin
Phn tch: Thuc chn beta (k c dng thuc nh mt) c th che lp cc triu
chng h glucose mu v tng tc dng ca insulin trong iu tr tiu ng. iu ny
c th dn n hn m h glucose mu khng c du hiu bo trc.
X l: Nu cn phi hp, thng bo cho ngi bnh v nguy c mt du hiu h
glucose mu (nhp tim nhanh, m hi, run, nh trng ngc, cm gic i, lo u...).
Trong iu tr tng huyt p, nn cho nhng ngi tiu ng dng cc thuc c ch
enzym chuyn th hn.
Phn tch: Tt c cc thuc chng tng huyt p v nht l cc thuc chn beta
c th tng tc dng chng tng huyt p ca interleukin.
X l: Interleukin l thuc ch c bc s chuyn khoa mi c k n s dng.
Nhng tng tc cn c cn nhc, cn c vo cc tc dng khng mong mun v
mc nng nh ca bnh l. Phi theo di tt c cc chc nng mt cch thng
xuyn.
Phn tch: Cc thuc chn beta (k c dng thuc nh mt) lm gim lu lng
mu trong gan, nh vy gim o thi v ng thi tng nng lidocain trong huyt
thanh. Tng tc ny c m t cho propranolol, metoprolol, nadolol.
X l: iu chnh liu lidocain. Theo di in tm v nng lidocain trong
huyt tng trong v khi ngng iu tr.
Mexiletin
Phn tch: Nguy c xut hin xon nh. Khong QT trn in tm ko di.
X l: Phi c bit theo di phi hp (in tm ). Ni chung phi trnh phi
hp cc thuc chng lon nhp tim nhm I theo phn loi Vaughan - Williams, v ko di
thi gian dn truyn tim.
823

tng thm nguy c h huyt p, i khi c th dn ti sc.
X l: Theo di huyt p trong khi dng v khi ngng dng mt trong hai liu
php. c bit thn trng khi dng ngi bnh cao tui.
Nicotin
Phn tch: Nicotin c tnh cm ng enzym; v th, n c th kch thch s bin i
sinh hc ca mt s thuc v dn n gim tc dng iu tr.
X l: Nn cnh gic vi cc thuc c phm vi iu tr hp trong khi iu tr thay
th bng nicotin v nu cn, xem li liu trong v sau khi iu tr; y hi n tng
c thy vi propranolol. Cm ng enzym l mt hin tng ch xut hin sau vi
ngy, tri vi c ch enzym.
Nilutamid
Phn tch: C l v tnh cht c ch enzym ca nilutamid m mt s thuc chn
beta c nguy c tng thm tc dng.
metoprolol, oxprenolol, propranolol, timolol, mt vi trng hp nhp tim chm v h
huyt p c m t. Thay i chin lc iu tr, hoc iu chnh liu ca thuc
chn beta lc bt u, trong v sau khi iu tr nilutamid. Cc yu t ny c n c
khng nh, tuy tng tc ny khng c ngha lm v mt lm sng. Nh r ng cc
thuc chn beta dng thuc nh mt cng c biu hin tc dng ton thn.
Phenothiazin
Phn tch: Tng tc dng h huyt p ca cc thuc ny. H huyt p l mt tc
dng khng mong mun ca cc thuc an thn kinh dn xut t phenothiazin.
X l: Mc du sotalol c k n lm thuc chng lon nhp tim nhiu hn l
thuc chng tng huyt p, nu cn phi hp phi tng cng theo di huyt p trong v
sau khi ngng iu tr mt trong hai thuc. Nu cn, tin hnh iu chnh liu. Nhn
mnh v k hoch dng thuc v s tun th. c bit cnh gic khi s dng ngi
bnh cao tui, c th b ng do h huyt p.
Primidon hoc dn cht
Phn tch: Barbiturat gy cm ng enzym mnh, nn lm tng chuyn ho mt s
thuc chn beta o thi qua gan (acebutolol, alprenolol, betaxolol, metoprolol,
oxprenolol, propranolol, timolol). Do , tc dng ca thuc chn beta b gim.
X l: Thuc chn beta b gim tc dng khi dng cho ngi iu tr barbituric lu
di, trong thi gian t nht 3 tun (thn trng vi ngi ng kinh). Thuc chn beta c
nguy c mt dn hot tnh. Hoc hi ngi bnh v hiu qu ca liu php (au tht
mch vnh hoc tng huyt p) v thng xuyn nh gi hiu qu ca liu php v
mt lm sng, hoc chn mt thuc chn beta khng b chuyn ho gan.
Phn tch: Vic s dng ng thi hai thuc c th dn ti nhng bin ng
quan trng v huyt p.
824
X l: Cc thuc c ch MAO him c s dng, c nhiu tng tc v v t khi

k n nn c t nhn xt v cnh gic thuc. Tuy nhin, cn thn trng gi mt thi
hn t 2 n 3 tun sau khi ngng thuc mi k n thuc c ch MAO.
Propafenon
Phn tch: Propafenon c tnh chng lon nhp tim v chn beta va phi. Phi
hp hai thuc c th dn n ri lon tnh co c, tnh t ng v tnh dn truyn km
theo, thng xuyn c ch cc c ch giao cm b tr.
X l: Phi hp ny do bc s chuyn khoa thc hin, c theo di in tm v
lm sng thng xuyn. Bo cho ngi bnh bit nguy c. Khuyn ngi bnh tip xc
vi ngi k n trong trng hp lon nhp tim.
Propylthiouracil
Phn tch: Dc ng hc ca mt s thuc chn beta c th b thay i v tc
dng dc l c th tng. Tng tc xy ra chm. C ch tng nng gip c th lm
tng thanh lc ca thuc chn beta, do tng lu lng mu qua gan, chuyn ho
bc u v th tch phn b.
X l: C th gim liu thuc chn beta khi ngi bnh tr thnh bnh gip.
Quinidin hoc dn cht
Phn tch: Mt c ch giao cm b tr v tng thm tc dng ca cc thuc chn
beta (ngay c di dng thuc nh mt) nn lm gim tn s v gim dn truyn tim.
X l: Tng tc nn do bc s chuyn khoa qun l, tu thuc vo nhng i u
kin theo di sn c (in tm ).
Phn tch: Thuc chn beta (k c dng thuc nh mt) c th che lp cc triu
chng h glucose mu v tng tc dng cc sulfamid h glucose mu trong tiu ng.
iu ny c th dn n hn m h glucose mu khng c du hiu bo trc.
X l: Nu cn phi hp, thng bo cho ngi bnh v nguy c khng thy xut
hin cc du hiu h glucose mu (nhp tim nhanh, m hi, run, nh trng ngc,
cm gic i, lo u...). Trong iu tr tng huyt p, i vi ngi tiu ng, nn dng
cc thuc c ch enzym chuyn dng engiotensin.
Tacrin
Phn tch: Tc dng lm chm nhp tim ca tacrin c nguy c cng thm vo tc
dng ca cc thuc chn beta.
X l: Theo di in tm v lm sng u n, nu cn phi phi hp.
Khuyn ngi bnh bo cho bc s k n, nu thy bt thng v tim.
Terfenadin
Phn tch: C tim nng gy nhim c tim (th d nh lon nhp tim, xon nh).
C ch c terfenadin v sotalol c bo co c kh nng gy xon nh.
X l: Phi gim st cht ch tim khi phi hp terfenadin vi sotalol. Nhim c
tim xy ra l do tng tc thuc hoc do terfenadin hn l do sotalol. C th thay th
terfenadin bng thuc an ton hn, chng hn nh cetirizin, fexofenadin, hoc loratadin.
825

Phn tch: Theophylin v cc dn cht do c ch phosphodiesterase, nn dn
n kch thch cc th th beta adrenergic, do c kh nng tc dng i khng.
Thuc chn beta lm gim thanh lc theophylin do c ch chuyn ho theophylin.
Cc thuc chn beta khng chn lc nh nadolol v propranolol c th gy co tht ph
qun mnh (chng ch nh dng cho ngi b hen), nh vy i khng l i tc d ng
gin ph qun ca theophylin.
X l: Gim st cc thay i v lm sng. Gim st nng huyt tng
theophylin, labetolol khi thm hoc ngng iu tr thuc chn beta. Vi ngi hen, trnh
dng thuc chn beta, nht l thuc chn beta khng chn lc.
Thuc an thn kinh cc loi (nhm thioxanthen)
Phn tch: Tng tc dng h huyt p ca cc thuc .
X l: Nu cn phi hp, tng cng theo di huyt p ng mch trong v sau
khi ngng dng mt trong hai thuc. Nu cn, tin hnh iu chnh liu ca mt trong
hai thuc. Nhn mnh v k hoch dng thuc v s tun th. c bit thn trng khi
dng ngi bnh cao tui.
Thuc ch vn morphin
ng.
Phn tch: Tng tc dng h huyt p v tng thm nguy c h huyt p t th
X l: Theo di huyt p khi phi hp hai thuc. Ty theo thuc dng, h huyt
p c th nng hoc nh. Nu cn iu chnh liu mt hoc hai thuc. Lp mt k
hoch ung thuc u n. Khuyn ngi bnh gp li bc s iu tr iu chnh
liu mt hoc hai thuc nu thy chng mt khi bt u iu tr. Tng cng theo di
ngi bnh cao tui (nguy c ng) v khuyn h chuyn dn dn t t th nm hoc
ngi sang t th ng.
Thuc chng lot khng H2 loi cimetidin
Phn tch: Cimetidin l cht c cc enzym oxydase gan (cytochrom P 450) cn cho
chuyn ho ca mt s thuc. Hn na cimetidin lm gim lu lng mu gan. Nh
vy, nng trong huyt tng ca mt s thuc s tng (nguy c qu liu), nhng
cng bng cch c ch mt s bin i sinh hc, cimetidin chn cc c ch kh c.
Nguy c tng nng trong huyt tng ca mt s thuc chn beta c chuyn ho
gan (acebutolol, alprenolol, betaxolol, labetalol, metoprolol, oxprenolol, propranolol,
timolol) c th dn n tt huyt p v nhp tim chm.
metoprolol, oxprenolol, propranolol, timolol thy mt s trng hp gy nhp tim
chm v h huyt p. Thay i thuc chng lot, hoc iu chnh liu thuc chn beta
khi bt u, trong v sau khi iu tr bng thuc khng H 2. Tng tc ny cn c
khng nh tuy khng c nhiu ngha v mt lm sng.
Thuc gy m cc loi (ngoi barbituric v thuc gy m bay hi cha halogen)
Phn tch: Tu thuc tc dng trn tim v lm chm nhp tim ca mt s chn
beta.
826
X l: Khuyn ngi bnh sp c phu thut cn cho bc s gy m bit

nhng thuc mnh v ang dng.
Phn tch: Thuc chn beta, k c dng thuc nh mt, c th ko di h huyt
p v chn p ng phn x tim do kch thch cc th th beta adrenergic. Tr ngi ny
c th qun l c bng cch cho dng rt thn trng dobutamin, dopamin,
isoproterenol...
X l: Bc s gy m phi c phng tin theo di (monitoring) thng xuyn,
cho php can thip vo bt c lc no.
Thuc gin mch chng tng huyt p; thuc li tiu gi kali; methyldopa
X l: Cn iu chnh liu, lp k hoch ung thuc v khuyn ngi bnh tun
th. Khi bt u iu tr, khuyn ngi bnh theo di huyt p u n, cho ti khi t
cn bng iu tr.
Phn tch: V thuc khng acid lm gim s hp thu qua ng tiu ho, nn tc
dng ca thuc phi hp b gim. Tng tc ny lin quan ti cc thuc chn beta:
atenolol, metoprolol v propranolol.
X l: Nht thit phi ung hai thuc cch nhau t nht 2 gi. Thuc chng acid
thng c ung 1 gi 30 pht sau ba n, v n ung l ngun gc tng tit dch v.
Phn tch: Tng tc dc lc: tng tc dng cng giao cm alpha aderenergic
v cc hu qu nh tng huyt p, nhp tim chm, v kh nng bloc tim. Nguy c ny t
hn vi labetalol l thuc chn beta duy nht c thm tc dng chn alpha.
X l: Tin hnh iu chnh liu v theo di cht ch huyt p.
Barbituric
Phn tch: Barbituric lm tng d ho gan do cm ng enzym cc thuc chn
beta c bin i sinh hc gan (acebutolol, alprenolol, betaxolol, labetalol, metoprolol,
oxprenolol, propranolol, timolol).
X l: Gim tc dng dc l ca thuc chn beta khi dng cho ng i c
iu tr barbituric lu di trong t nht ba tun (thn tr ng v i ng i ng kinh). Nguy
c mt dn tc dng ca thuc chn beta. Hi ngi bnh v hiu qu ca i u tr
(au tht ngc hoc tng huyt p) v nh gi u n hi u qu lm sng, ho c
chn mt thuc chn beta khng b gan chuyn ho.
Dihydropyridin
Phn tch: Phi hp lm tng tc dng chng tng huyt p. Tuy nhin, nn cnh
gic v c thm tnh cht co c tim b gim (i vi thuc chn beta, k c d ng thuc
nh mt) ngi bnh suy tim c kim sot hay khng. ngi suy mch vnh, gin
827
mch do dihydropyridin c th dn ti nhp tim nhanh phn x nhng c thuc chn

beta lm gim.
X l: Phi da vo tnh trng bnh. Tt c ph thuc vo mc tiu iu tr chnh
(au tht mch vnh hoc tng huyt p) v thi gian iu tr bng thuc ny ho c
thuc kia. C th tht bi trong iu tr tng huyt p. C th thy phi hp thuc ny
di dng mt bit dc.
Indometacin hoc dn cht; pyrazol; salicylat; thuc chng vim khng steroid
Phn tch: Gim tc dng h huyt p. Cc thuc chng vim khng steroid c
ch tng hp cc prostaglandin thn gy gin mch v/ hoc gy gi nc v natri.
X l: Kim tra m bo ngi bnh c tip nc tt, theo di chc nng
thn ( thanh lc creatinin), kim sot tnh n nh ca huyt p ng mch, c bit
khi bt u iu tr. Khuyn ngi bnh t theo di u n huyt p.
Khng cholinergic
Phn tch: Sinh kh dng ca atenolol c th tng khi phi hp. C ch thuc
khng cholinergic (atropin...) lm tng thi gian lu gi thuc chn beta d dy v nh
vy lm tng ho tan v sinh kh dng ca atenolol. Tng tc xy ra nhanh.
X l: Nu nghi tng tc dng ca thuc chn beta, c th phi gim liu.
Phn tch: Nguy c nhp tim chm (c thng bo vi mefloquin).
X l: Nu cn phi hp, cn nhc nguy c/ li ch ngi tng huyt p hoc
ngi au tht ngc. Nu thuc chn beta c dng ln u, nn dng thuc chn
beta c tc dng cng thn kinh giao cm ni ti. Thng ch dng mefloquin ngn
ngy. Thng bo cho ngi bnh v nguy c, c bit vi ngi bnh cao tui.
Quinolon
Phn tch: C th lm tng tc dng dc l ca metoprolol v ca mt s thuc
chn beta c chuyn ho qua cytochrom P450 (th d betaxolol, propranolol). C ch
cha r. Tuy nhin, ciprofloxacin c th lm gim thanh lc ca metoprolol qua
ng ung do c ch chuyn ho gan.
X l: Gim st chc nng tim khi bt u hoc ngng iu tr ciprofloxacin
ngi ang dng metoprolol.
Rifampicin
Phn tch: Tng d ho gan do cm ng enzym ca cc thuc chn beta c
chuyn ho gan (acebutolol, alprenolol, betaxolol, labetalol, metoprolol, oxprenolol,
propranolol, timolol).
X l: Theo di lm sng v nguy c iu tr tht bi, cn phi iu chnh liu.
Phn tch: Vic ng thi s dng thuc chng tng huyt p hoc thuc c th
gy h huyt p vi thuc gy m barbituric c th gy h huyt p nng.
828
X l: Ngi bnh phi phu thut, cn bo cho bc s gy m bit cc thuc

mnh ang dng.
Phn tch: Tng tc dng h huyt p ca cc thuc . H huyt p l tc dng
khng mong mun ca cc thuc chng trm cm ba vng.
X l: Nu cn phi hp, tng cng theo di huyt p ng mch, trong khi iu
tr v khi ngng mt trong hai liu php. Tin hnh iu chnh liu nu cn. Nhn mnh
v k hoch dng thuc v vic tun th. c bit thn trng khi dng ng i bnh
cao tui.
Thuc chng au tht ngc nitrat
Thuc chng au tht ngc m cht u bng l trinitrin
Cc thuc trong nhm
NITROGLYCERIN nang tan chm 2,5 mg; cao dn ngm qua da 50 mg; 25 mg;
dung dch tim 5 mg/1mL; 15 mg/10 mL; dung dch phun m 1%; vin nn tan chm 2,6
mg; vin trn 0,15 mg; nang 2,5 mg; 7,5 mg
Nitro Mack nang tan chm 2,5 mg
Nitroderm TTS 10 cao dn ngm qua da 50 mg
Nitroderm TTS 5 cao dn ngm qua da 25 mg
Ntroglycerin dung dch tim 5 mg/1mL; ng: 5 mL, 10 mL
Nitromint dung dch phun m 1% chai 8 g
Nitromint vin nn tan chm 2,6 mg
Trinitrine simple Laleuf vin trn 0,15 mg
Lenitral dung dch tim truyn 15 mg/10mL
Lenitral nang: 2,5 mg, 7,5 mg
Moniphens nang gii phng chm: 20 mg, 40 mg, 60 mg
Monocinque vin nn 40 mg
ISMN 40 Stada retard nang tan chm 40 mg
Apo-ISDN vin nn: 10 mg, 30 mg
ISOSORBID DINITRAT vin nn: 5 mg, 10 mg, 20 mg, 30 mg, nang: 20 mg, 40
mg, dung dch phun m
Apo ISDN vin nn 30 mg
Iso Mack nang 20 mg
Iso Mack nang tan chm 40 mg
Iso Mack dung dch phun m chai 20 mL
Isosorbide dinitrate vin nn 10 mg
829
Novo- Sorbide vin nn 10 mg

Risordan LP vin nn 20 mg
Risordan 5 vin nn 5 mg
Risordan 10 vin nn 10 mg
ISOSORBID MONONITRAT vin nn: 20 mg, 40 mg, 60 mg; nang 60 mg; nang
tan chm: 40 mg; 60 mg
Imdur vin nn 60 mg
Ismo vin nn 20 mg
Moniphens nang gii phng chm: 20 mg; 40 mg; 60 mg
Monocinque vin nn 40 mg
Apo- ISDN vin nn: 10 mg; 30 mg
ch khi ch nh thuc
Cn nhc- nguy c/ li ch: mc 3
Thi k cho con b, thi k mang thai : Do khng c nhng nghin cu chuyn
v vn ny.
Tng tc thuc
Sildenafil (Viagra)
Phn tch: Vic dng Viagra cho ngi dng cc hp cht nitrat gin mch,
chng au tht ngc c th gy h huyt p nghim trng, dn ti t vong. Sildenafil
lm tng cng tc dng ca nitric oxyd, v ca cc hp cht nitrat gy h huyt p,
thng qua vic c ch phosphodiestease typ 5, l enzym c chc nng chuyn ho
guanosin monophosphat vng (cGMP) trong th hang dng vt. H qa l hm
lng cGMP tng, lm c trn th hang th doi, to iu kin cho dng mu c th
chuyn nhiu vo .
X l: Mt hp cht nitrat hu c di bt k dng no m dng ng thi vi
sildenafil l chng ch nh. Khi k n cc nitrat, phi cnh bo ngi bnh tuyt i
khng c dng sildenafil. Trng hp cp cu khi ngi bnh au tht ngc, bc s
phi hi xem trc 24 gi tr li, ngi bnh c dng sildenafil khng, ri hy cho
dng nitrat.
Ru
Phn tch: Nguy c tng tc dng h huyt p do hip ng tc dng gin mch. Tc
dng mnh nht khi dng dn cht nitrat 1 gi trc lc ung ru.
830
X l: Phi hp thuc gy phin h cho ngi bnh nn cn trnh. Khuyn ngi

bnh ng ung ru v cc ch phm c ru trong thi gian iu tr vi cc d n
cht nitrat chng au tht ngc.
Bepridil; clonidin hoc thuc tng t; furosemid hoc thuc tng t;
guanethidin hoc thuc tng t; nicorandil; papaverin hoc dn cht; reserpin; sotalol;
thuc chn beta; thuc gin mch chng tng huyt p; thuc li tiu gi kali; thuc li
tiu thi kali
Phn tch: Phi hp vi tt c cc thuc chng tng huyt p c th lm tng
X l: Theo di huyt p trong khi iu tr v lc ngng dng mt trong hai thuc.
Cn c bit ch iu ny vi ngi bnh cao tui.
Clozapin
X l: Theo di huyt p. iu chnh liu lng thuc chng tng huyt p trong
iu tr v sau khi ngng iu tr vi clozapin.
Dihydroergotamin
Phn tch: Cc nitrat lm tng sinh kh dng ca dihydroergotamin v cc alcaloid
ca nm ca g, nn lm tng huyt p tm thu. Do tnh i khng v chc nng ny,
dihydroergotamin lm gim tc dng chng au tht ngc ca nitroglycerin. C ch
nh sau: Nitroglycerin lm tng lu lng mu trong ni tng, lm gim s chuyn ho
dihydroergotamin, tng sinh kh dng, nh vy tng tnh i khng vi tc dng gin
mch vnh.
X l: Cn phi theo di ngi bnh, v nu cn phi gim liu
dihydroergotamin.
Dihydropyridin; thuc ch vn ca morphin
X l: Phi theo di huyt p khi phi hp hai thuc ny. Ty theo thuc dng, h
huyt p c th nng hay nh. Nu cn, iu chnh liu lng ca mt hay c hai
thuc. Xy dng mt k hoch dng thuc u n. Tng cng theo di ngi bnh
cao tui (nguy c ng) v khuyn h chuyn dn dn t t th nm hay ngi sang t
th ng. Khuyn ngi bnh gp li bc s iu chnh liu lng, nu thy chng
mt lc bt u iu tr.
Phn tch: Tng tc kiu i khng dc l. Cc thuc cng beta c tc dng
lm tng huyt p, cho nn cc tc dng chng tng huyt p c th b gi m khi dng
ng thi vi cc thuc cng giao cm beta.
X l: Theo di u n huyt p. Thng bo cho ngi bnh nhng nguy c
bin ng huyt p. Lp mt k hoch ung thuc u n, v phi ch
n dng bo ch c dng nh gi mc nghim trng ca s
bin ng v huyt p (dng cc thuc cng beta khi hen hoc khi e do non)
831

Phn tch: Tc dng chng tng huyt p s b gim khi s dng ng thi vi
cc thuc cng giao cm.
X l: Phi theo di huyt p lin tc. Tt c ph thuc vo hon cnh iu tr c
th v vo dng bo ch thuc c dng. Phi trnh phi hp thuc ny ngn
chn nhng nguy c nghim trng do bin ng v huyt p.
Phn tch: Tng nguy c h huyt p, ch xut hin vi liu cao.
X l: Khuyn ngi bnh sp phu thut, cn thng bo cho bc s gy m
nhng thuc ang dng.
Thuc gin c khng kh cc (pancuronium, tubocurarin)
Phn tch: Nitroglycerin lm tng tc dng ca pancuronium, c th dn n c
ch mnh h hp. Tng tc xy ra nhanh. C ch cn cha r.
X l: Gim st suy h hp ngi bnh. Cn h tr h hp nu cn.
X l: Theo di huyt p v iu chnh liu lng thuc chng tng huyt p
trong khi iu tr v sau khi ngng dng cc nitrat chng au tht ngc. Cn quan tm
c bit n ngi bnh cao tui.
Phn tch: S dng ng thi cc thuc chng tng huyt p hay cc thuc c
th lm h huyt p vi cc thuc gy m barbituric c th gy h huyt p nghim
trng
X l: Khuyn ngi bnh bo cho bc s gy m bit cc thuc ang dng.
thuc ung chng ng mu khng vitamin K
Thuc dng hoc tip theo liu php heparin, hoc trc tip d phng
huyt khi nghn mch
Cc thuc trong nhm
ACENOCOUMAROL vin nn 4 mg
Sintrom vin nn 4 mg
ch khi ch nh thuc
Thi k cho con b: Cc thuc khng vitamin K qua c sa m.
Thi k mang thai: Nguy c chy mu tr s sinh (i khi gy t vong), v cc
coumarin vo h tun hon thai nhi, gy tng tc dng chng ng mu v gim ging
832
ho thuc. Warfarin v acenocoumarol c th gy qui thai, km theo gim sn mi

v nhng d tt khc.
Tng huyt p: Nguy c chy mu khi tng huyt p nng.
Suy gan: Tng c tnh cc thuc khng vitamin K, do suy gan lm chm bt
hot, v lm ri lon tng hp cc yu t ng mu ph thuc vitamin K, ko theo nguy
c chy mu quan trng. Phenindion c c tnh vi gan.
Suy thn: Gim o thi qua thn gy tch lu cc thuc khng vitamin K, km
theo nguy c chy mu.
Lot d dy-t trng; vim d dy: Nguy c chy mu ng tiu ho.
Cc trng hp khc: Khi c hi chng chy mu, khi c cc tn thng thc
th c th chy mu, khi phi can thip ngoi khoa.
Cn theo di: mc 2
n ung - ru: Ung mt lng ln ru sung, s lm gim chuyn ho gan
cc thuc khng vitamin K, gy nguy c qu liu. Mt s rau giu vitamin K (bp ci, da)
c th lm gim tc dng cc thuc khng vitamin K.
Ngi bnh cao tui: Ngi bnh cao tui d b tai bin chy mu do c nhng
tn thng kn (thot v honh, tn thng mi no), nn i hi phi theo di lm
sng v sinh hc tht cht ch.
Tng tc thuc
Phn tch: Tng tc dng cc thuc khng vitamin K ung ( m t tng tc
gia warfarin vi itraconazol, fluconazol v miconazol), ch yu do gim d ho gan.
Tng tc dc ng hc, do c ch enzym.
X l: Nu bt buc phi k n ng thi hai thuc ny, phi tng cng theo
di thng qua cc xt nghim v t l prothrombin, t l chun ho quc t - INR lc bt
u, trong v sau khi iu tr vi nhng thuc chng nm k.
Cn nhc nguy c / li ch: Mc 3
Cephalosporin c nhn thiomethyl tetrazol
Phn tch: Tng nguy c chy mu, ch yu vi cc cephalosporin cha nhn
thiomethyl tetrazol (cc thuc: latamoxef, cefoperazon, cefamandol, cefmenoxim,
cefotetan). Nhn ny nh mt dn cht coumarin c tnh cht chng ng mu (khng
vitamin K), b sung thm tc dng chng ng mu vo tc dng khng vitamin K, hoc
vo tc dng chng kt tp tiu cu ca cc thuc chng ng mu.
X l: Nn trnh phi hp thuc, ch yu vi latamoxef, do tng nguy c chy
mu. Cn cnh gic vi cc khng sinh ny liu cao.
Dipyridamol
Phn tch: Phi hp vi tt c cc thuc c tnh cht chng kt tp tiu cu hay
chng ng mu u lm tng nguy c chy mu. Hin nay tng tc ny c v b nghi
ng, v khng c mt nhn xt lm sng no khng nh nguy c chy mu.
833
X l: Nu cn phi hp thuc ny, phi theo di cht ch bng nhng xt

nghim ng mu thch hp (thi gian Quick, t l chun ha quc t-INR) trong v sau
khi iu tr bng kt hp thuc.
Dextrothyroxin (D-tyroxin)
Phn tch: Dextrothyroxin lm tng tc dng ca thuc chng ng mu dng
ng ung. C ch cn cha r.
X l: Theo di ngi bnh khi dng kt hp thuc ny, c bit v hot
chng ng mu. Gim liu thuc chng ng mu khi cn.
Phn tch: Cc dng c t trong t cung gy vim nim mc t cung, do tng
nguy c chy mu ni.
X l: Bo cho ngi bnh bit nguy c ny v khuyn h nhanh chng n gp
bc s khi c chy mu. Lu nguy c ny la chn bin php nga thai.
Indomethacin hoc dn cht; pyrazol; salicylat; thuc chng vim khng steroid
Phn tch: Tng tc dng chng ng mu do y thuc chng ng ra khi cc
lin kt vi protein huyt tng v do tc dng hip ng chng kt tp tiu cu.
Thuc chng vim khng steroid kch ng nim mc d dy v lm tng nguy c lot
chy mu, nht l khi dng nhng ngi bnh cao tui.
X l: Khng nn k n cc thuc ny cng nhau, v nguy c chy mu. i vi
aspirin, mc du c gp phi hp trn thc t, nhng ch c th thc hin vi liu thp
(di 200 mg). Vi liu cao hn, phi hp ny nn trnh, v l chng ch nh chnh
thc. Trong trng hp ngi bnh t iu tr, thng bo cho h bit nguy c ny.
Phenicol
Phn tch: Tng tc c m t vi dicoumarol, acenocoumarol. Hot tnh chng
ng mu tng ln, c th do c ch enzym.
X l: Theo di t l chun ha quc t - INR v t l prothrombin, v nu cn,
hiu chnh liu lng cho thch hp lc bt u, trong khi, v sau khi iu tr vi
cloramphenicol.
Ritonavir
Phn tch: Ritonavir c i lc cao vi isoenzym 3A4 ca cc cytochrom P450. C s
cnh tranh mnh gia ritonavir vi cc thuc b chuyn ho bi isoenzym ny. S cnh
tranh ny gy gim chuyn ho, v gy nguy c lm tng ng k nng ca cc
thuc trong huyt tng. Tng nguy c chy mu ( m t vi warfarin). Tng tc
X l: Cch nhau tng thi gian ngn, phi xc nh t l prothrombin (hay t l
chun ha quc t - INR), v nu cn th gim liu warfarin.
Sulfamid khng khun
Phn tch: Do lin kt mnh vi cc protein, sulfamid c th y cc thuc khng
vitamin K, c bit l warfarin (Coumadine) ra khi cc lin kt vi protein huyt tng.
C nguy c chy mu. Cng c th l do sulfamid lm gim tng hp vitamin K rut.
Ring sulfamethoxazol hay vin thuc cha hn hp sulfamethoxazol vi trimethoprim
834
(Bactrim; co-trimoxazol) c ch c s chuyn ho warfarin gan, nn tc dng ca

warfarin tng mnh v gy chy mu.
X l: Theo di t l prothrombin hay t l chun ha quc t-INR, v hiu chnh
liu lng cho thch hp lc bt u, trong khi iu tr v trong vng 8 ngy k t khi
ngng iu tr.
Sulfinpyrazon
Phn tch: Kt hp thuc ny lm cho hot tnh ca thuc chng ng mu, c
bit l warfarin tng ln, c th gy chy mu. C ch c th do sulfinpyrazon c ch s
chuyn ho ca warfarin ng phn i hnh S gan.
X l: Theo di cht ch cc ch s v ng mu. Thng th cn phi hiu chnh
liu warfarin: Gim liu warfarin khi bt u ung sulfinpyrazon, v tng liu warfarin khi
ngng iu tr vi sulfinpyrazon.
Thioamin khng gip
Phn tch: Khi dng thioamin khng gip, tc dng ca cc thuc chng ng
mu thng b thay i theo chiu hng gim. C ch tc dng cha r.
X l: Theo di cc ch s v ng mu, v theo di p ng vi thuc chng
ng mu dng ng ung. Ch c hai chiu hng: p ng yu i hoc mnh
ln. Nu cn, th hiu chnh liu thuc chng ng mu.
Ticlopidin
Phn tch: Ticlopidin chng kt tp tiu cu ko di 6 n 7 ngy. Lm tng rt
nhiu nguy c chy mu, nu phi hp vi cc thuc chng ng mu.
X l: Do ticlopidin c th gy chy mu nghim trng, i khi gy t vong, nn
cn trnh k n phi hp ny. Khi gp mt n thuc nh th, dc s phi thng bo
cho ngi k n.
Vitamin E
Phn tch: Vitamin E lm tng tc dng cc thuc chng ng mu dng ng
ung. C ch c th do vitamin E lm ri lon chc nng ca cc yu t gy ng mu
ph thuc vitamin K, do s c tc dng hip ng vi thuc chng ng mu.
X l: Phi theo di ngi bnh cn thn xem cc thuc chng ng mu dng
ng ung c gy hin tng gim prothrombin qu mc khi dng vitamin E khng.
Theo di cc ch s v ng mu v nu cn, gim bt liu thuc chng ng mu. V
ngi bnh hay t dng vitamin E, nn trc khi k n thuc chng ng mu, hi
xem ngi bnh c dng vitamin E hay khng.
Phn tch: Acetaminophen lm tng tc dng ca thuc ung chng ng mu,
tc dng ny ph thuc vo liu dng. Tc dng ny khng quan tr ng v lm sng
nu dng paracetamol liu thp v thnh thong mi dng (ngha l 6 vin 325
mg/tun). C ch cha r.
835
X l: Hn ch dng paracetamol v gim st cc thng s ng mu thng

xuyn hn (ngha l 1-2 ln/tun) khi bt u hoc ngng, c bit khi dng > 2275
mg/tun. iu chnh liu thuc ung chng ng mu khi cn.
Phn tch: Tng na i ca thuc chng ng mu do c ch chuyn ho gan.
Tng tc dc ng hc v chuyn ho thuc gan.
X l: Nu cn phi hp thuc, nn kim tra u n hn thi gian Quick v t l
chun ha quc t - INR, tu theo tng trng hp, khi bt u, trong v sau khi iu tr
vi alopurinol. Sau khi hiu chnh liu, khuyn ngi bnh dng thuc u n vo
nhng gi c nh. Khng c ngng iu tr t ngt, cng nh khng thay i cch
iu tr khi khng c kin ca bc s.
Aminosid ung
Phn tch: Tng tc dng khng vitamin K, c th do tc dng ca khng sinh (tn
ti trong rut) do vi khun ng rut sinh ra vitamin K hoc do lm gim hp thu
vitamin K.
X l: Phi hp ny i hi tng cng theo di vic iu tr vi cc thuc khng
vitamin K bng cch xc nh t l prothrombin hay t l chun ha quc t - INR. iu
chnh liu lng khi bt u v khi ngng iu tr bng thuc khng sinh nu cn.
Amiodaron
Phn tch: Phi hp vi cc dn cht coumarin, thy thi gian Quick c th tng
gp i, thm ch gp ba. Tng tc ny c m t vi acenocoumarol (Sintrom*)
v warfarin (Coumadine*).
X l: Gim 30-50% liu ca thuc khng vitamin K v theo di thi gian Quick v
t l chun ha quc t - INR nhiu tun l k t lc ngng iu tr vi amiodaron (na
i ca amiodaron l 28 ngy).
Antipyrin
Phn tch: Tc dng ca thuc khng vitamin K b gim do antipyrin l mt cht
cm ng enzym tim tng, lm tng chuyn ho v thanh lc, c bi t ca warfarin
(coumadine), nh vy lm gim tc dng ca cht chng ng mu.
X l: Antipyrin (phenazon) c khi dng phi hp trong mt s bit dc gim
au v h st. Vi ngi bnh ang dng thuc khng vitamin K (c bit, ang dng
warfarin), nn trnh dng cc bit dc cha antipyrin (phenazon). Nu cn phi phi
hp vi thuc khng vitamin K, phi theo di t l prothrombin hay t l chun ha quc
t - INR, v khi cn phi iu chnh liu dng lc bt u, trong, v sau khi i u tr v i
bit dc cha antipyrin.
Barbituric; carbamazepin; griseofulvin; phenytoin; primidon hoc dn cht;
rifampicin
Phn tch: Cc thuc ny gy cm ng enzym, lm tng tc d ho cht chng
ng mu gan. Cm ng enzym khng phi l mt hin tng tc th. Cn phi iu
tr vi cht cm ng enzym trc t nht mi ngy th tng tc mi biu hin.
X l: Cn phi lu tng tc ny iu chnh liu cho thch hp, v phi thc
hin nhng xt nghim sinh hc (nh t l prothrombin, t l chun ha quc t -- INR)
836
mt cch thng xuyn hn, ti lc bt u, trong v khi ngng iu tr vi nhng thuc

c tnh cht cm ng enzym. Phi ch n trnh t thi gian cc ln dng thuc.
Benzofuran hoc dn cht
Phn tch: Tng tc dc ng hc: liu cao, c s tng cng tnh cht cc
khng vitamin K do gim d ho gan.
X l: iu chnh liu dng lc bt u, trong khi v nu cn th c khi ngng
iu tr thuc chng bnh thng phong. Phi theo di cht ch t l chun ha quc t
-INR v / hoc t l prothrombin.
Cholestyramin
Phn tch: Gim hp thu nhiu thuc qua ng tiu ho.
X l: Khi phi hp hai thuc, khuyn nn ung thuc chng ng mu hoc
trc hai gi, hoc bn gi sau khi dng cholestyramin.
Cisaprid; fluoxetin; fluvoxamin; paroxetin; sulfasalazin hoc dn cht
Phn tch: Do c lin kt mnh vi protein, thuc phi hp c th y cc thuc
khng vitamin K, c bit acenocoumarol ( Sintrom*) ra khi lin kt vi protein huyt
tng. C nguy c chy mu.
X l: Theo di t l prothrombin hoc t l chun ha quc t-INR v iu chnh
liu lng cho thch hp lc bt u, trong v 8 ngy sau khi ng ng thuc ph i h p.
INR l cch biu th quc t mi, cho php gim nhng bin ng kt qu xt nghi m
ng mu gia cc phng xt nghim khc nhau.
Danazol
Phn tch: Tng tc dng chng ng mu do gim tng hp cc yu t ng
mu gan. C nguy c chy mu. Tng tc ny ch c pht hin vi warfarin
(Coumadine).
X l: Nu cn phi hp thuc, phi theo di t l prothrombin v / hoc t l
chun ha quc t-INR lc bt u, trong v sau khi iu tr vi danazol. T , i u
chnh liu lng cho thch hp.
Diazoxyd
Phn tch: Do lin kt mnh vi protein huyt tng, diazoxyd c th y cc
khng vitamin K, c bit acenocoumarol (Sintrom) ra khi lin kt vi protein huyt
tng. Nguy c chy mu.
X l: Thng ch thc hin phi hp thuc ny ti c s bnh vin. Cn phi
hiu chnh liu lng, cn c kt qu xc dnh t l prothrombin hoc t l chun ha
quc t - INR.
Disulfiram
Phn tch: Tng tc dng ca thuc khng vitamin K do c ch enzym, nn
ngn chn chuyn ho ca thuc khng vitamin K.
X l: Nu cn phi hp thuc ny, phi theo di t l prothrombin v / hoc t l
chun ha quc t - INR lc bt u, trong v sau khi iu tr bng disulfiram. Hi u
chnh liu cho thch hp.
837
Fibrat
Phn tch: C nguy c gim thrombin huyt do thuc khng vitamin K b y khi
nhng v tr lin kt vi protein huyt tng. Phn t do ca thuc khng vitamin K tng
ln. Tng tc dc ng hc.
X l: Nu cn phi hp thuc, phi theo di t l prothrombin huyt v / hoc t
l chun ha quc t - INR lc bt u, trong v sau khi iu tr bng fibrat. Tu theo
cc kt qu ca nhng xt nghim sinh hc m hiu chnh liu hay khng hiu ch nh
liu lng.
Glucagon
bit.
Phn tch: Tng tc dng ca thuc khng vitamin K do mt c ch cha c
X l: Tng tc dng ny c m t khi dng nhng liu trn 25mg mt ngy,

dng hai hoc nhiu ngy, v t khi dng ti liu ny. Nu cn n liu , phi theo di
thng xuyn thi gian Quick v / hoc t l chun ha quc t -INR, lc bt u, trong
khi v lc ngng dng phi hp thuc ny. iu chnh liu cho thch hp theo cc kt
qu xt nghim sinh hc.
Glucocorticoid
Phn tch: Tc dng gy lot ng tiu ho ca cc corticoid lm tng nguy c
lot chy mu, nht l ngi bnh cao tui.
X l: Hi ngi bnh v tin s lot (ng tiu ho). Phi tng cng theo di
v mt lm sng v v sinh hc khi phi hp thuc ny. Khuyn ngi bnh i khm
li, nu li thy au kiu lot xut hin.
Glutethimid hoc thuc tng t
Phn tch: Aminoglutethimid l cht cm ng enzym, c tc dng y nhanh d
ho thuc chng ng mu gan. Cm ng enzym khng phi l mt hin tng t c
th. c tng tc, phi iu tr vi cht cm ng enzym trc t nht 10 ngy.
X l: Phi tnh n tng tc ny hiu chnh liu thuc. Vic theo di sinh
hc (t l prothrombin v t l chun ha quc t - INR) phi thc hin nhiu hn, lc
bt u iu tr vi cht chng ng mu, trong thi gian v khi ngng iu tr vi cht
cm ng enzym.
Heparin
Phn tch: Phi hp hai thuc c tc dng chng ng mu, ko theo tng nguy
c chy mu.
Hormon tuyn gip
Phn tch: Tc dng ca thuc chng ng mu c th b ri lon. Tng liu
hormon gip trng i hi gim liu cc thuc khng vitamin K (to iu kin d ho cc
yu t prothrombin).
X l: Thay i liu lng hormon tuyn gip gy nh hng n tc dng ca
thuc khng vitamin K. Phi hp thuc ny i hi hiu chnh thng xuyn liu lng
theo t l prothrombin hay t l chun ha quc t - INR. Kim tra xem vic ny c c
thc hin khng.
838
Lansoprazol
Phn tch: Tng tc dc ng hc. Cn thn trng vi cc thuc b chuyn ho
bi cc cytochrom P450 (nh lansoprazol v thuc ung chng ng mu), v c nguy c
gim hot tnh cc thuc ny do cm ng enzym v iu c th d n t i tht bi
trong iu tr.
X l: Lansoprazol l thuc tng i mi, nn cn thiu nhn xt lm sng. C
th y c tng tc thuc, v vy khuyn nn chuyn cc nhn xt lm sng v cc
Trung tm cnh gic thuc. Xt nguy c ny trong bi cnh iu tr. Thng bo cho
ngi bnh. Hiu chnh liu lng cho thch hp theo kt qu xt nghim sinh hc khi
bt u v khi ngng iu tr vi lansoprazol. Khuyn ngi bnh n khm li nu c
nhng bin ng v t l prothrombin hay t l chun ha quc t -INR.
Macrolid
Phn tch: Tng nguy c chy mu (c bit vi warfarin) do gim chuyn ho v
gim thanh lc (warfarin), c bit nhng ngi bnh cao tui (n nay cha c ti
liu v roxithromycin).
X l: Nu phi hp thuc, phi theo di t l prothrombin hay t l chun ha
quc t - INR, trong v sau khi iu tr bng macrolid (c ni nhiu vi
troleandomycin (TAO) v erythromycin). Tng tc ny i khi kh qun l, v thi gian
xy ra tng tc ngn.
Phn tch: Natri valproat c th gy gim tiu cu, gim prothrombin huyt v
gim kt tp tiu cu. Nh vy, n c th gy chy mu ngi bnh iu tr bng
cc thuc ung khng vitamin K hoc heparin hoc cc thuc lm tan huyt khi.
X l: Khi phi hp thuc, tu theo thuc chng ng mu dng, cn tng
cng theo di m tiu cu, thi gian cephalin hot ho (TCA), thi gian Howell, thi
gian chy mu, t l prothrombin, t l chun ha quc t -INR.
Nilutamid
Phn tch: Tng tc dng ca thuc khng vitamin K, c th do gim chuyn ho
cc thuc .
X l: iu chnh liu cho thch hp theo t l prothrombin v t l chun ha quc
t - INR lc bt u, trong khi v sau khi iu tr bng nilutamid. Bo cho ng i bnh
khng c ngng iu tr mt cch t ngt.
Nitroimidazol
Phn tch: Tng tc dng ca thuc khng vitamin K do c ch enzym c trch
nhim chuyn ho thuc khng vitamin K. Tng tc ny d c m t vi warfarin
(Coumadine).
X l: Nu cn phi hp thuc, phi theo di t l prothrombin v/ hoc t l
chun ha quc t - INR lc bt u, trong v sau khi iu tr bng nitroimidazol. i u
chnh liu cho thch hp.
Omeprazol
839
Phn tch: Omeprazol c ch cytochrom P450 c th ko theo s chm tr trong

chuyn ho warfarin, lm tng nng warfarin trong huyt thanh, v tng nguy c
chy mu do qu liu.
X l: Theo di t l prothrombin v t l chun ha quc t -INR, v iu chnh
liu cho thch hp lc bt u, trong v sau khi iu tr bng omeprazol (qu trnh i u
tr ko di 4 n 6 tun l), hoc thay i cht c ch bm proton.
Pentoxyfylin
Phn tch: Tng nguy c chy mu (c ch cha bit).
X l: Tng cng theo di mt cch u n thi gian Quick v/ hay t l chun
ha quc t - INR lc bt u, trong khi hay khi ngng phi hp thuc. iu chnh li u
cho thch hp theo cc kt qu xt nghim sinh hc.
Propafenon
Phn tch: Tng tc ny mi c m t vi warfarin (Coumadine). Tng tc
dng chng ng mu, v do tng nguy c chy mu, c th do c ch chuyn ho
oxy ho warfarin.
X l: Hiu chnh liu theo t l prothrombin v/ hoc t l chun ha quc t INR lc bt u, trong khi v khi ngng iu tr bng propafenon.
Quinidin hoc dn cht
Phn tch: C th lm tng tc dng ca thuc khng vitamin K, do gim tng hp
mt s yu t ng mu gan, cng c th do tng i lc ca th th i v i ch t
khng vitamin K.
X l: Nu cn phi hp thuc, phi theo di t l prothrombin v/ hoc t l
chun ha quc t -INR lc bt u, trong v sau khi iu tr bng quinidin. Da vo
m hiu chnh liu lng cho thch hp. Gii thch ngi bnh thy cn phi theo
di sinh hc.
Quinolon
Phn tch: Do lin kt mnh vi protein, thuc phi hp c th y thuc khng
vitamin K ra khi lin kt vi protein huyt tng, c bit vi acenocoumarol
(Sintrom*), ciprofloxacin (Ciflox*, Uniflox*), ofloxacin (Oflocet*, Exocine*) v norfloxacin
(Noroxine*400). C nguy c chy mu.
X l: Theo di t l prothrombin hay t l chun ha quc t- INR v iu chnh
liu lng cho thch hp lc bt u, trong khi iu tr v trong vng 8 ngy sau khi
ngng iu tr.
Rifamycin
Phn tch: Rifamycin lm gim tc dng chng ng mu ca warfarin, do
rifamycin lm tng chuyn ho warfarin gan.
X l: C th phi tng liu lng thuc ung chng ng mu khi phi hp vi
rifamycin. Phi gim st cht cc xt nghim v ng mu khi ngng rifamycin trnh
chy mu.
840
Phn tch: Tc dng chng ng mu tng do mt c ch cha c r. C th l

do gim s lng mt s tin yu t ng mu, hay do d ho v do tng i lc ca cc
th th vi cht chng ng mu.
X l: Hiu chnh liu cho thch hp, lc bt u, trong v sau khi iu tr, c ch
ti th t thi gian ung mi th thuc. Theo di da vo cc t l prothrombin v t l
chun ha quc t - INR.
Sucralfat
Phn tch: Gim hp thu cc thuc ny khi phi hp vi sucralfat (tng tc dc
ng hc v hp thu thuc).
X l: Khuyn ngi bnh phi m bo mt khong cch 2 gi gia cc l n
ung hai thuc d.
Tamoxifen
Phn tch: Tng mnh nguy c chy mu.
X l: Theo di u n thi gian Quick v/ hoc t l chun ha quc t- INR, lc
bt u, trong khi hoc lc ngng dng phi hp thuc. Hiu chnh liu lng cho thch
hp theo kt qu cc xt nghim sinh hc. Gii thch cho ng i bnh thy cn phi
theo di sinh hc.
Tetracyclin
Phn tch: Nguy c chy mu do mt c ch cha r. Tng tc ny rt t c
ni ti trong y vn.
X l: Theo di t l prothrombin hay t l chun ha quc t -INR, v hiu chnh
liu cho thch hp lc bt u, trong khi iu tr v trong vng 8 ngy sau khi ng ng
iu tr.
Phn tch: Cimetidin l cht c ch enzym oxydase gan (cytochrom P450) xc tc
cho chuyn ho mt s thuc. Ngoi ra, n lm gim lu l ng mu gan. Do ,
nng mt s thuc trong huyt tng tng ln (nguy c qu liu), v trong khi c
ch mt s bin i sinh hc, cimetidin cng phong b cc c ch gii c. C nguy c
h thrombin mu, v hin tng ny c m t vi acenocoumarol do c ch s d
ho cht ny gan.
X l: Vi mt s thuc khng vitamin K nh acenocoumarol (Sintrom*),
phenindion (Pindione), warfarin (Coumadine), thy nguy c h thrombin huyt c
m t. Nh vy, phi thay thuc chng lot d dy hoc iu chnh li liu thuc khng
vitamin K lc bt u, trong v sau khi iu tr vi thuc khng H 2 da theo kt qu xt
nghim t l prothrombin, hoc t l chun ha quc t - INR (mt t iu tr vi thuc
khng H2 ko di 4 n 6 tun l)
Phn tch: Thuc chng trm cm ba vng lm tng na i v sinh kh dng
ca dicoumarol, do lm tng tc dng ca thuc chng ng mu ny. C ch c
th do c ch s chuyn ho dicoumarol gan, cng c th l tng hp thu dicoumarol.
841
X l: Theo di thi gian prothrombin v nhng du hiu v chy mu ng i

bnh. Nu cn, gim liu dicoumarol.
Thuc chng ung th
Phn tch: Lm tng tc dng ca warfarin, c th do c ch s chuyn ho hoc
do y cht ny khi lin kt vi protein huyt tng, cng c th do c ch s t ng
hp cc yu t ng mu.
X l: Theo di cn thn cc thng s v ng mu khi dng v sau khi ng ng
dng ho liu php chng ung th. Hiu chnh liu warfarin khi cn.
Phn tch: Thuc khng acid lm gim hp thu ng tiu ho, nn lm gim
X l: Cn phi c mt khong thi gian cch nhau t nht 1 n 2 gi gia l n
ung thuc khng acid vi ln ung thuc ny. Cc thuc khng acid thng c
ung sau ba n 1 gi 30 pht, v n l nguyn nhn ca tng tit dch d dy.
Phn tch: Gim hiu qu iu tr chng ng mu khi dng thm carbimazol
(Neo-mercazole), do mt c ch cha c gii thch r.
X l: Hiu chnh li liu lng theo t l chun ha quc t - INR v / hoc thi
gian Quick, lc bt u, trong v sau khi iu tr bng thuc khng gip.
Phn tch: Dng du paraffin vi cc thuc khng vitamin K lm gim hp thu v
lm gim tc dng ca thuc khng vitamin K.
X l: C th trnh c nhng hu qu ca tng tc ny bng cch khuyn
ngi bnh dng cc thuc cch nhau nhiu gi (hoc trc 2 gi, hoc 4 gi sau
khi dng du paraffin).
Thuc nhun trng to thch v thm thu
Phn tch: Dng cc thuc nhun trng to thch v thm thu cng vi cc
khng vitamin K lm gim hp thu thuc khng vitamin K v lm gim hot tnh c a
chng.
X l: C th trnh c tng tc ny, nu cc thuc c dng cch nhau t
nht 2 gi.
Vitamin A
Phn tch: Do vitamin A lin kt vi protein, nn c th y cc thuc khng
vitamin K ra khi lin kt vi protein huyt tng, v lm tng tc dng ca chng.
Tng tc dc ng hc xy ra trong thi gian phn b thuc khi vitamin A dng vi
liu cao.
X l: Theo di t l prothrombin khi bt u dng vitamin A (c th c s hi u
chnh liu thuc ung chng ng mu, nu cn) v khi ngng dng (c th cn hiu
chnh li liu).
Vitamin K
842
Phn tch: Tc dng ca thuc chng ng mu dng ng ung s b gim i,

thm ch b o ngc dn n to huyt khi. C ch l tc dng c
ch cc yu t ng mu do ung thuc chng ng mu b trit tiu bi vitamin K.
X l: Trnh dng kt hp hai thuc ny. Trnh n thc phm giu vitamin K khi
ung thuc chng ng mu. Theo di cht ch cc ch s ng mu, ch n cc
du hiu phn nh s to thnh huyt khi. Hiu chnh liu thuc chng ng mu khi
cn.
Citalopram
Phn tch: Tng tc dc ng hc: tng tc dng chng ng mu v tng
nguy c chy mu.
X l: Hiu chnh liu lng khi iu tr bng citalopram v khi ngng iu tr.
Kim tra thng xuyn t l prothrombin v t l chun ha quc t -INR.
Phn tch: Do lin kt mnh vi protein, thuc phi hp c th y thuc khng
vitamin K ra khi lin kt vi protein huyt tng. C nguy c chy mu. Cng cn thy
tng nguy c h glucose mu, i khi gy hn m. iu ny c m t khi dng phi
hp dicoumarol vi tolbutamid (Dolipol); dicoumarol vi clorpropamid (Diabinese*);
acenocoumarol (Sintrom*) vi clorpropamid (Diabinese*); warfarin (Coumadine) vi
glibenclamid (Daonil*).
X l: Theo di t l prothrombin hay t l chun ha quc t -INR, v hiu chnh
liu lng cho thch hp lc bt u, trong khi iu tr v trong vng 8 ngy sau khi iu
tr.
Ru
Phn tch: Ung nhiu ru c coi nh dng mt cht c ch enzym v c kh
nng c ch s bin i sinh hc ca thuc chng ng mu, do lm tng tc dng
ca cht ny. Tri li, khi ung ru thng xuyn, c coi nh dng cht cm ng
enzym, nh vy c nguy c y nhanh bin i sinh hc ca thuc chng ng mu v
lm gim tc dng ca thuc ny.
X l: iu tr ngi bnh bng cc thuc khng vitamin K s kh khn nu
ngi bnh nghin ru. Nhng bin ng ca t l prothrombin v t l chun ha
quc t -INR l ng ngi. Nu ngi bnh nghin ru, phi tnh n iu ny
hiu chnh liu lng lc ban u cho thch hp, sau tip tc hiu chnh li theo kt
qu thu c. Cn thn nu ngi bnh quyt nh ngng ung ru trong khi cn
iu tr vi cht chng ng mu v khi nn hiu chnh li liu lng.
Thuc lm tan huyt khi
Phn tch: Tng nguy c chy mu, cn bc s chuyn khoa theo di.
X l: Thng thng k n cc thuc lm tan huyt khi, v cho dng cc thuc
ny phi c cc bc s chuyn khoa (cc chuyn gia tim mch v bc s ca i cp
cu) thc hin, v thuc c phm vi iu tr hp, v cch iu tr chuyn bit. Kim tra
m bo ngi bnh cha dng thuc chng ng mu. Nu c, th phi tnh n nguy
c.
843
Thuc chng hen

L cc thuc chng
v chng co tht ph qun
tng
tit
dch,
chng
ph
nim
mc
Cc thuc trong nhm

EPROZINOL vin nn 50 mg; vin n 100 mg
Eufineron vin nn 50 mg
Eupneron vin n 100 mg
FENSPIRID vin nn bao 80 mg; vin n: 40 mg, 80 mg; ng tim 40 mg
Pneumorel vin nn bao 80 mg
Pneumorel vin n: 40 mg; 80 mg
Pneumorel ng tim 40 mg
ch khi ch nh thuc
Cn theo di: mc 1
Thi k mang thai: Khuyn khng nn dng fenspirid trong cc thng u ca
thai k, v thn trng.
Thuc chng ho khng opi
Thuc chng ho tc dng trung tm, khng c tc dng c ch h hp
Cc thuc trong nhm
BROMOFORM
CLOBUTINOL ng tim 20 mg; thuc git 6%; vin bc 40 mg
Silomat ng tim 20 mg; thuc git 6%; vin bc 40 mg
OXELADIN siro 2g/1000 mL
Paxeladine siro 2g/1000 mL
Ch khi ch nh thuc
Chng ch nh: mc 4
ng kinh: Trong nhm ny, khng dng clobutinol cho cc i tng ng kinh
hoc c tin s co git.
Cn theo di: mc 1
Thi k cho con b: Thn trng, v khng bit thuc c qua c sa m hay
khng.
Thi k mang thai: Thn trng, khng dng thuc trong thai k.
L cc dn cht ca imidazol, c tc dng chng nm vi ph rng
nhiu hay t tu theo hp cht
Cc thuc trong nhm
844
BIFONAZOL dung dch dng ngoi 1%; thuc m 1%

Neltolon dung dch dng ngoi 1%
Mycospor Onychoset thuc m 1%
CLOTRIMAZOL kem bi da 1%; vin t m o: 100 mg; 500 mg
Canesten kem bi da 1%
Canesten vin t m o: 100 mg
Clomaz vin t m o: 100 mg
Cristan vin t m o 100 mg; 500 mg
Lykamidil vin t m o 100 mg; 500 mg
ECONAZOL
Encodax-G kem bi
Endix-G kem bi
Econazine kem bi 1 %
Gyno-Pevaryl Depot vin trng t m o 100 mg
FENTICONAZOL vin trng 200 mg; kem bi da 600 mg/30 g
Lomexin vin trng 200 mg
Lomexin kem bi da 600 mg/30 g
FLUCONAZOL nang 150 mg
Diflucan nang 150 mg
Flunco nang 150 mg
Mycosyst nang: 50 mg; 100 mg; 150 mg; dch truyn 2 mg/ml
Nofung nang 100 mg
Triflucan nang 150 mg
Zolstan vin nn 100 mg
ISOCONAZOL kem bi da 2%
Fazol kem bi da 2%
ITRACONAZOL nang 100 mg
Canditral nang 100 mg
Sporal nang 100 mg
KETOCONAZOL kem bi da 2%; vin nn 200 mg
Comozol kem bi da 2%
Fungazole vin nn 200 mg
Fungicide vin nn 200 mg
845
Funginoc kem bi 2%
Kenazol kem bi da 2%
Ketoconazole vin nn 200 mg
Kezole vin nn 200 mg
Micozal kem bi da 2 %
Nizoral du gi u 2%
Nizoral kem bi 20 mg/g; vin nn 200 mg
Nora du gi u 2 %
Nora vin nn 200 mg
Spike vin nn 200 mg
Yucomy vin nn 200 mg
MICONAZOL kem bi 2%; vin t: 100 mg, 200 mg, 400 mg
Betnovate-GM-kem bi da 2% (phi hp)
Daktarin kem bi 2%
Daktarin Oral gel- Gel bi ming 2%
Micostat vin t 100 mg
Mycoheal 200 vin t 200 mg
Mycoheal 400 vin t 400 mg
TIOCONAZOL kem bi 1%; vin trng 300 mg
Trosyd kem bi 1%
Trosyd vin trng 300 mg
Ch khi ch nh thuc
Chng ch nh: mc 4
Thi k cho con b: Do thuc qua c sa m.
Suy gan: Mt s thuc c vi gan (ketoconazol), dn n vim gan mt hoc
nhiu khi tiu t bo.
Thi k mang thai: Mt s dn cht c kh nng sinh qui thai trn sc vt
(ketoconazol...)
Tng tc thuc
Cisaprid
Phn tch: Mt s t trng hp lon nhp tht (ko di khong QT vi xon nh)
c m t vi ketoconazol, miconazol v itraconazol.
846
X l: Chnh thc chng ch nh phi hp cisaprid vi ketoconazol, miconazol

hoc itraconazol. Thn trng trc khi dng cisaprid cho ngi bnh b ri lon in
gii cha c iu chnh (h kali mu), h magnesi mu, ko di bm sinh khong
QT, hoc ang dng thuc c kh nng dn n ko di khong QT.
Phn tch: Tng mnh tc dng h glucose mu bi cc dn xut ca imidazol do
c ch cytochrom P450. Gim st glucose mu. Tng tc ny ch yu c m t i
vi miconazol v fluconazol.
X l: Nu cn phi hp thuc, bo trc cho ngi bnh bit nguy c h
glucose mu tng cng t gim st v iu chnh liu lc bt u, trong v sau khi
iu tr.
Phn tch: Gim chuyn ho astemizol gan gy ra bi ketoconazol, itraconazol,
c th d gy xon nh. Cha thy tng tc vi cetirizin v loratadin.
X l: V nguy c , khng phi hp vi astemizol. Phi chn mt khng
histamin khng an thn khc khng c nhng bt li nh vy.
Phn tch: Tng tc dng ca cc thuc ung khng vitamin K ( c m t vi
warfarin, itraconazol, fluconazol v miconazol) do gim d ho gan. Tng tc kiu
dc ng hc do c ch enzym.
X l: Nu phi k n hai thuc, phi tng cng gim st t l prothrombin
v/hoc t l chun ha quc t - INR lc bt u, trong v sau khi iu tr bng cc
thuc chng nm k trn.
Benzodiazepin
Phn tch: Fluconazol, itraconazol v ketoconazol lm tng rt nhiu nng
trong huyt tng ca midazolam v triazolam khi ung, do lm tng tc d ng an
thn bun ng, hay qun v ko di tc dng gy ng, nhng c th tc d ng ny
khng xy ra khi tim tnh mch cc thuc ny c liu mt lc. Ketoconazol c tc dng
rt t, c th khng quan trng v mt lm sng i vi hot tnh ca clordiazepoxid,
nhng thuc lm tng tc dng ca alprazolam v midazolam. Khng c tng tc quan
trng gia temazepam v itraconazol. C ch: C l cc thuc khng nm lm gi m
ng k chuyn ho trong gan ca midazolam v triazolam, t lm gim o thi ra
ngoi c th, lm tng nng trong huyt tng v lm tng tc dng.
X l: Tng tc midazolam/itraconazol, midazolam/ ketoconazol, triazolam/
itraconazol v triazolam/ketoconazol c xc nh l quan trng v mt lm sng.
Liu lng midazolam cn phi gim khong 75%, c khi hn na, khi phi hp vi cc
thuc khng nm , trnh gy bun ng qu mc v ko di. Tng tc
clordiazepoxid/ ketoconazol v temazepam/itraconazol c xc nh, nhng tc
dng t v khng quan trng v mt lm sng.
Cc cht c ch protease (amprenavir, indinavir, ribonavirsa, quinavir...)
847
Phn tch: Cc cht c ch protease c chuyn ho ch yu bi cc isoenzym

3A ca cytochrom P450. V vy chng cnh tranh theo cng con ng chuyn ho vi
hng lot cc thuc cng c chuyn ho tng t, do thng lm tng ln nhau
nng trong huyt tng v tng nguy c c tnh. Tng tc dc ng hc khu
chuyn ho.
X l: Nn xem xt gim liu ca cht c ch protease v c ca thuc chng
nm imidazol phi hp. Theo di ngi bnh v c tnh ca hai loi thuc ny v iu
chnh liu, nu cn.
Phenytoin
Phn tch: Gim nng thuc chng nm trong huyt tng, thy vi
itraconazol, fluconazol v miconazol do cm ng enzym (gim hiu qu). Tng tc xy
ra chm v c tn sut cao.
X l: iu tr c nguy c tht bi nu phi hp ko di t nht mi ngy. Trong
trng hp ny, iu chnh liu, v nu cn, nh lng itraconazol trong huyt tng.
Ru
Phn tch: Tc dng antabuse (kiu disulfiram) cng vi nguy c c vi gan: mt
lng bt thng acetaldehyd tch lu trong cc m (c ch enzym), dn n mt s
du hiu lm sng, nh cn bng vn mch, gin mch mnh, nhp tim nhanh, st cao,
bun nn, nn, ban da, i khi h huyt p v try mch. Nhng triu chng ny quan
trng t hay nhiu, ty thuc lng ru ung. Hn na, vi mt s thuc chng
nm, dn xut t imidazol (ketoconazol), tng nguy c c vi gan.
X l: Gim st rt cht chc nng gan, c bit khi dng ketoconazol. Bo cho
ngi bnh trnh ung ru v cc ch phm c ru trong sut thi gian iu tr bng
thuc chng nm. Khuyn ngi bnh, nu thy bun nn hoc vng da, phi n bc
s theo di chc nng gan.
Statin (thuc c ch HMG-CoA reductase)
Phn tch: C th tng nng trong huyt tng v tc dng khng mong mun
ca statin. xy ra tiu c vn cp v c tnh i vi gan. Tng tc xy ra nhanh.
C ch thuc chng nm azol (c bit fluconazol khi liu 200 mg/ngy) c th c
ch chuyn ho ban u gan (cytochrom P450 3A4) ca statin.
X l: Nu tht cn phi phi hp, cn xem xt gim liu statin v theo di cn
thn p ng ca ngi bnh. iu chnh liu nh hng dn.
Zalcitabin
Phn tch: C th xy ra nhng bnh thn kinh ngoi bin.
X l: Gim st lm sng thng qua s xut hin cc d cm.
Amineptin
Phn tch: Phi hp hai thuc c tim nng c vi gan.
X l: Bn thn amineptin c th gy nhng phn ng min dch d ng v gan,
phc hi c khi ngng thuc. Khi dng cc thuc chng nm dn xut t imidazol,
phi gim st cht chc nng gan (ASAT, ALAT, phosphatase kim, bilirubin), c bit
848
vi ketoconazol, hoc nu c th hon dng mt trong hai thuc. Phi chc chn l
ngi bnh khng thng xuyn ung ru, v khng c tin s vim gan virus. Cc
triu chng lm sng chnh khng c hiu l bun nn, st, vng da Nu thy ng
thi ban da, nga v hch to th c th ngh nhiu n nguyn nhn do thuc. Cn c
kt qu th nghim sinh hc, cn phn bit nguy c xut hin vim gan tiu t bo
khng hi phc c vi vim gan mt c th hi phc khi ngng thuc.
Amphotericin B
Phn tch: C th c i khng tc dng chng nm, thy vi ketoconazol v
miconazol. Khng bit r c ch.
X l: Trong tnh hnh hiu bit hi n nay ca chng ta, nn trnh ph i h p ny.
Azathioprin; carmustin hoc dn xut; dantrolen: estrogen hoc thuc nga thai
phi hp estrogen + progesteron; fluvoxamin; griseofulvin; macrolid; mercaptopurin;
methotrexat; natri valproat hoc dn xut; vng
Phn tch: Phi hp nhng thuc u c tim nng c vi gan (hip ng cc
tc dng khng mong mun).
X l: Khi phi hp hai thuc u c vi gan th, hoc phi gim st cht chc
nng gan (ASAT, ALAT, phosphatase kim, bilirubin), hoc nu c th th hon dng
mt trong hai thuc. Phi m bo rng ngi bnh khng thng xuyn ung ru,
v khng c tin s vim gan virus. Cc triu chng lm sng chnh khng c hi u l
bun nn, st, vng da. Nu thy ng thi ban da, nga v hch to, th c th ngh
nhiu n nguyn nhn do thuc. Cn c kt qu th nghim sinh hc, cn phn bit
nguy c xut hin vim gan tiu t bo khng hi phc c vi vim gan mt c th
hi phc c khi ngng thuc.
Barbituric; carbamazepin; primidon hoc dn xut
Phn tch: Gim nng thuc chng nm trong huyt tng, thy khi phi
hp vi itraconazol , do cm ng enzym (gim hiu qu).
X l: Nguy c iu tr tht bi nu phi hp vi cc cht cm ng enzym ko di
t nht mi ngy. Trong trng hp ny, iu chnh liu v nu cn, nh lng
itraconazol trong huyt tng.
Ciclosporin
Phn tch: Tng nng ciclosporin trong huyt thanh v c tnh, thy r nht i
vi ketoconazol (tng t 5 n 10 ln), itraconazol v c th c fluconazol v miconazol.
Cha bit r c ch. Tng tc xy ra chm t 1 n 3 ngy sau khi cho thuc chng
nm v ko di trn mt tun sau khi ngng.
X l: Phi hp ny, thc hin ti c s chuyn khoa, phi c trnh, tr khi liu
c gim mt cch ng k, nhm trnh c vi thn. x l chnh xc tng tc
ketoconazol/ ciclosporin c m t, cn gim trn 70% liu ciclosporin (gia 68%
v 89%), nhm gim chi ph do ciclosporin. Tuy nhin, phi theo di u n hn v
thng xuyn hn nng ciclosporin trong mu.
Cilostazol
849
Phn tch: Itraconazol, etoconazol c kh nng lm tng nng trong huyt

thanh ca cilostazol. V itraconazol, ketoconazol c ch c CYP3A 4, do c th c
ch s chuyn ho ca cilostazol.
X l: Cc nh sn xut khuyn co nu dng phi hp, nn chia i liu
cilostazol (50mg, ngy 2 ln) hoc trnh dng phi hp.
Didanosin
Phn tch: Cc vin nn didanosin u cha mt cht khng acid, nn lm gim
hp thu cc thuc chng nm qua ng tiu ho (c m t vi itraconazol) tu
thuc s tng pH dch v. Tng tc xy ra nhanh.
Glucocorticoid
Phn tch: Tng tc dc ng hc. Cc thuc chng nm, nht l ketoconazol,
c ch mt s cytochrom P450 cn cho chuyn ho ca glucocorticoid, nn lm gim
thanh lc o thi v gim tit cortisol ni tit. Tng tc ny r rt vi prednisolon,
metylprednisolon v prednison v xy ra chm.
X l: Tng din tch di ng cong (AUC) v gim o thi corticoid c th ti
50%. S tng tc dng corticoid ny c th c nhng hu qu lm gim mi n d ch.
Gim st cht cc tc dng khng mong mun ca corticosteroid v iu chnh liu khi
cn.
Glycosid tr tim
Phn tch: Nng digoxin trong huyt thanh c th tng, lm tng tc dng dc
l v tc dng c hi. Tng tc xy ra chm. C th do gim thanh lc v tng hp
thu digoxin.
X l: Gim st nng trong huyt tng ca digoxin v theo di cc du hiu
nhim c digoxin. iu chnh liu digoxin cho ph hp.
Indinavir
Phn tch: Ketoconazol c ch chuyn ho indinavir gan, dn n tng nng
indinavir trong huyt tng v do tng c tnh (si tit niu, tng bilirubin huyt).
X l: Gim liu indinavir (khuyn dng 1,8g/ ngy).
Phn tch: Mc tiu iu tr chnh l ung th tuyn thn (adenocarcinom).
Interleukin cng gy c vi gan. y l phi hp hai thuc u c tim nng c vi
gan.
X l: Liu php ch c th tin hnh ti c s chuyn khoa. Phi cn nhc k
trc khi phi hp tu theo trng thi ca ngi bnh. Phi gim st cht chc nng
gan (ASAT, ALAT, phosphatase kim, bilirubin) hoc nu c th, hon dng mt trong
hai thuc.
850
Phn tch: Ch ring vi ketoconazol, phi ch hai iu khi phi hp thuc: Mt

l phi hp hai thuc u c tim nng c vi gan (c th tiu t bo gan); Hai l
thy gim ng k nng ketoconazol trong huyt thanh (do tng chuyn ho gan).
X l: Khi phi hp hai thuc u c vi gan, phi gim st cht chc nng
gan (ASAT, ALAT, phosphatase kim, bilirubin), hoc nu c th hon dng mt trong
hai thuc. Phi m bo l ngi bnh khng ung ru thng xuyn, v khng c
tin s vim gan virus. Cc du hiu lm sng chnh khng c hiu l bun nn, st,
vng da... Nu thy ng thi ban da, nga, v hch to, c th ngh t i ngu n g c do
thuc. Cn c kt qu cc th nghim sinh hc, cn phn bit ng nguy c xu t
hin vim gan tiu t bo khng hi phc c vi vim gan do mt c th h i
phc c khi ngng iu tr. Tu theo mc tiu iu tr, nu c th, ch n mt thu c
chng nm khc.
Niridazol
Phn tch: Phi hp hai thuc u c vi gan. Niridazol cn gy c thn kinh.
Nguy c xut hin co git, lon tm thn, v c vi gan, nu phi hp.
X l: Khi phi hp hai thuc u c vi gan, phi gim st cht chc nng gan
(ASAT, ALAT, phosphatase kim, bilirubin), hoc nu c th hon dng mt trong hai
thuc. Phi m bo l ngi bnh khng ung ru thng xuyn, v khng c tin
s vim gan virus. Cc du hiu lm sng chnh khng c hiu l bun nn, st, vng
da... Nu thy ng thi c thm ban da, nga, v hch to, c th do thuc. Da vo
kt qu xt nghim sinh hc, cn phn bit nguy c vim gan tiu t bo khng h i
phc c vi vim gan do mt c th hi phc c khi ngng iu tr.
Progabid
Phn tch: Phi hp hai thuc c tim nng c vi gan, ch yu lin quan t i
ketoconazol v progabid.
thuc. Phi chc chn l ngi bnh khng ung ru thng xuyn, v khng c tin
da... Nu thy ng thi ban da, nga, v hch to, c th l do thuc. Da vo kt qu
xt nghim sinh hc, cn phn bit nguy c vim gan tiu t bo khng hi phc c
vi vim gan mt hi phc c khi ngng iu tr.
Phn tch: Gim nng thuc chng nm trong huyt tng thy vi
itraconazol, fluconazol v ketoconazol, do cm ng enzym (gim hiu qu). Tng tc
xy ra chm. Ngc li itraconazol c ch chuyn ho rifabutin nn lm tng nng
rifabutin trong huyt tng dn n vim mng mch nh.
X l: iu tr c nguy c b tht bi nu phi hp t nht mi ngy. Trong
trng hp ny, iu chnh liu v nu cn nh lng itraconazol trong huyt tng.
Saquinavir
Phn tch: Ketoconazol c ch chuyn ho saquinavir gan dn n tng nng
saquinavir trong huyt tng gp 1,5 ln v do tng c tnh.
851
X l: Nu liu khng vt qu 200 mg/ngy vi ketoconazol v 1,8 g/ngy vi

saquinavir, khng cn thay i liu ca saquinavir. Trng hp ngc li, phi gim
liu saquinavir.
Sirolimus
Phn tch: Tng nng sirolimus huyt tng do itraconazol, ketoconazol,
miconazol v voriconazol (trnh phi hp vi voriconazol), c nguy c tng c tnh.
Tng tc xy ra chm. C ch c kh nng do c ch chuyn ho rut ca
sirolimus hoc do c ch hot tnh ca P.glycoprotein rut.
X l: Theo di nng sirolimus trong huyt tng v triu chng nhim c
sirolimus, khi bt u hoc lc ngng thuc chng nm azol. iu chnh liu sirolimus
nu cn.
Tacrolimus
Phn tch: Tng nng trong huyt tng ca tacrolimus, do b c ch chuyn
ho gan v/hoc rut. Tng tc ny c m t vi clotrimazol, fluconazol,
miconazol v ketoconazol. Nu chuyn ho rut, th c tng kh dng sinh hc ca
tacrolimus, nhng tng tc kiu ny s khng xy ra khi dng thuc chng nm tim
tnh mch. Ngoi ra, i vi fluconazol, tng tc ny cn ph thuc vo liu.
X l: Cn gim liu tacrolimus v gim st chc nng thn thng qua nh lng
creatinin mu. Gim st nng tacrolimus trong huyt tng trong khi iu tr v sau
khi ngng.
Thuc chn calci (felodipin, isradipin, nifedipin...)
Phn tch: Itraconazol c th lm tng ng k nng trong huyt thanh ca
felodipin, isradipin, nifedipin, do lm tng tc dng khng mong mun, c bi t ph
chn v mt c chn. C kh nng c ch chuyn ho ca felodipin, isradipin, nifedipin
(CYP3A4)
do
itraconazol.
Tng
tc
xy
ra chm.
X l: Nu cn thm itraconazol cho ngi ang dng thuc chn knh calci, phi
theo di lm sng v tnh trng tim mch khi cn phi gim liu thuc chn knh
calci.
Thuc chng st rt
Nh sn xut artemether phi hp vi lumefantrin. Khuyn co trnh phi hp vi
cc thuc chng nm azol.
Bosentan
Phn tch: Luconazol lm tng nng trong huyt tng ca bosentan (trnh
phi hp). Itraconazol v ketoconazol c th lm tng nng trong huyt tng ca
bosentan.
Ergotamin
Phn tch: Voriconazol lm tng nguy c nhim c nm ca g (ergotin); cn
trnh phi hp.
Eletriptan
852
Phn tch: Itraconazol v fluconazol lm tng nng huyt tng eletriptan. Cn

trnh phi hp.
Vardenafil
Phn tch: Ketoconazol hoc itraconazol c th lm tng nng trong huyt
tng ca vardenafil. Cn trnh phi hp.
Thuc gim au:
Alfentanil
Phn tch: Ketoconazol c ch chuyn ho ca alfentanil (CYP3A4), lm tng tc
dng dc l v tc dng c hi ca thuc ny: Nguy c c ch h hp ko di hoc
xy ra mun. Tng tc xy ra nhanh.
X l: Phi thn trng khi cho alfentanil ngi ang dng thuc chng nm
azol. Theo di c ch h hp ko di hoc ti din. C th phi dng alfentanil li u
thp hn thng thng.
Celecoxib
Phn tch: Fluconazol lm tng nng trong huyt tng ca celecoxib,
parecoxib, valdecoxib.
X l: Gim liu celecoxib mt na, gim liu parecoxib.
Phn tch: V thuc khng acid gy gim hp thu qua ng tiu ho nn tc
dng ca thuc phi hp cng b gim.
X l: Nht thit phi ung thuc khng acid v thuc chng nm cch nhau t
nht 1 n 2 gi. Cn nh l thng ung thuc khng acid 1 gi 30 pht sau ba n,
khi thc n l ngun gc tng bi tit dch v.
Thuc khng H2 chng lot kiu ranitidin
Phn tch: Tc dng ca ketoconazol c th b gim, pH d dy tng, lm gim
hp thu ketoconazol (vin thuc kh ho tan). Tng tc xy ra chm.
X l: Ch dn cn thn ngi bnh dng ring r hai thuc, cch nhau
2 gi. Cn theo di nh gi tc dng ca ketoconazol. Nu cn, c th dng acid
glutamic 680mg, 15 pht trc khi cho ketoconazol.
Phn tch: Cc thuc khng cholinergic lm tng pH d dy rut, do gim hp
thu ketoconazol.
X l: Khuyn ngi bnh dng cc thuc khng cholinergic 2 gi sau
ketoconazol.
Zidovudin
Phn tch: Phi hp cc thuc ny lm tng nng zidovudin trong huyt tng,
do gim chuyn ho zidovudin (vi fluconazol: khi dng liu cao).
X l: Gim liu zidovudin. Gim st cc tc dng khng mong mun lin quan
n zidovudin (gim st huyt hc v lm sng).
853

Paracetamol
Phn tch: Paracetamol, dng ko di vi liu cao hn 6 gam/ngy (tu thuc vo
th trng) s c vi gan (vim gan kiu tiu t bo). Khi phi hp vi mt thuc c
vi gan khc, nguy c tng ln.
thuc. Phi chc chn l ngi bnh khng ung ru thng xuyn v khng c tin
da... Nu thy ng thi ban da, nga, v hch to, c th l do thuc. Da vo kt qu
cc xt nghim sinh hc, cn phn bit nguy c vim gan tiu t bo khng hi phc
c vi vim gan do mt c th hi phc c khi ngng iu tr.
Theophylin
Phn tch: Trong s cc dn xut imidazol chng nm, ch thy c fluconazol gy
gim thanh lc ca theophylin. Tng tc dc ng hc.
X l: Nu cn phi hp thuc ny, phi cn nhc trc khi k n theophylin v
iu chnh liu lng trong khi v sau khi iu tr. Phi gim st lm sng v iu tr
(theo di theophylin mu).
Galantamin
Phn tch: Ketoconazol lm tng nng trong huyt tng ca galantamin.
854
Thuc chng nm khc

Thuc chng nm dng ngoi da hoc trong ph khoa
Cc thuc trong nhm
ACID SALICYLIC
ASA dung dch bi ngoi
Betnovate-S- kem bi 3% (phi hp vi betamethason)
Lorinden A thuc m 30 mg/g
Acid Undecylenic v mui kem bi 5%
Undecylenat km kem bi 5%
ACID CRYSOPHANIC thuc m 5%
Crysophanic thuc m 5%
NAFTIFIN kem bi da 1%
Exoderil kem bi da 1%
TERBINAFIN vin nn 250 mg; kem bi da 1%
Exifine vin nn 250 mg; kem bi da 1%
Hifen cream kem bi da 1%
Lamisil cream kem bi da 1%
Ch khi ch nh thuc
Cn theo di: mc 1
Trng hp: Qu mn cm vi mt trong cc thnh phn ca ch phm l mt
chng ch nh.
thuc chng st rt
Dn xut t amino - 4 - quinolein. Thuc chng st
dn xut ca amino-4-quinolein, liu cao v di ngy c tc dng chng vim
rt,
Cc thuc trong nhm

CHLOROQUIN (PHOSPHAT) vin nn: 250 mg, 200 mg; ng tim: 10 mg/ 2mL,
322,5 mg/5mL
BIDI - Malaquin ng tim 322,5 mg/5mL
Cloroquin vin nn 250 mg
MK-Cloroquin vin nn 100 mg
Nivaquine vin nn 100 mg
Cloroquin ng tim 10 mg/ 2mL
Cloroquin phosphat vin nn 200 mg
HYDROXYCLOROQUIN vin bc ng 200 mg
855
Plaquenil vin bc ng 200 mg

Ch khi ch nh thuc
Cc trng hp: Ri lon th gic v bnh vng mc. Qu mn vi thuc.
Thn trng: mc 2
Thi k cho con b: Thn trng, v khng c d liu.
Thi k mang thai: Thn trng; vi liu cao, thy d dng mt v tai trong.
Tng tc thuc
Thuc chng lon nhp: Thuc ko di khong QT
Amiodaron
Phn tch: Tng nguy c lon nhp tht. Phi hp hai thuc ko di khong QT v
c nguy c tc dng hip ng, dn n xon nh c tim nng gy
t vong.
X l: Phi hp nn trnh.
Khng sinh
Phn tch: Moxifloxacin, sparfloxacin, erythromycin tim tnh mch lm tng nguy
c lon nhp xon nh c tim nng gy t vong khi phi hp. Cn trnh phi hp.
Mefloquin
Phn tch: Lm tng nguy c co git khi dng phi hp. Cn trnh dng.
Glycosid tr tim
Phn tch: Hydroxycloroquin v c th c cloroquin lm tng nng digoxin trong
huyt tng. C ch cha r.
Ciclosporin
Phn tch: Cloroquin lm tng nng ca ciclosporin trong huyt tng (tng
nguy c nhim c). C ch cha r.
Thuc khng acid hoc thuc hp ph
Phn tch: Lm gim hp thu cloroquin v hydrocloroquin; kaolin lm gim hp thu
hydrocloroquin.
X l: Ung hai thuc cch xa nhau khong 2-3 gi.
Thuc ph giao cm
Phn tch: Cloroquin v hydrocloroquin c tim nng lm tng cc triu chng ca
bnh nhc c v nh vy lm gim tc dng ca neostigmin v pyridostigmin.
Cimetidin
856
Phn tch: c ch chuyn ho cloroquin (lm tng nng cloroquin trong huyt
tng). Cn theo di cc triu chng qu liu.
Thuc chng suy nhc kch thch tm thn
Cc thuc kch thch tm thn khc nhau c ngh trong nhng trng hp
suy nhc tm thn chc nng
Cc thuc trong nhm
GLUTATHION l 300 mg; 600 mg
Tad 300 bt pha dung dch tim 300 mg
Tad 600 bt pha dung dch tim 600 mg
Thnh phm c nhn sm, di dng:
Dch chit nhn sm, nh cc bit dc: Geriton; Ginsomin; Homtamin Ginseng;
Nutri Ginsen; Panaxia; Pharmagin plus; Pharmaton; Pharmax v Pharmax G2; Revigin;
v.v
Bt nhn sm, nh cc thnh phm y hc c truyn: H xa i t o hon; Nhn
sm tam tht (vin ngm); Sm nhung linh dc; Nhn sm lc nhung; Nhn sm hi
m v.v
ch khi ch nh thuc
ng kinh: Mt s hot cht c th gy cc cn ng kinh
Cn theo di: mc 1
Thi k cho con b: Do thn trng, khi cha c y c liu.
Thuc chng tng huyt p loi lit hch
Thuc tc dng bng cch c ch th th nicotinic
Cc thuc trong nhm
TETRAMETHYLAMMONIUM IODID
HEXAMETHONIUM
TRIMETHAPHAN (Arfonad)
MECAMYLAMIN
Ch khi ch nh thuc
Chng ch nh: mc 4
Va x ng mch nng; bnh tim nng; hp mn v; mang thai
Thn trng: mc 2
Suy gan v suy thn, tiu ng, ngi bnh cao tui, bnh ng mch vnh
hoc no, bnh Addison, bnh thoi ho h thn kinh trung ng.
Tng tc thuc
857
Thuc chn thn kinh-c

Phn tch: Trimethaphan c th lm tng tc dng ca suxamethonium
(succinylcholin) gy ngng th ko di. Tng tc ny cng c th xy ra vi cc thuc
chn thn kinh-c khc (nh alcuronium). C ch cha hiu y . Trimethaphan c
th c ch pseudocholinesterase trong huyt thanh n mc lm gim chuyn ho ca
suxamethonium v do ko di tc dng. Trimethaphan cng c tc d ng trc ti p
chn thn kinh-c. Tc dng ny c tnh hip ng vi tc dng chn thn kinh-c ca
aminoglycosid.
X l: Tng tc c xc nh. Nu phi hp trimethaphan v
suxamethonium, phi cnh gic c tng v ko di tc dng chn thn kinh - c. Ngng
th gp ngi dng liu cao trimethaphan m khng dng thuc chn thn kinh c, do khi phi hp, li cng phi thn trng. C th dng neostigmin v
calcigluconat o ngc tc dng ca thuc chn thn kinh - c v trimethaphan.
Thuc chng tiu fibrin
Thuc c ch tiu fibrin
Cc thuc trong nhm
ACID ACEXAMIC thuc m 1 g/20 g:
Plastenan 1 g/20 g
ACID TRANEXAMIC vin nn 500 mg; ng tim 250 mg/5 mL
Examin ng tim 250 mg/5 mL
Transamin 500 mg
Transamin 250 mg/5 mL
Trepin nang 250 mg
APROTININ ng tim 100.000 UIK
Trasylol ng tim 100.000 UIK
Ch khi ch nh thuc
Mn cm vi thuc (c bit vi aprotinin).
Thi k mang thai: Trn ng vt, chng minh aprotinin, acid tranexamic u
c c tnh vi thai, v vy chng ch nh dng trong 3 thng u ca thai k.
Trng hp: ng mu ni mch ri rc. Biu hin hoc nguy c huyt khitc mch.
Cn theo di: mc 1
Thi k cho con b: Acid tranexamic qua c sa m.
Tng tc thuc
Aprotinin + heparin
858
Phn tch: Ngi bnh c iu tr bng aprotinin c th cn phi tng liu

heparin khi phi hp. Aprotinin c kh nng tc ng n antithrombin III. Nhng cng
cn mt l do na l, ngi dng aprotinin cng c cho protamin l cht i khng
tc dng ca heparin.
X tr: D bt c cch gii thch no, cng cn ch n kh nng phi dng
heparin nhiu hn bnh thng, khi ngi bnh dng aprotinin.
Aprotinin + thuc chn thn kinh - c (suxamethonium)
Phn tch: Aprotinin c th gy ngng th ngi bnh mi dng suxamethonium
hoc tubocurarin. C ch cha c bit y . Aprotinin l cht c ch
pseudocholinesterase huyt thanh rt yu, nn rt t nh hng n chuyn ho ca
suxamethonium. Nhng n c th lm mt cn bng ngi bnh c cholinesterase
rt thp.
X tr: Trnh dng aprotinin ngi dng cc thuc gin c suxamethonium
hoc tubocurarin trong 2 3 ngy trc.
thuc chng trm cm ba vng hoc thuc tng t
Cc thuc hng tm thn tc dng hng thn, dn xut ca imipramin
Cc thuc trong nhm
AMITRIPTYLIN vin nn 25 mg; vin nn bao 25 mg
Apo- Amitriptyline vin nn 25 mg
Novo- Triptyn vin nn bao 25 mg
AMOXAPIN vin nn 50 mg; 100 mg
Moxadil vin nn 50 mg; 100 mg
CLOMIPRAMIN vin nn bao 10 mg; 25 mg; ng tim 25 mg/2 mL
Anafranil vin nn bao 10 mg; 25 mg
Anafranil ng tim 25 mg/2 mL
Ch khi ch nh thuc
Chng ch nh: mc 4
n ung; ru: Khng dng ru trong khi iu tr.
Tng nhn p: Cc thuc dn cht imipramin c tc dng lm lit ph giao cm
do phong b cc th th: tc dng khng cholinergic biu hin qua gin ng t, c th
gy cn tng nhn p cp tnh nhng ngi c t bm gc mng mt-gic mc hp.
Ph i tuyn tin lit; u tuyn tin lit: Cc thuc dn cht imipramin gy b
i do tc dng khng cholinergic.
Cn theo di: mc 1
nh.
859
Thi k cho con b: Cc thuc dn cht imipramin qua c sa m vi lng
ng kinh: Thuc chng trm cm ba vng lm h thp ngng gy ng kinh

v khi mo cc cn co git ngi c tin s ng kinh. Cn tng li u l ng cc
thuc chng co git.
Thi k mang thai: Cc thuc dn cht imipramin c th khng sinh qui thai.
Suy tim: Cn theo di, v tc dng khng cholinergic ca cc thuc trong h ny
gy nhp tim nhanh. Ngoi ra, dng liu cao, imipramin c vi tim, gy r i lon ti c c
v nht l ri lon dn truyn tim, c th gy ngng tim.
Tng tc thuc
Cisaprid
Phn tch: Phi hp gy tng nguy c lon nhp tim, bao gm c xon nh, c
th gy t vong do tc dng hip ng ko di khong QT.
X l: Vi ngi bnh iu tr bng thuc chng trm cm ba vng, chng ch
nh dng cisaprid.
Phn tch: Gim tc dng h huyt p ca cc cht ny do i khng ti cc th
th adrenergic. Hn na, c tc dng hip ng c ch h thn kinh trung ng (tc
dng an thn).
X l: Nu cn phi hp thuc, phi tng cng theo di huyt p trong qu trnh
kt hp thuc v khi ngng dng mt trong hai thuc . Thn trng vi desipramin v
imipramin, v tc dng i khng trn cc th th alpha adrenergic, c th c ch tc
dng chng tng huyt p. Khng nn phi hp thuc. Thn trng vi tc dng an thn
bun ng nhng ngi li xe v vn hnh my. Khuyn ngi bnh khng ung ru
v khng dng cc ch phm c ru.
Oxitriptan
Phn tch: Oxitriptan l mt tin cht ca serotonin (amin co mch): cn c vo
tnh cht dc l ca cht ny, trnh phi hp.
nng.
X l: Trnh phi hp; thay i chin lc iu tr; c nguy c ri lon huyt p

Quinolon
Phn tch: Phi hp gy tng nguy c lon nhp tim, bao gm c xon nh c th
gy t vong. C ch cn cha r.
X l: Vi ngi bnh iu tr bng thuc chng trm cm ba vng, chng ch nh
dng sparfloxacin. Tng t, cng chng ch nh dng grepafloxacin, tr khi c y
phng tin theo di hot ng ca tim. Vi nhng khng sinh quinolon khc, khng c
tc dng ko di khong QT hoc khng b chuyn ho bi isoenzym CYP 3A4, th khng
lm tng nguy c ni trn.
Phn tch: Nguy c cn tng huyt p gy t vong, cc bnh no, co git, st cao,
t vong.
860
X l: Chng ch nh phi hp ny, ngay c khi mt s bc s chuyn khoa dng

phi hp ny iu tr mt s ngi bnh khng thuc.
Phn tch: H huyt p l tc dng khng mong mun ca thuc chng trm cm
ba vng. Tc dng h huyt p ca guanethidin b c ch khi phi hp thuc, khi n
cho vic ch ng huyt p nhng ngi bnh tng huyt p tr nn kh khn.
X l: Khng nn phi hp. Nn chn mt thuc chng tng huyt p khc. Nu
cn phi hp ny, phi tng cng gim st huyt p trong v sau khi ngng dng mt
trong hai thuc.
Ritonavir
Phn tch: V ritonavir c i lc cao vi izoenzym 3A4 ca cc cytochom P450, nn
c nguy c cnh tranh gia ritonavir v cc thuc khc c chuyn ho bi izoenzym
. S cnh tranh ny s dn n gim chuyn ho cc thuc v nguy c tng ng
k nng ca chng trong huyt tng. Nguy c an thn, l ln, ri lon nhp tim,
nhng ch yu l nguy c tc dng kiu atropin ( c m t i vi imipramin,
amitriptylin, nortriptylin). Tng tc dc ng hc v chuyn ho thuc.
X l: Gim st cht ch ngi bnh. C th xut hin nhng tc dng c v
phi gim liu thuc chng trm cm.
Ru
Phn tch: Tng tc dng c ch h thn kinh trung ng dn n tng thm tc
dng an thn gy bun ng. Mt s thuc c th gy tc dng tm thn vn ng,
nht l trong tun u iu tr. Tng tc dc lc.
X l: Khng nn phi hp hai cht, v ngi k n khng th kim sot c
vic ung ru ca ngi bnh. Nguy c an thn bun ng c bit nguy him
ngi li xe hoc vn hnh my. Khuyn ngi bnh khng ung ru v khng dng
cc ch phm c ru.
Phn tch: V thuc chng trm cm loi imipramin c tnh cng giao cm do c
ch ti thu nhn noradrenalin ch ni thn kinh, nn cn phng s tng mnh tc
dng tng huyt p ca cc cht cng giao cm. Cn ch tng tc ny vi
adrenalin v noradrenalin (cc cht cng giao cm alpha v beta).
X l: Khng phi hp vi adrenalin v noradrenalin. Khi dng ti ch c m
mu, cn theo di nhng tc dng ton thn c th gp.
Thuc c ch MAO typ A
Phn tch: Qu liu serotonin, do tc dng hip ng ca cc thuc. C th xut
hin hi chng serotonin cc mc khc nhau, nhng c th dn n t vong.
X l: Hi chng serotonin c nhiu hnh thi, vi nhng triu chng ki u tm
thn (l ln, vt v, thm ch hn m...), ki u v n ng (co gi t c , run, tng ho t
ng, co cng...), kiu thc vt (h hoc tng huyt p, nhp tim nhanh, rng mnh,
m hi...), kiu tiu ho (tiu chy...). Khng nn phi hp.
861

Phn tch: Amantadin c v to thun li cho s xut hin nhng tc dng l ln
v o gic ca thuc cholinergic. Cn ch l ketotifen (Zaditen), oxadomid (Tinset) c
th khng c tc dng cholinergic.
X l: Nu nghi tng tc gy cc tc dng khng mong mun, phi iu chnh
liu lng cc thuc cholinergic khi dng phi hp vi amantadin. Bo cho ngi bnh
bit nhng tc dng khng mong mun c th xy ra.
Amineptin ; medifoxamin
Phn tch: Tng tc dng c ch h thn kinh trung ng, tc dng gy c ch
h hp v tc dng h huyt p. Hn na, nu bt u ph thuc thuc, phi hp
hai thuc c th lm tng thm nguy c ph thuc.
X l: iu chnh liu lng hai thuc ny, nu cn phi hp thuc. Ch t i
gim tnh to ngi li xe v ngi vn hnh my. Khuyn khng ung ru v khng
dng cc ch phm c ru.
Barbituric; phenytoin; primidon hoc dn cht; progabid; natri valproat hoc dn
cht; thuc chng ng kinh khng barbituric
Phn tch: Thuc chng trm cm ba vng h ngng sinh ng kinh, do c
nguy c xut hin nhng cn co git ngi bnh c iu tr bng thuc chng
ng kinh .
X l: Lu nguy c v iu chnh liu lng, nu cn.
Carbamazepin
Phn tch: To thun li xut hin cn co git bng hai c ch: 1. Gim ngng
sinh ng kinh bi cht chng trm cm loi imipramin v bi cm ng enzym. 2. Tng
nhanh chuyn ho thuc chng trm cm , dn n km hiu qu.
X l: Ngoi gim st hiu qu lm sng, nn iu chnh liu lng mt hoc hai
thuc lc bt u, trong v sau khi iu tr.
Fluoxetin
Phn tch: Gim o thi cc thuc chng trm cm ba vng v tng nng
trong mu, nn c th dn n mt trng thi l ln v co git.
X l: Cn ngh t nht 5 tun sau khi dng fluoxetin, ri mi dng thuc chng
trm cm ba vng, v fluoxetin c na i di. C th dng thuc chng trm cm
trc, nhng phi cho dn dn, bt u vi liu thp.
Fluvoxamin
Phn tch: Gim o thi cc thuc chng trm cm ba vng v tng nng
trong mu, nn c th dn n trng thi l ln v co git.
X l: Nn ngh t nht mt tun sau khi dng fluvoxamin, ri mi dng thuc ba
vng v fluvoxamin c na i di. C th dng thuc chng trm cm trc, nhng
phi cho dn dn, bt u vi liu thp.
Hormon tuyn gip
862
Phn tch: S dng ng thi hai thuc lm tng tc dng iu tr v c tnh ca

c hai thuc.
X l: Gim st lm sng v nu cn, iu chnh liu lng lc bt u, trong v
sau khi iu tr bng hormon tuyn gip.
Nicorandil
Phn tch: Phi hp vi thuc chng tng huyt p no cng c th tng nguy c
tt huyt p, i khi dn ti sc.
X l: Phi gim st huyt p ng mch trong khi iu tr v sau khi ngng mt
trong hai thuc, c bit ch ti ngi bnh cao tui.
Paroxetin
X l: Ch ti gim tnh to ngi li xe v ngi vn hnh my. Khuyn
Thuc acid ho nc tiu
Phn tch: V cc thuc chng trm cm ba vng l nhng base, cc cht acid
ho nc tiu c th lm tng bi tit chng qua nc tiu. Ngc li, cc cht ki m
ho nc tiu c th lm gim s bi tit (to thun li cho s ti hp thu qua ng
thn).
X l: D tng tc ny c th xy ra v mt l-ho, nhng biu hi n lm sng
cha c ngha.
Phn tch: Cimetidin l cht c ch enzym oxydase gan (cytochrom P 450) xc tc
cho chuyn ho mt s thuc. Hn na, c gim lu lng mu gan. Nh vy, nng
trong huyt tng ca mt s thuc tng ln (nguy c qu liu), nhng cng do c
ch mt s bin i sinh hc, cimetidin c ch mt s c ch kh c. C l chuyn
ho ti gan ca cc cht chng trm cm ba vng b cimetidin c ch, do c nguy
c qu liu.
X l: Qu liu ca mt s thuc chng trm cm ba vng nh amitriptylin,
desipramin, doxepin, imipramin, v nortriptylin c m t. V mt l thuyt, nhng
du hiu qu liu nh vy cng c th xut hin vi cc thuc chng tr m c m ba
vng khc. iu l tng l, hoc thay i thuc chng lot, hoc iu chnh liu lng
lc bt u, trong khi v sau khi iu tr bng khng H 2 (c th gim t 33% n 50%
liu lng thuc chng trm cm). Cc du hiu qu liu thuc chng trm cm ba
vng l chng mt, vt v, mt iu ho, co git, trng thi sng s, hn m, gin ng
t, bloc ni tm tht, ri lon ti cc, try tim, nhp tim nhanh, lon nhp tim, h huyt
p v c ch h hp.
Phn tch: Tc dng i khng. C th lm tng tnh hung hn ngi nghin
amphetamin.
863

ngi bnh gp li bc s, nu thy kt qu iu tr khng n nh.
Baclofen; benzodiazepin; carbamat hoc thuc tng t; dextropropoxyphen;
oxaflozan; thuc c ch h thn kinh trung ng cc loi; viloxazin.
X l: Ch ti gim tnh to ngi li xe v ngi vn hnh my. Khuyn
Benzamid; butyrophenon; interferon alpha ti t hp; thuc an thn kinh cc loi;
thuc ch vn morphin
h huyt p. Hn na, nu bt u ph thuc thuc, phi hp hai thuc c th lm
tng thm nguy c ph thuc.
X l: Phi iu chnh liu lng hai thuc nu cn phi hp. Ch ti gim tnh
to ngi li xe v ngi vn hnh my. Khuyn khng ung ru v khng dng cc
ch phm c ru.
Clozapin; disopyramid; phenothiazin; quinidin hoc dn cht; thuc khng
cholinergic; thuc khng histamin khng H1 an thn
Phn tch: Tng tnh cht khng cholinergic do hip ng cc tc dng khng
mong mun. Cc tc dng ny biu hin tng nguy c b tiu tin, kh mi ng v to
bn.
X l: Cn lu nhng bt li ca loi thuc ny. Nu xt thy phi hp thuc l
c ch, phi bo trc cho ngi bnh v nhng s bt li ny. Trnh dng cho ngi
b bnh tuyn tin lit v bnh tng nhn p.
Dihydropyridin; diltiazem; furosemid hoc thuc tng t; methyldopa; reserpin;
sotalol; thuc chn beta; thuc gin mch chng tng huyt p; thuc li tiu gi kali;
thuc li tiu thi kali; thuc c ch enzym chuyn i dng angiotensin
Phn tch: Tng tc dng h huyt p ca cc thuc ny. H huyt p l tc dng
khng mong mun ca thuc chng trm cm ba vng.
X l: Nu cn phi hp, phi tng cng theo di huyt p ng mch, trong lc
iu tr v khi ngng iu tr mt trong hai thuc. Tin hnh iu chnh liu lng, nu
cn. Nhn mnh cch dng thuc v s tun th y lnh. c bit cnh gic vi ng i
bnh cao tui.
Phn tch: Gluthetimid c tnh khng cholinergic v an thn bun ng, nn phi
hp thuc dn n tng cc tc dng khng cholinergic v an thn bun ng , gy c
ch h thn kinh trung ng v tng cc nguy c b tiu tin, kh ming, to bn.
X l: Cn lu nhng bt li ca loi thuc ny. Nu xt thy phi hp l c
ch, th bo trc cho ngi bnh v nhng bt li . Trnh dng cho ngi b bnh
tuyn tin lit v glcm. Thn trng vi nhng ngi li xe v ngi vn hnh my
(tng tc dng an thn bun ng).
864
Methadon
Phn tch: Tng tc dng c ch h thn kinh trung ng, km theo an thn bun
ng mnh, c bit c hi cho ngi li xe v ngi vn hnh my.
X l: Phi lu s tng tc dng an thn bun ng ny, cho nhng li
khuyn thch hp: khng li xe, khng vn hnh my. Bo trc cho ngi xung quanh
v mi nguy him.
Rifamycin
Phn tch: Rifamycin l cht gy cm ng cytochrom P450, lm tng chuyn ho v
lm gim nng cc thuc chng trm cm ba vng trong huyt tng, lm gim cc
tc dng dc l ca cc thuc ny.
X l: Cn theo di nng thuc chng trm cm ba vng trong huyt tng khi
bt u, khi ngng dng hoc khi thay i liu lng rifamycin. Hiu chnh liu thuc
chng trm cm, a nng thuc v gi tr lc cha dng rifamycin.
Sertralin
Phn tch: Vic kt hp vi sertralin lm tng tc dng dc l v c tnh ca
thuc chng trm cm ba vng, c th xut hin hi chng serotonin. C th l s
chuyn ho ca thuc chng trm cm gan, thng qua enzym CYP2D6 b c ch.
X l: Nu cn phi kt hp thuc ny, cn theo di ngi bnh v ch nhng
du hiu nhim c thuc chng trm cm. Theo di nng thuc chng trm cm
trong huyt tng. Hiu chnh nng ny khi bt u dng v khi ngng dng
sertralin. Lu n s xut hin hi chng serotonin (bt thng v thn kinh - c, ri
lon tm thn, ri lon chc nng t ng). Phi chun b n hon cnh phi ngng
dng thuc chng trm cm v iu tr cc trng thi sinh ra do ngng thuc.
Sulfonylurea
Phn tch: Tc dng dc l ca sulfonylurea c th tng. C ch cha r.
X l: Nu nghi c tng tc, nh lng glucose mu v iu chnh liu.
Thuc chng ng mu (dicoumarol)
Phn tch: Thuc chng trm cm ba vng lm tng na i v sinh kh dng
ca dicoumarol, do lm tng tc dng ca thuc chng ng mu ny. C ch c
th do c ch chuyn ho dicourmarol gan, cng c th do tng hp thu dicoumarol.
X l: Theo di thi gian prothrombin v nhng du hiu v chy mu ng i
bnh. Nu cn, gim liu dicoumarol.
X l: Nu cn phi hp hai thuc, lu nguy c ny trong khi gy m v khi
chn liu lng.
Thuc gy m cc loi
Phn tch: Tng cc tc dng trn tim mch nh lon nhp tim, nhp tim nhanh
hoc tng huyt p nng.
865
X l: V gy m i hi chuyn khoa rt su, mt khc v cc thuc gy m ch

yu c dng cc khoa ngoi, nn ch ra cc h thuc c th gy nguy c, ty
thuc vo thuc gy m c s dng.
Phn tch: C th c tc dng trn tim mch kiu lon nhp v tng huyt p.
X l: Khuyn ngi bnh phi can thip ngoi khoa thng bo vi bc s gy m
cc thuc mnh dng.
Verapamil
X l: Gim st huyt p, mc du s phi hp ny l ph bin m khng nht
thit phi iu chnh liu lng hoc thay i cch iu tr.
Thuc km t bo hoc chng phn bo. V c tnh ca cc thuc ny, phi hp
cc thuc chng ung th vi nhau phi do bc s chuyn khoa ch nh. Do t ng tc
c bit, mt s nhm thuc khc c tch ring
Cc thuc trong nhm
ALTRETAMIN nang 100 mg
Hexastat nang 100 mg
AMSACRIN ng tim 75 mg
Amekrin ng tim 75 mg
BISANTHREN l bt ng kh: 50 mg; 250 mg
Zantrene l bt ng kh: 50 mg; 250 mg
BLEOMYCIN l 15 mg
Bleocin l 15 mg
CHLORAMBUCIL vin nn 2 mg
Leukeran vin nn 2 mg
CHLORMETHIN dung dch tim 1 mg/mL
Caryolysine dung dch tim 1 mg/mL
CYTARABIN tim: 2%, 5%; l 100 mg
Alexan dung dch tim 2%
Cytarabin dung dch tim 5%
Cytosar l bt pha tim 100 mg
DACARBAZIN dung dch tim 1 mg/mL
Deticene dung dch tim 1 mg/mL
ELLIPTINIUM dung dch tim 50mg/10mL
866
Celiptium dung dch tim 50 mg/10 mL

ESTRAMUSTIN nang 140 mg
Emcyt nang 140 mg
ETOPOSID nang 100 mg; dung dch tim 20 mg/mL
Etoposide Ebewe dung dch tim 20 mg/mL
Vepesid nang 100 mg
FORMESTAN bt pha dung dch tim 250mg
Lentanron IM depot l bt pha tim 250 mg
HYDROXY CARBAMID nang: 200 mg; 500 mg
Hydrea nang: 200 mg; 500 mg
IRINOTECAN dung dch tim: 40mg/2mL; 100mg/5mL
Campto dung dch tim: 40 mg/2 mL; 100 mg/5 mL
MITHRAMYCIN dung dch tim 2,5mg/5mL
Mithracin dung dch tim 2,5 mg/5mL
MITOGUAZON l 100 mg
Methyl Gag l bt ng kh 100 mg
MITOMYCIN dung dch tim: 2mg/5mL, 10mg/5mL; l: 2 mg, 10 mg
Ametycin dung dch tim: 2 mg/5mL; 10 mg/ 5mL
Mitomycin C Kyowa bt pha dung dch tim: 2 mg/l; 10 mg/l
MITOXANTRON dung dch tim: 20mg/10mL; 5mL
Genefadrone dung dch tim: 20 mg/10 mL
Novantrone dung dch tim: 20 mg/ 5 mL; 20 mg/ 10 mL
IPOBROMAN vin nn 25 mg; dung dch bi da 0,5%
Vercyt vin nn 25 mg
PODOPHYLLOTOXIN dung dch bi da 0.5 %
Vartec dung dch bi da 0,5%
TENIPOSID ng tim 50 mg/5 mL
Vumon ng tim 50 mg/ 5mL
VINDESIN l: 1 mg; 4 mg; 5 mg
Eldesin l bt ng kh: 1 mg; 4 mg; 5 mg
VINORELBIN l thuc tim 10mg/5mL
Navelbine l thuc tim 10 mg/ 5mL
Ch khi ch nh thuc
867
Cc thuc ny do bc s chuyn khoa ch nh. V vy, cc chng ch nh phi

c cn nhc ty theo trng thi ca ngi bnh v phi c bc s chuyn khoa
nh gi.
Tng tc thuc
Ciclosporin
Phn tch: Hip ng cc tc dng khng mong mun, biu hin bng tng c
vi thn.
X l: Thc hin phi hp thuc c s chuyn khoa. Tng cng gim st chc
nng thn.
Actinomycin D (dactinomycin); azathioprin; carmustin hoc dn cht; cisplatin
hoc dn cht; cyclophosphamid hoc thuc tng t; doxorubicin hoc dn cht;
fluoro-5-uracil; interferon alpha ti t hp; melphalan; mercaptopurin; methotrexat;
procarbazin; thiotepa; vincristin hoc thuc tng t
Phn tch: Nguy c tng c tnh vi mu do c ch ty xng, v tc dng hip
ng c th lm mt bch cu ht.
X l: Trnh phi hp, nu c th. Khi cn phi phi hp, dng nhng liu thp
cho tng thuc v cn theo di cht huyt . Cc phc iu tr c chuyn
khoa xc nh.
Amphotericin B
Phn tch: Phi hp amphotericin B tim vi cc thuc khc c vi ty xng
cn phi rt thn trng. Nguy c thiu mu hoc cc ri lon huyt hc khc.
X l: Nu cn phi hp thuc, phi theo di k huyt v gim liu khi cn.
Clozapin
Phn tch: Nguy c tng c tnh vi mu do c ch ty xng, v c tc dng
hip ng nn c th dn n mt bch cu ht. Vi clozapin hoc noramidopyrin, c
th mt bch cu ht nng, thm ch gy t vong, ngay khi ch dng mt thuc duy
nht (c tnh min dch).
X l: Trnh phi hp. Khi cn phi hp, phi dng liu thp cho mi thuc.
Khng c g cho php d bo xy ra mt bch cu ht do clozapin. Phi gim st k
huyt k c khi khng phi hp. Tuy nhin, nu c st nh, vim hng hay lot
ming, phi ngng iu tr v bo cho bc s bit.
Colchicin hoc dn xut
Phn tch: Lm tng t l acid uric trong mu. Hn na, tng nguy c gim bch
cu v gim tiu cu do hip ng cc tc dng khng mong mun ca cc thuc.
X l: Nn trnh phi hp v liu php chng bnh thng phong s tht bi. Nn
s dng alopurinol (c ch tng hp acid uric) hn l cc thuc thi acid uric ni u
trnh cc bnh v thn.
Glycosid tr tim
868
Phn tch: Phi hp vi thuc km t bo dn n km hp thu cc thuc digitalis

khong 50%, do tn thng nim mc rut c th hi phc.
X l: Gim st k nng digitalis trong huyt thanh trong sut liu trnh.
Digoxin vin nn t c hp thu. C th dng dung dch digoxin, hoc nang cha dung
dch digoxin, hoc thay bng digitoxin.
Phn tch: y l phi hp hai thuc c ch ty xng.
X l: Interleukin ch c th c dng ti c s chuyn khoa do tnh nghim
trng ca bnh. Khi phi cn nhc xem xt cc tng tc v tt c cc chc nng
ca c th phi c gim st thng xuyn. Nht thit phi gim st huyt .
Khng nm azol
Phn tch: Fluconazol t b cc thuc chng ung th tc ng hn itraconazol. Khi
phi hp vincristin vi itraconazol, gp c tnh nghim trng cho thn kinh (d cm,
yu c bn tay bn chn, lit rut, lit nh thanh qun). C ch cha r, c th
itraconazol c ch chuyn ho vincristin thng qua enzym ph thuc P450.
X l: Nn trnh dng itraconazol v thay bng fluconazol.
Khng sinh nhm quinolon
Phn tch: Ciprofloxacin v ofloxacin c th b gim hp thu. V lm sng, c th
khng nh hng. C ch cha r, c th do tn thng thnh rut do thuc chng
ung th, nn khng sinh quinolon b km hp thu.
X l: Nu c ch ng, nh vy c th thay ung bng tim.
Pentostatin
Phn tch: Hai thuc u c ch ty xng, nn c th dn n ri lon huyt
hc nng tu theo thi gian iu tr di hay ngn.
X l: Cn gim st huyt hc khi phi hp thuc.
Phenicol
Phn tch: Nguy c tng c tnh vi mu do c ch ty xng, do tc dng hip
ng, nn c th dn n mt bch cu ht. C th mt bch cu ht nng, thm ch
gy t vong, khi ch dng c nht thuc nhm phenicol (c tnh min dch).
X l: Khi cn phi phi hp, dng liu thp cho mi thuc. Khng c du hiu
d bo mt bch cu ht do dng cc thuc nhm phenicol. Phi gim st k huyt .
Cn cnh bo cho ngi bnh rng nu thy st nh, vim hng hay lot ming, phi
ngng iu tr cc thuc phenicol.
Vaccin sng gim c lc
Phn tch: C nguy c pht trin nhim khun tng ng vi vaccin do gim min
dch ca thuc kt hp.
X l: Phi dng hai thuc cch nhau khong ba thng ti mt nm, ty thuc
cng gim min dch.
Thuc chng ng (warfarin)
869
Phn tch: Tng tc xy ra chm.

Carboplatin, chlormethin (mustin), doxorubicin, etoposid, 5-fluorouracil,
ifosfamid/mesna, methotrexat, procarbazon, sulofenur, vincristin, vindesin: lm tng tc
dng ca warfarin.
Azathioprin, mercaptopurin: lm gim tc dng ca warfarin.
Cyclophosphamid c khi lm tng, c khi lm gim tc dng ca warfarin. C ch
cha r, tr mercaptopurin t ra lm tng tng hp hoc hot ho prothrombin.
X l: Phn ln vn phi hp, nhng phi theo di cht tc dng ca warfarin c
trong v sau khi iu tr vi cc thuc chng ung th bo m thi gian prothrombin
c kim sot tt. iu chnh liu warfarin nu cn.
Thuc chng co git (carbamazepin, phenytoin, natri valproat)
Phn tch: Nng huyt thanh ca cc thuc chng co git c th b gim do
cc thuc chng ung th v c th xut hin co git nu liu thuc chng co git khng
tng thch hp. Ngc li, mt s thuc chng ung th b gim tc dng hoc thay i
tc dng do thuc chng co git. C ch cha bit y ; c th nng trong huyt
thanh ca thuc chng co git b gim l do cc thuc chng ung th lm t n thng
thnh rut, dn n gim hp thu. Cng c th nng huyt thanh ca phenytoin
tng do gim chuyn ho ti gan ca phenytoin do thuc chng ung th.
X l: Phi gim st cht nng thuc chng co git trong khi iu tr vi bt c
mt thuc chng ung th no.
Thuc iu tr thp khp mn: Penicilamin hoc thuc tng t; pyrasol; vng
Phn tch: Tng nguy c c vi mu do c ch ty xng, v tc dng hip ng
c th lm mt bch cu ht.
X l: Trnh phi hp. Nu phi hp, dng liu thp cho mi thuc v cn theo
di cht huyt .
Thuc iu tr tiu ng
Phn tch: Paclitaxel c th c ch chuyn ho rosiglitazon. L- asparaginase c
th gy tiu ng. Cyclophosphamid c th gy h glucose mu cp ngi tiu
ng ang iu tr insulin v carbutamid. C ch cha r, c th do c ch tng hp
insulin, tng thng trc tip o Langerhans v s gn insulin b gim.
X l: Cn gim st glucose mu khi phi hp.
Thuc khng virus: ganciclovir hoc zidovudin
Phn tch: Tng nguy c c ch ty xng c th dn n gim bch cu ht
X l: Trnh phi hp. Nu cn phi phi hp, dng liu thp cho mi thuc v
cn theo di cht huyt .
Thuc chng vy nn dng ti ch
Thuc dng ngoi da gim tc sinh sn biu b, thng c dng sau khi
lm bong sng da bng nhng thuc tiu lp sng
Cc thuc trong nhm
870
COALTAR dung dch bi ngoi 1%

Polytar dung dch bi ngoi 1%
Polytar plus dung dch bi ngoi 1%
Cc ch khi ch nh thuc
Cn theo di: mc 1
Cc trng thi khc: Trnh bi ln da b bnh c chy nc.
Thuc c s dng do c tnh chng vim v c khi cn gim au
v h st tu theo hp cht
Cc thuc trong nhm
ACID MEFENAMIC vin: nn 500 mg; nang 250 mg
Dolarac vin bao 250 mg
Dolfenal vin nn 500 mg
Dolnaltic vin bao 500 mg
Femic nang 250 mg
Idoirac vin nn 200 mg
Ponstan nang 250 mg
Mefenamic vin bao 250 mg
Mefenix nang 250 mg
ACID NIFLUMIC: gel bi da 2,5%; nang 250 mg; kem bi da 3%; gel 3%
Niflugel gel bi da 2,5%
Nifluril nang 250 mg
Nifluril kem bi da 3%
Nifluril gel 3%
ACID TIAPROFENIC: ng tim 200 mg; vin nn: 100 mg, 300 mg
Tiafen vin nn: 100 mg; 300 mg
Tiafen ng tim 200 mg
ACECLOFENAC vin nn 100 mg
Bristaflam vin nn 100 mg
Speenac vin nn 100 mg
ALMINOPROFEN vin nn: 150 mg; 300 mg
Minalfene vin nn 150 mg
BENZYDAMIN dung dch sc ming 1,5 mg/mL x 100 mL
Difflam dung dch sc ming 1,5 mg/mL
871
+++
AZAPROPAZON nang 300 mg

Prolixan nang 300 mg
BUFEXAMAC Kem bi da 50mg/g
Mastu-S vin thuc n 250mg (phi hp)
DICLOFENAC: vin bao 25 mg, 50 mg; vin nn gii phng chm 75 mg; vin t
trc trng 100 mg; ng tim 75 mg/3mL, 75 mg/2mL; gel bi da 1%; vin nn tan chm
100 mg; vin t cho tr em: 12,5 mg, 25 mg, 50 mg; vin nn bao tan rut 25 mg
Apo-Diclo-SR vin 75 mg (gii phng chm)
Cataflam vin bao 25 mg
Clofenac vin nn bao 50 mg
Diclac 50 vin nn bao 50 mg
Diclac 75 LD vin nn bao 75 mg
Dicloberl vin bao 50 mg
Diclo-denk 100 retard vin nn gii phng chm 100 mg
Diclo-denk 100 vin t trc trng
Diclo-denk ng tim 75 mg/3 mL
Diclofam gel bi 0,348 g/30 g
Diclofam vin nn 50 mg
Diclofenac sodium vin nn 50 mg
Dicloran SR vin nn 100 mg
Lydic vin nn 50 mg
Naclof dung dch nh mt 0,1%
Neo-Pyrazon vin nn 50 mg
Opta-vin nn bao 12.5 mg
Staren ng tim 75 mg/3 mL
Voltaren vin nn 100 mg
Voren vin nn 50 mg
Voren nang 50 mg
Voren plus gel bi da 1%
Voltaren Emulgel gel bi da 1%
Voltaren SR 75 vin nn bao 75 mg
ENOXOLON kem nha khoa 1%
Arthrodont kem nha khoa 1% tub: 5g; 40g; 80g
ETODOLAC vin nn 400 mg; nang 300mg
872
Febret 400 vin nn 400 mg

Lodine nang 300 mg
ETOFENAMAT gel bi da 5%; dung dch phun m 10%; dung dch tim 50% x
2mL
Irifone gel bi da 5%
Rheumon gel bi da 50 mg/g
Rheumon IM ng tim 2 mL dung dch 50%
Traumon dung dch phun m 10%
FLURBIPROFEN dung dch nh mt 0,3 mg/mL; vin nn 100 mg
Antadys vin nn 100 mg
Ocufen dung dch nh mt 0,3 mg/mL
IBUPROFEN vin nn 200 mg; 400 mg; hn dch 100 mg/mL; kem bi da 5%;
nang tan chm 500 mg
Alaxen vin nn 200mg phi hp vi paracetamol 325mg
Antidol vin bao 400 mg
Advil vin nn 200 mg
Butafen vin nn 200mg
Childrens Advil hn dch 100 mg/mL
Dofen forte vin nn bao 400 mg
Hildene vin nn bao 200mg
Motrin vin nn bao phim 400 mg
Motrin vin nn 300mg
Dolgit kem bi da 5% x 50 mg
Fenbid nang tan chm 500mg
Ibuprofen vin nn: 200 mg; 600 mg
Mofen 400 vin nn 400 mg
KETOPROFEN: gel bi da 2,5%; vin nn: 100 mg, 200mg; ng tim 100 mg/3mL
Apo- Keto nang 50 mg
Fastum gel bi da 2,5 %
Kefenin ng tim 100 mg/ 3 mL
Ketofen nang 50 mg
Ketorudis vin nn 100 mg
Profenid vin nn 100 mg
Profenid l tim 100 mg
873
Profenid gel 2,5%

Profenid LP vin nn 200 mg
Keprofen nang 50 mg
LOXOPROFEN vin nn 60 mg
Loxfen vin nn 60 mg
Loprofen vin nn 60mg
MORNIFLUMAT vin t 700 mg
Nifluril vin t 700 mg
MELOXICAM vin nn: 7,5 mg; 15 mg
Intermeciam vin nn 7.5mg
M-Cam vin nn 7,5mg
Mecam vin nn 7,5mg
Medoxicam vin nn 7,5mg
Melgesic vin nn 7,5mg Melobic
Mel-OD vin nn 7,5mg
Melogesic vin nn 7,5mg
Melonex vin nn: 7,5 mg, 10mg
Melwin vin nn: 7,5 mg, 10mg
Mobic vin nn 7,5 mg
NABUMETON vin nn bao 500 mg
Nabuflam vin nn bao 500 mg
NAPROXEN vin nn: 500 mg; 550 mg; 275 mg; 250 mg; 220 mg
Ameproxen vin nn 220 mg
Anapran vin nn bao 275 mg
Apo- Naproxen vin nn 500 mg
Naproxen vin nn 220 mg; 250 mg
Proxen vin nn 500 mg
Danproxen vin nn 250 mg
Apranax vin nn 550 mg; 275 mg
NIMESULID: vin nn 100 mg; gel 1%
Aulin vin nn 100 mg
B-Nalgesine vin nn 100mg
Nimerid vin nn 100 mg
874
Nimetab vin nn 100mg

Nimfast vin nn 100mg
Nimica vin nn 100mg
Nimotas-CD vin nn 100mg
Nimovon-MD vin nn 100mg
Nise vin nn 100 mg
Mesulid vin nn 100 mg
Auronim vin nn 100 mg
Nivolid gel 1% tub 20 mg
Nimegesic vin nn 100 mg
Samulide vin nn 100mg
PIROXICAM: nang 10 mg, 20 mg; dung dch tim 20 mg/mL; gel bi da 0,5 g/100g;
vin nn 20 mg
Feldene: vin nn 20 mg; dung dch tim 20 mg/mL
Feldene Melt vin nn ngm 20 mg
Felxicam 20 nang 20 mg
Focus nang 10 mg
Neodene nang 10 mg
Geldene gel bi da 0,5 g/100 g
Hotemin nang: 10 mg; 20 mg
Neotica nang 10 mg
Oximezin vin nn 20 mg
Piroxicam nang 20 mg
Polipirox ng tim 20 mg/mL
Proxalyoc vin ng kh ung 20 mg
Fenxicam vin nn 20 mg
TENOXICAM: vin nn bao phim 20 mg; vin nn 20 mg; vin n 20 mg; dung
dch tim 20 mg/2mL
Arthrinal vin nn bao 20 mg
Tenoxicam vin nn 20 mg
Tenoxitec nang 20mg
Tilcotil vin n 20 mg
Tilcotil dung dch tim 20 mg/2 mL
Tobitil vin nn 20 mg
875
Ch khi ch nh thuc
Chng ch nh: mc 4
Lot d dy - t trng - vim d dy : Chng ch nh thuc chng vim khng
steroid trong cc t kch pht lot. Dng thuc thn trng ngi bnh c tin s lot
d dy-t trng.
Thi k mang thai: Ni chung, cc thuc chng vim khng steroid c th gy
chm v c nh hng n h tim mch ca thai nhi.
nng.
nng.
Suy gan: Dng thuc thn trng vi ngi bnh c tin s suy gan va hoc
Suy thn: Dng thuc thn trng vi ngi bnh c tin s suy thn va hoc
Thn trng: mc 2
Thi k cho con b: Ni chung, thuc chng vim khng steroid c th qua c
sa m.
Cn theo di: mc 1
Tr em, tr cn b: Phi thn trng khi dng nhng thuc ny cho tr em, v c
th c nhng tc dng khng mong mun.
Ngi bnh cao tui: Phi lu n tc dng gy lot v tc ng trn thn
ca cc thuc ny.
Trng hp khc: Khi c nguy c nhim khun v b nhim khun. Mi b vim
trc trng hoc chy mu trc trng.
Tng tc thuc
Methotrexat
Phn tch: Tng tc dng c vi mu ca methotrexat, do methotrexat b y ra
khi cc protein huyt tng v/ hoc gim o thi qua thn. Tc dng ny tu thuc
vo liu (vi ketoprofen, tc dng c vi mu nghim trng hn).
X l: Tng tc ny c th gp bnh vin. Vi liu methotrexat cao, phi
ngng thuc chng vim khng steroid 12 n 24 gi trc khi dng methotrexat cho
ti khi nng methotrexat tr v nhng gi tr khng c. Mc d u tng tc ny
khng c m t vi tt c cc thuc chng vim khng steroid, vn cn p dng quy
tc ny v trnh k n ng thi.
Ritonavir
Phn tch: Ritonavir c i lc mnh vi isoenzym 3A4 ca cc cytochrom P450, nn
cnh tranh lm gim chuyn ho ca cc thuc cng b chuyn ho qua cytochrom P450
(isoenzym 3A4). Do , nng cc thuc tng trong huyt tng v c nguy c
tng c tnh. Nguy c c vi thn (c m t vi piroxicam). Tng tc dc ng
hc v chuyn ho thuc.
876
X l: Trnh phi hp ny. Tm mt liu php thay th.

Phn tch: Tng nguy c mt hiu qu ca dng c t trong t cung khi dng thuc
chng vim khng steroid (nht l aspirin) v lm mt c ch vim.
X l: Mc du cn ang tranh lun, vn nn trnh k n thuc chng vim
khng steroid cho ph n khi ang dng cch nga thai ny. Khi phi hp thuc chng
vim khng steroid cng vi dng dng c nga thai t trong t cung m vn c hi u
qu, nn thng bo cho c quan cnh gic thuc bit v tng tc ny vn cn cn c
thm t liu.
Heparin
Phn tch: Nguy c tng chy mu do c ch ng thi c ch ng mu v cm
mu do tiu cu.
X l: Nu nht thit phi phi hp, cn theo di cht ch cc xt nghim ng
mu nh thi gian Howell v thi gian Cephalin - Kaolin trong v sau khi dng thu c
chng vim khng steroid. Ketorolac liu thp c th lm gim nguy c chy mu.
Pentoxyfilin
Phn tch: Pentoxyfilin lm gin mch, nn lm tng nguy c chy mu do
ketorolac; nguy c ny cng c th xy ra khi phi hp pentoxyfilin vi cc thuc chng
vim khng steroid khc.
X l: Trnh phi hp. Nu nht thit phi phi hp, cn theo di cht ch cc
xt nghim nh thi gian Howell v thi gian Cephalin Kaolin trong v sau khi dng
thuc chng vim khng steroid.
Indometacin hoc dn xut; pyrazol; salicylic
Phn tch: Phi hp khng hp l, hip ng cc tc dng gy lot v tng nguy
c chy mu ng tiu ho.
X l: K n trng lp; thay i chin lc iu tr, khng nn phi hp.
Mifepriston
Phn tch: Nguy c gim hiu qu iu tr.
X l: Ngng iu tr bng thuc chng vim khng steroid 24 gi trc khi dng
mifepriston.
Ticlopidin
Phn tch: Phi hp vi thuc chng kt tp tiu cu hoc chng ng mu lm
tng nguy c chy mu.
X l: Nu cn phi hp, phi gim st cht ch bng cc xt nghim ng mu
thch hp nh thi gian Howell, thi gian cephalin kaolin trong v sau khi iu tr bng
thuc chng vim khng steroid. Nu c th, nn tm mt liu php khc.
877
Phn tch: Tng tc dng ca thuc chng ng bng cch: y thuc chng
ng ra khi lin kt vi cc protein huyt thanh; tc dng hip ng chng kt tp tiu
cu. Thuc chng vim khng steroid kch ng nim mc d dy lm tng nguy c lot
chy mu, nht l ngi bnh cao tui.
X l: khng nn phi hp cc thuc ny v c nguy c chy mu. Vi aspirin, ch
c th phi hp vi nhng liu nh (khong 200 mg). Vi liu cao, cn trnh phi hp
v vn chng ch nh. Bo cho ngi bnh bit mi nguy him trnh t dng
thuc.
Ciclosporin
Phn tch: C th tng nguy c c vi thn khi phi hp hai thuc: cc thuc
chng vim khng steroid c ch prostaglandin do thn sn xut, cn bn thn
ciclosporin gy c vi thn.
X l: Ch c th phi hp nu theo di tt chc nng thn ( thanh lc
creatinin). Ch c th gim st v iu chnh liu ti c s chuyn khoa, do c nh ng
bin i nng ciclosporin trong mu v nguy c ca mt s tng tc gia ngi
bnh. Khuyn ngi bnh khng nn t dng thm thuc g m khng bo co cho bc
s chuyn khoa k n c bit.
Biphosphonat (alendronat, elidronat, pamidronat, risedronat, tiludronat)
Phn tch: C th tng nguy c lot d dy do tc dng hip ng ca hai thuc
cng gy lot d dy.
X l: Thn trng khi phi hp. Phi theo di cn thn v tc dng c hi ng
tiu ho, c bit lot d dy.
Cholestyramin
Phn tch: Tc dng dc l ca thuc chng vim khng steroid c th b gim
do gim hp thu ng tiu ho. Tng tc xy ra chm.
X l: Nu nghi ng c tng tc xy ra, c th tng liu thuc chng vim khng
steroid trong khi dng cholestyramin.
Glucocorticoid
Phn tch: Tng cc tc dng khng mong mun c tc dng hip ng hi gy
lot trn nim mc d dy.
X l: Cn nhc li ch/ nguy c trc khi phi hp. Cn ch n ngi bnh
cao tui v nhng ngi bnh c tin s lot. Nu cn nn phi hp thm cc thuc
bo v nim mc d dy.
Phn tch: V cc prostaglandin tham gia vo c ch iu ho glucose mu, nn
c th thy tng nguy c h glucose mu.
X l: C th c nhng bin i glucose mu tm thi trong khi iu tr bng
thuc chng vim. Thng bo cho ngi bnh tng cng t gim st.
878

cc dn cht salicylic, nhng c l cng c gi tr vi cc thuc chng vim khng
steroid khc. C ch cha r.
X l: Phi lu s gim tc dng ny trc khi phi hp cc thuc. Cn cn
nhc nguy c/ li ch v ph tn/ hiu qu.
Phn tch: Nguy c hip ng c tnh vi thn ca hai thuc.
X l: Ch c th iu tr bng interleukin ti c c chuyn khoa do tnh nghim
trng ca ch nh. V vy phi cn nhc tng tc ty theo tnh trng ca ngi bnh.
Nu khng th hon mt trong hai thuc, phi ch gim st ion v thanh l c
creatinin.
Khng sinh aminoglycosid (amikacin, gentamicin...)
Phn tch: Nng aminoglycosid trong huyt tng c th tng tr non, do
thuc chng vim khng steroid lm gim thanh lc qua thn ca khng sinh. Tng
tc xut hin chm.
X l: Gim liu aminoglycosid trc khi bt u cho thuc chng vim khng
steroid. nh lng nng aminoglycosid trong huyt tng iu chnh liu v
gim st chc nng thn.
Khng sinh quinolon
Phn tch: Thuc chng vim khng steroid c kh nng lm tng nguy c gy co
git do khng sinh quinolon (ciprofloxacin + feribufen, indometacin, mefenamic acid,
naproxen hoc enoxacin, ofloxacin + fenbufen). C ch cha c hiu bit y .
X l: Cn ch n tng tc ny, tuy him xy ra.
Lithi
Phn tch: Thuc chng vim c th lm gim thanh lc qua thn ca lithi do
lm tng ti hp thu lithi ng thn, c th dn n qu liu lithi.
X l: Khi phi hp, phi iu chnh liu ca lithi lc bt u, trong v sau khi
iu tr bng thuc chng vim khng steroid. Nu cn phi gim st cht ch nng
lithi trong mu.
Phenytoin
Phn tch: Cc dn cht salicylic v acid tiaprofenic c th y phenytoin khi lin
kt vi protein huyt tng v nh vy lm tng nng trong huyt tng ca thuc
chng ng kinh phenytoin.
X l: iu chnh liu tu theo nng phenytoin trong mu trong v sau khi dng
thuc chng vim khng steroid. Gim st cc du hiu lm sng ca nhim c
phenytoin.
Probenecid
Phn tch: Tng mnh nng thuc chng vim khng steroid trong huyt tng
( c m t ch yu vi ketoprofen) do gim thanh lc qua thn v gim lin kt
vi cc protein huyt tng.
879
X l: Nguy c tng cc tc dng khng mong mun ca cc thuc chng vim.

Gim liu ca thuc chng vim khng steroid, tu tnh hnh.
Rifampicin
Phn tch: Lm gim nng huyt tng ca etoricoxib v rofecoxib.
X l: Ch n tng tc lm gim tc dng ca thuc chng vim khng
steroid. Theo di tc dng iu tr.
Tacrolimus
Phn tch: Ibuprofen v cc thuc chng vim khng steroid khc lm tng nguy
c c cho thn.
X l: Phi theo di chc nng thn.
Tetracosactid
Phn tch: Nguy c tng cc tc dng gy lot chy mu. Nhng trong mt s
dng vim khp, s phi hp ny c th c li.
X l: Cn nhc nguy c/ li ch trc khi k n. Nu phi hp, phi theo di
lm sng. Thng bo cho ngi bnh bit nguy c.
Thuc chng kt tp tiu cu: aspirin, clopidogrel, dipyridamol
Phn tch: Ibuprofen c th lm gim tc dng bo v tim ca aspirin. Phi hp vi
thuc chng kt tp tiu cu hoc chng ng mu u c th lm tng nguy c chy
mu. Hin nay, hnh nh tng tc ny khng c cng nhn, v khng c nhn xt lm
sng no khng nh mt nguy c chy mu.
X l: Mc du vn c th phi hp, phi gim st cht ch bng cc th nghim
ng mu thch hp trong v sau khi iu tr bng thuc chng vim khng steroid.
Thng bo cho ngi k n.
Thuc h huyt p: clonidin; diazoxyd; guanethidin; methyldopa; reserpin; thuc
chn beta; sotalol; thuc chn knh calci: dihydropyridin; verapamil; (thuc gin mch
chng tng huyt p: hydralazin, minoxidil.v.v. thuc li niu: gi kali; thi kali); thuc
c ch enzym chuyn
Phn tch: Lm gim tc dng h huyt p; gim li niu v ng thi c nguy c
lm tng c tnh ca thuc chng vim khng steroid i vi thn, c bit l vi
indometacin. Ngoi ra, indometacin v c th c cc thuc chng vim khng steroid
khc lm tng nguy c tng kali mu khi cc thuc ny phi hp vi thuc l i ni u gi
kali. C ch cn cha r v phc tp. C th lin quan n tng hp prostaglandin t i
thn cn cho bi tit natri, duy tr lu lng mu qua thn v bi ni u. Khi t ng h p
prostaglandin thn b thuc chng vim khng steroid cn tr, lu lng mu qua
thn v s o thi nc tiu b gim.
X l: Tt nht l trnh phi hp. Nu cn phi hp, ch nn phi hp ngn ngy
(nhiu kh nng t gy tai bin), nhng nu thng xuyn phi hp, cn phi b nc
y cho ngi bnh, gim st chc nng thn ( thanh lc creatinin), gim st
huyt p v gi cho huyt p n nh (c khi phi tng liu thuc h huyt p nu cn),
c bit khi bt u phi hp.
880
Phn tch: Phi hp vi thuc chng kt tp tiu cu hoc chng ng mu lm

tng nguy c chy mu.
X l: Nu nht thit phi phi hp, phi gim st bng cc th nghim ng
mu thch hp nh thi gian Howell v thi gian Cephalin-Kaolin. Nu c th, tm mt
gii php iu tr khc.
Thuc gim au tc dng trung ng v chng ho dn cht ca codein,
c tnh cht tng t morphin 3 loi th th. Cc cht ch vn-i khng thuc nhm
ny, khi dng di ngy s gy nghin (tr dextropropoxyphen, dextromethorphan)
Cc thuc trong nhm
ALFENTANIL ng tim: 1mg; 5mg
Rapifen ng tim: 1mg; 5mg
CODEIN: nang mm; hn dch 1,1 g/ 100 g; nang 150,8 mg; vin nn; vin s i;
vin bao ng; vin bao phim;
Acetadein vin nn
Acodine vin nn
Acoralen F vin nn
Actadol codein vin nn
Alicopin vin bao ng
Codepect nang mm
Codipront hn dch 1,1g/100 g
Codipront N nang 150,8 mg
Copin tab vin bao ng
Dafalgan codein vin nn
Dopharalgin vin nn
Efferalgan codein vin nn si
Eucalyptine Le Brun nang mm
Neo-Codion vin nn bao
Nicol Fort nang
Nucofed nang
Mekodin nang
Paracetamol codein: nang, vin nn bao
Paracodein 10 vin nn bao
Pacodal nang
Polery siro
881
Terpincodein vin bao ng, vin nn

Terpicod vin nn
Terpin-codein F nang
Tercodin vin nn
Tercodin nang
DEXTROMETHORPHAN: siro; vin nn 0,01 g; vin ngm 2,5 mg; nang; vin bao
ng; vin bao phim 15 mg
Actifed DM siro
Alex
Alrafen cough
Ameflu vin nn
Atussin siro
Agrodin vin nn
B ho thuc cm
Blue Cap nang
Coandin vin nn
Cetamol plus nang
Cofdex vin nn
Dantuoxin vin bao
Decolsin nang
Dexpin vin bao ng
Dexpin vin nn
Dotouxi vin nang, vin nn
Dotussal siro
Edcophar vin ngm2,5mg
Hadosena nang
Lykadex: vin ngm, siro
Maxcom nang
Medicol
Methorphan siro
Neo-coadon vin bao ng
Neogodian DM vin bao ng
Necovon vin nn
Necovo vin bao ng
882
Neogodian DM vin nn
Nortussin siro
Recotus nang mm
Pulmofar nang
Rhumenol D 500 vin nn
Sedopharm nang
Siro Natussal siro
Terpin Copham vin bao ng
Terpin Copham nang
Terpin Mekong nang
Terpin Mekong vin bao ng
Terpin Trodex vin bao ng
Terpotrophan vin bao phim
Touxirup siro
Tuxo siro
Tustophan siro
DEXTROMORAMID vin nn 5 mg
Palfium vin nn 5 mg
DIHYDROCODEIN vin nn 30 mg
Codaewon (phi hp) vin nn
Dicodin vin nn 30 mg
FENTANYL: dung dch tim 0,05 mg/mL; ng tim 10 mL/ 0,5 mg
Fentanyl citrat dung dch tim 0,05 mg/mL
Thalamonal ng tim 10 mL/ 0,5 mg
MORPHIN: vin nn 10 mg; ng tim 0,01 g/1 mL
Morphin hydroclorid ng tim 0,01 g/1 mL
Moxcontin vin nn 10 mg
NALBUPHIN ng tim 20 mg/ 2 mL
Nubain ng tim 20 mg/ 2 mL
NOSCAPIN: vin bao ng; vin nn 20 g; nang
Neo-Terpin vin bao ng
Terpina vin nn
Terpin-narcotin nang
883
Noscapin vin nn 20 mg
OPI (CAO): vin nn; cn opi 1 %; vin bao ng
Aliopin vin bao ng
Ho long m vin nn
Lc thn thu (Cn opi 1% )
Opiterpen vin nn
Opi-Terpin vin nn
Opizoic vin nn
Otecpin vin nn
Oterben vin nn
Paregoric vin nn
Siro khuynh dip ( Cn opi 1% )
Tecopi vin nn
PHOLCODIN siro
Denoral (ngi ln) siro
Denoral (tr em) siro
PENTAZOCIN vin nn 30 mg
Fortalgesic vin nn 30 mg
PETHIDIN ng tim 2 mL/ 100 mg
Dolargan ng tim 2 mL/ 100 mg
Ch khi ch nh thuc
Tr em: c tnh ca thuc c opi s ln hn nu dng tr nh v nht l tr
cn b lm tng nguy c c ch h hp v tim mch. Nn cng hay gp hn, km theo
l ri lon in gii.
ng kinh: Dn cht ca morphin c th lm h thp ngng sinh ng kinh v
to iu kin xut hin cc cn ng kinh.
Suy gan: Suy gan lm chm ging ho cc dn cht ca morphin km theo tng
c tnh, c th dn ti hn m gan ngi x gan.
Suy h hp; hen: Morphin gy c ch h hp do trung tm hnh no gim nhy
cm v lm c ch phn x ho, gy ng m nghim trng. ngi hen, c nguy
c kh th cp tnh, phn ln do tc dng co tht ph qun ca morphin v cc d n
cht.
Thn trng: mc 2
Thi k mang thai: Cc dn cht morphin khng gy qui thai. Hi chng cai
nghin gp tr s sinh, thng l tr non, c m nghin ma tu, vi nhng ri
884
lon ng x (d b kch thch, tng trng lc), mt ng, nn, tiu chy, tot m hi, c
th hn m, tin ti t vong.
Cn theo di: mc 1
Ph i tuyn tin lit; u tuyn tin lit; suy thn : Hin tng suy thn v/
hoc b tiu tin do bnh l niu o tuyn tin lit khin cng phi thn tr ng (v
thuc chm o thi)
Ngi bnh cao tui: Tn s tim chm c th tr nn trm trng ngi bnh
cao tui hoc ngi suy h hp nng.
Tng tc thuc
Thuc c ch MAO typ B
Phn tch: Tng tc gia thuc c ch MAO typ B vi pethidin (Dolosal,
Dolargan) c th gy l ln, kch thch, tng thn nhit, co git, co tht mch v tng
huyt p (hi chng serotoninergic). Hin cn tranh lun v mc nng nh ca cc
nguy c vi cc cht ch vn khc.
X l: Cc nguy c ni trn thy vi pethidin. Vi cc thuc khc, nu cn phi
hp thuc, lm mt test vi liu thp pht hin tng tc v nh gi mc nng
nh. Nu khng, nn thn trng i sau khi ngng thuc IMAO c hai tun l mi
dng cc cht ch vn ca morphin.
Phn tch: Vi pethidin (Dolosal*), c kh nng xut hin cc triu chng nghim
trng v khng d on trc c, gi l hi chng serotoninergic, vi nhng ri lon
tm thn (kch thch, l ln, c khi hn m), ri lon vn ng (git c, run, c ng c ,
tng hot ng), ri lon thn kinh thc vt (tng hoc gim huyt p, nhp tim nhanh,
st cao, tot m hi, rng mnh). Vi cc thuc gim au khc thuc loi morphin, nn
thn trng; khi cn phi hp thuc th lm mt test vi mt phn t liu thuc gim
au, v theo di nhng phn ng ngi bnh.
X l: Chng ch nh phi hp thuc ny vi pethidin. Vi thuc gim au khc
thuc loi morphin, nn thn trng. Nu cn phi hp thuc ny, phi lm mt test,
dng mt phn t liu thuc gim au v theo di phn ng ca ngi bnh nhiu gi
sau khi lm test. Trnh dng thuc ho c cc dn cht ca thuc phin.
Methadon
Phn tch: Tng tc dc lc hc: Tc dng hip ng gia hai cht cng
nhm.
X l: Trnh dng thm mt cht ch vn ca morphin cho ngi bnh ang iu
tr cai nghin ma tu.
Ritonavir
Phn tch: Ritonavir c i lc mnh vi isoenzym 3A4 ca cc cytochrom P450 v
do cnh tranh, n lm gim chuyn ho cc thuc c chuyn ho mnh qua xc tc
ca cytochrom P450. Do nng cc thuc ny tng trong huyt tng v c nguy c
885
tng c tnh: nguy c c ch h hp nng i vi pethidin v thm nguy c gy bun

ng ko di i vi fentanyl. y l tng tc dc ng hc trong chuyn ho thuc.
X l: Khng k n phi hp ny.
Ru
Phn tch: Tng c ch thn kinh trung ng: tng tc dng an thn gy bun
ng, tng c ch h hp v tng h huyt p.
X l: Vi ngi nghin ru, phi gim liu thuc ch vn ca morphin. Khi k
n mt thuc c ch thn kinh trung ng, cn khuyn ngi bnh khng dng ru
ng thi. Cn quan tm n hm lng ru c trong bit dc hoc ung m
ngi bnh t dng. Cn ch trng hp ngoi tr, i vi ngi li xe v ngi ng
my.
Thuc c ch MAO typ A
Phn tch: Trong h thuc ny, tng tc ch mi c m t vi pethidin.
Pethidin (Dolosal*) l mt cht gim au loi morphin c tc dng nhanh v ng n, hay
dng trong nhng cn au qun thn. Khi phi hp vi thuc c ch MAO typ A
(moclobemid v toloxaton) hay typ B (selegillin) l nhng thuc c ch MAO chn lc v
thun nghch, c nguy c tch ly serotonin vi cc hin tng st cao, cng c, thm
ch m sng.
X l: Chng ch nh phi hp. Cn chn mt thuc gim au khc hn l thay
i t ngt thuc chng trm cm hay thuc b tr iu tr Parkinson (selegillin).
Amineptin; interferon alpha ti t hp; medifoxamin; thuc chng ng kinh khng
barbituric
Phn tch: Tng c ch thn kinh trung ng, tng c ch h hp v tng h
huyt p. Ngoi ra, s phi hp hai thuc c th lm tng nguy c ph thuc thuc.
X l: Tnh n nguy c ny hiu chnh liu lng hai thuc, nu cn phi
hp. Phi tnh n gim tnh to nhng ngi li xe v ngi ng my.
Bepridil; bromocryptin hoc thuc tng t; diazoxid; dihydropyridin; diltiazem;
furosemid hoc thuc tng t; gluthetimid hoc thuc tng t; levodopa; lidocain
hoc thuc tng t; methyldopa; nitrat chng au tht ngc; quinidin hoc dn cht;
sotalol verapamil; thuc chn beta; thuc gin mch lm h huyt p; thuc l i tiu
gi kali; thuc li tiu thi kali, thuc c ch enzym chuyn i
X l: Theo di huyt p trong thi gian dng phi hp hai thuc. Ty theo thuc
dng, thy h huyt p nhiu hay t. Khi cn, hiu chnh li u ca mt hay hai thu c.
Lp mt k hoch dng thuc u n. Dn ngi bnh gp li bc s hiu chnh
liu thuc, nu thy chng mt khi bt u iu tr.
886
X l: Thng bo cho ngi bnh bit nguy c. Theo di huyt p trong thi gian
dng phi hp thuc. Lp mt chng trnh dng thuc u n. Ty theo thuc dng,
h huyt p c mc nng nh khc nhau, nu cn iu chnh liu lng ca mt
hoc hai th thuc. Dn ngi bnh gp li bc s nu cn, hiu chnh li liu
lng, khi thy chng mt lc bt u iu tr. Tng cng theo di ngi bnh cao
tui (nguy c ng) v khuyn h chuyn dn dn t th nm hoc ngi sang t th
ng.
Lincosamid
Phn tch: Tc dng c ch h hp ca thuc c tc dng phong b ch ni thn
kinh c c cng thm vo tc dng c ch h hp ca thuc gim au tc d ng
trung ng.
X l: Phi hp thuc ny ch thc hin ti c s chuyn khoa, c chun b d
phng y , nhm m bo an ton cho ngi bnh. Nhc ngi bnh cn thng
bo cho bc s gy m bit nhng thuc dng trc khi ln bn m. Bc s gy m
cn phi tnh n tng tc ny, v c khi phi h tr h hp cho ngi bnh. Cn ch
lc ngi bnh tnh li v lc h tr ngng h hp.
Nicotin
Phn tch: Do c tnh cm ng enzym chuyn ho thuc, nicotin kch thch bin
i sinh hc ca mt s thuc khc, lm gim hot tnh iu tr.
X l: Cn lun lun cnh gic vi nhng thuc c ch s iu tr thp trong liu
php thay th bng nicotin, v c khi phi xem li liu dng trong v sau thi gian i u
tr ( y hin tng ny c ghi nhn vi thuc pentazocin (Fortal*). Cm ng enzym
l hin tng ch xut hin sau nhiu ngy, tri vi c ch enzym l mt hi n t ng
xy ra tc th.
Phenothiazin
Phn tch: Tng tc dng c ch h thn kinh trung ng ko theo tng tc dng
an thn gy bun ng. C ch do tng tc dc lc.
X l: Phi ngh n gim tnh to ngi li xe hoc ng my. Khuyn khng
dng thm ru v cc thuc hoc ung c ru).
Thuc i khng vi morphin
Phn tch: i khng dc l, c bit i khng tc dng gim au, c ch h
hp, c ch thn kinh trung ng ca cc cht ch vn ca morphin.
X l: C th dng nh thuc gii c. Khi dng cho ngi nghin ma tu, phi
ch n nguy c hi chng cai nghin.
Phn tch: Tng nguy c to bn do tc dng hip ng.
X l: Nu cn phi hp thuc, phi tnh n nhc im ny v bo trc cho
ngi bnh bit. Nu cn, k n thm thuc nhun trng.
Thuc loi curar
Phn tch: Tc dng c ch trung tm h hp ca cc thuc gim au trung ng
c th thm vo nguy c lit h hp do thuc loi curar.
887
X l: Khi gy m, tng tc ny c th c c gii quyt bng h tr h

hp. Cn theo di k ngi bnh sau phu thut.
Phn tch: i khng tc dng. C kh nng tng tnh hung hn ngi nghin
amphetamin.
X l: Ch n tng tc ny xc nh mc ch iu tr chnh.
Baclofen; barbituric; benzamid; benzodiazepin; butyrophenon; carbamat hoc
thuc tng t; carbamazepin; fluoxetin; fluvoxamin; khng histamin khng H1 c tc
dng an thn; mianserin; oxaflozan; phenytoin; primidon hoc dn cht; thuc an thn
kinh khc; thuc c ch h thn kinh trung ng khc
Phn tch: Tng tc dng c ch thn kinh trung ng, ko theo tng tc dng an
thn gy bun ng. C ch do tng tc dc lc.
X l: Nu cn phi hp thuc, phi tnh n nguy c ny xc nh liu lng
ca hai thuc. Cn ngh ti gim tnh to ngi li xe hay ng my.
Citalopram
X l: Phi ngh n gim tnh to ngi li xe hay ng my khuyn khng
ung ru, khng dng thm thuc hoc ung c ru.
Phn tch: Tng cc tc dng c ch thn kinh trung ng, tc dng c ch h
hp v h huyt p. Mt khc, nu xc nh ngi bnh ph thuc thuc, th phi
hp hai thuc c th lm tng s ph thuc. Nn ch l cht rilmenidin vi liu dng
thng thng khng lm tng tc dng c ch thn kinh trung ng ca cc thuc ny.
X l: Nu cn phi hp thuc, phi ngh n nguy c trong vic xc nh li u
lng hai thuc. Lp mt chng trnh dng thuc u n. Phi ngh n gim tnh
to ngi li xe v ngi ng my. Phi theo di huyt p trong qu trnh phi hp
hai thuc. H huyt p nng hay nh tu thuc thuc c th dng phi hp. Nu
cn, hiu chnh liu lng ca mt hoc hai th thuc. Khuyn ngi bnh gp li bc
s hiu chnh liu nu cn, khi ngi bnh thy chng mt lc u iu tr. Khuyn
khng ung ru, khng dng thm thuc hoc ung c ru. Tng cng theo di
ngi bnh cao tui (nguy c ng) v khuyn phi chuyn dn dn t th nm hay
ngi sang t th ng.
Detropropoxyphen; reserpin; thuc chng trm cm ba vng hoc thuc tng t
Phn tch: Tng tc dng c ch thn kinh trung ng, c ch h hp v h
huyt p. Ngoi ra, nu xc nh ngi bnh c ph thuc thuc, th vic phi hp ny
s lm tng tnh ph thuc.
X l: Phi tnh n nguy c ny iu chnh thch hp liu lng hai thuc nu
cn phi hp ny. Phi ngh n gim tnh to ngi li xe v hoc ng my.
Khuyn khng ung ru v thuc hoc ung c ru.
Paroxetin
888
Phn tch: Tng tc dng c ch thn kinh trung ng, ko theo tng tc dng an
thn gy bun ng (tng tc dc lc).
X l: Phi tnh n nguy c, khi xc nh liu lng ca hai thuc phi hp. Ngh
n gim tnh to ngi li xe, ngi ng my. Khuyn khng ung ru, khng
dng thm thuc hoc ung c ru.
Thuc gy m barbituric; thuc gy m bay hi cha halogen; thuc gy m khc
X l: Nu cn phi hp hai th thuc, phi ch n nguy c ny khi gy m v
nhc ngi bnh phi phu thut thng bo cho bc s gy m bit nhng thuc
dng.
Thuc va ch vn va i khng vi morphin
in hnh l buprenorphin, dng trong hai ch nh: mt ch nh kinh in l cht
gim au mnh (Temgesic*), mt ch nh khc dng trong trng hp nghin thuc
loi morphin (Subutex *). Liu dng khc nhau trong hai ch nh
Cc thuc trong nhm
BUPRENORPHIN: vin t di li 0,2 mg; ng tim 0,3 mg/ 1mL
Buprenex vin t di li 0,2 mg
Temgesic ng tim 0,3 mg/ 1mL
Ch khi ch nh thuc
Thi k cho con b: Tnh khng c hi cha c chng minh, thuc qua c
sa m.
Tr em: c tnh ca thuc ln hn i vi tr cn b v tr t tui: nguy c suy
h hp; tnh khng c hi cha c chng minh.
Thi k mang thai: Tnh khng c cha c chng minh ngi mang thai.
Ngi k n phi cn nhc nguy c /li ch.
Suy gan: Suy gan lm thuc chm chuyn ho v lm tng c tnh.
Suy h hp; hen: Nh mi dn cht ca morphin, chng ch nh khi suy h hp
nng; khi suy h hp va th phi tnh ti tc dng c ch h hp ca cc dn cht ca
morphin.
tng tc thuc
Methadon
Phn tch: Vi cc cht va ch vn, va i khng vi morphin (loi Temgesic),
cn ch n gim tc dng gim au do phong b cnh tranh t i cc th th ca
morphin.
X l: Chn mt loi thuc gim au khc cho ngi nghin ma tu trong thi
gian iu tr cai nghin.
889

Cimetidin hoc thuc i khng histamin H2
Phn tch: Tc dng v c tnh ca buprenorphin c th tng, do chuyn ho b
gim. Tng tc xy ra nhanh.
X l: Nu h thn kinh trung ng b c ch mnh, phi ngng buprenorphin, v
nu cn phi dng thuc i khng th th ca morphin nh naloxon.
Thuc gy m barbituric (thiopental)
Phn tch: Liu khi m thiopental cn thit c th phi gim khi dng thuc gim
au gy nghin (c opi); ngng th thng xy ra khi phi hp. Tng tc xut hi n
nhanh. C ch tc dng hip ng gia hai thuc.
X l: Ngoi thn trng thng quy khi gy m, khng cn phi x l g thm.
Thuc cng giao cm alpha v beta
Thuc c hot cht mang tnh cht cng giao cm trc tip hay gin tip, c tc
dng
ng thi trn cc th th alpha v beta. Tc dng trn th th beta c khi r hn
(adrenalin), c khi tng ng (ephedrin) so vi tc dng trn th th alpha
Cc thuc trong nhm
DIPIVEFRIN thuc nh mt 0,1%
Propine thuc nh mt 0,1%
EPHEDRIN: dung dch nh mi 1 %; vin nn 0,01 g; ng tim 0,01 g/1 mL;
0,05g/1mL
Asmalin vin nn
Asmin vin nn
Coderin vin nn
Dophasmin vin.nn
Ephedrin HCl ng tim 1 mL 0,01 v 0,05g
Ephedrin vin nn 5 mg
Ephedrin vin nn 0,01g
Rhinarin dung dch nh mi
Sulfedrin dung dch nh mi
Sunfarin dung dch nh mi 1 %
EPINEPHRIN ng tim 1 mg/ 1mL
Adrenalin ng tim 1 mg/ 1mL
Medicaine (phi hp vi lidocain) dung dch tim
Scandonest 2% special (phi hp vi mepivacain) dung dch tim
890
ETILEFRIN: vin nn 5 mg; ng tim 10 mg/ 1mL

Effortil vin nn 5 mg
Effortil ng tim 10 mg/ 1mL
FENOXAZOLIN dung dch 0,1% phun m
Aturgyl dung dch 0,1% phun m
NAPHTAZOLIN: thuc nh mi 0,0005g/mL; thuc nh mt
Collydexa thuc nh mt
Daigaku thuc xt mi 7.5mg/15mL dng nitrat
Icool
Iridina Due dng HCl thuc nh mt 0,05%
Naphacollyre dng nitrat thuc nh mt 0,025%
Naphtazolin 0,0005g/mL thuc nh mi
Naphtazolin dung dch nh mi 0,05%
Nedelin dng nitrat thuc xt mi 7,5mg/15mL
Opcon-A
Polydeta thuc nh mt
Polydoxancol dng nitrat thuc nh mt 0,05%
Polymax thuc nh mt
Polyxacol dung dch nh mt
Rhinex 0,05% dung dch nh mi; Polodesol dung dch nh mt
Rhisolin 0,05% dung dch nh mi
Tipharhinal 0,05% thuc nh mi; Polydelzal dung dch nh mt
Virondo dung dch nh mt
OXYMETAZOLIN: dung dch nh mi 0,05 %; thuc xt mi; dung dch nh mt;
dung dch nh tai
Coldi thuc xt mi 0,05% dng HCl
Coldi B thuc xt mi 0,05% dng HCl
Coldex 0,05% dung dch nh mi
Colden thuc xt mi
Benecole -B dung dch nh mt, mi, tai
Benecole-D dung dch nh mt
Kotocol thuc nh mi
Nasivion thuc nh mi: 0,05%; 0,025%
Otilin thuc xt mi
891
Xyclometazolin: 0,05 %; 0,01 %

Vincoldem thuc nh mi hoc xt mi
Visine LS dung dch nh mt 0,05%
PHENYLEPHRIN thuc nh mi 0,5%
Andol-S vin nn
Hemoxal thuc xt mi (phi hp)
Hexapneumine tub, vin nn (phi hp)
Nortussine siro ngi ln
Polydexa (Php) thuc nh mi (phi hp)
Rhinil thuc nh mi 0,5%
Rhinopront nang (phi hp)
Rhinotussal nang (phi hp)
Tiffy siro
PHENYLPROPANOLAMIN: siro; vin nn; vin nn bao phim; nang
Aller fort nang
Allermin vin bao
Andol fort nang
Antituss siro
Blue- Cold- tab vin nn bao phim
Capcold nang
Captussin nang
Coadecoagen fort vin nn
Codepect nang mm (phi hp)
Coen nang mm (phi hp)
Cold capF nang
Coldagen nang
Coldagro nang
Coldaur nang tc dng chm (phi hp)
Coldfacon nang
Coldmin vin nn
Conler F nang
Contussin siro
Cotussin nang
892
Covialler F vin bao

Dallerrin vin bao phim
Dantussin vin nn
Decamol vin nn
Decolgen liquid dung dch ung (phi hp)
Decolgen vin nn
Decolsin vin nn (phi hp)
Deconal vin nn
Deflucold vin nn
Dehanogen vin nn
Denoral vin nn
Devicolgen vin nn
Dicold forte vin nn
Dipadol F vin nn
Dotoux vin nn, nang (phi hp)
Dotussal siro
Facolgen vin nn
Feemnil nang (phi hp)
Hadocolcen vin nn
Hadocold nang
Komix siro (phi hp)
Medgen vin nn
Medicoldac nang
Meko-Allergy F vin bao phim
Mekotamol vin nn
Methorphan siro
Nidol nang
Nidol vin nn
Padol plus nang
Padolgen vin nn
Pafemin vin nn
Pandol plus vin nn
Protimol
893
Protimol F vin nn
Pultissin: nang
Rhicap nang
Rhumenol D vin nn
Rhumenol NF vin nn
Natussal siro
Sofgard nang mm (phi hp)
Tiffy siro
Tiffy vin nn
Tiller fort vin bao phim
Triacold vin bao phim
Triamein D vin nn
Trinacin vin bao phim
Trivacocin vin bao phim
Tuspi vin nn
Tustophan siro
Tuxiril siro (phi hp)
Tuxo siro
TV colmax vin nn
Vaco aller F vin bao phim
Vicold nang
Vidacold vin nn
Vioral vin nn
PSEUDO-EPHEDRIN vin nn; nang; vin bao ng
Actifed/Actifed DM vin nn, siro (phi hp)
Ameflu ban m/ban ngy vin nn (phi hp)
Atafed vin bao
Corimol nang
Coryzal nang
Dotoux - F nang (phi hp)
Iyafin funior siro (phi hp)
Loratin D sinus siro (phi hp)
Loratin - D sinus vin bao phin (phi hp)
894
MK-Actitab vin nn
Nucofed nang
Rhinafed vin nn (phi hp)
Sudafed vin bao ng
Sedopharm nang
Supercold nang
SYNEPHRIN ng tim 60 mg/ 1mL
Sympatol ng tim 60 mg/ 1mL
TETRYZOLIN dung dch nh mt 0,05%
Visine dung dch nh mt 0,05%
XYLOMETAZOLIN: thuc xt mi 0,1%; thuc nh mi: 0,05%, 0,1%
Eftinasex thuc nh mi 0,05%
Hadocort- D thuc xt
Hadocort- H thuc xt
Hadocort thuc xt
Nostravin dung dch nh mi 0,05%
Omeli thuc xt mi 0,1%
Otrivin dung dch phun mi 0,1%
Otrivin dung dch nh mi 0,1%
Otdin thuc xt mi 0,1%
Otilin thuc xt mi 0,1%
Otilin thuc nh mi 0,05%
V-Coldin thuc xt mi
Xylobalan thuc nh mi: 0,05%; 0,1%
Xylometazolin thuc nh mi 0,05%
Xylometazolin thuc nh mi 0,1%
Ch khi ch nh thuc
Bnh tng nhn p: Cc thuc cng giao cm, cng alpha trc tip hay gin
tip, lm gin ng t, c th gy cn tng nhn p cp nhng ngi bm cht d
mc bnh c gc mng mt - gic mc hp.
Ph i tuyn tin lit/ u tuyn tin lit: Tt c cc thuc cng giao cm phi
dng thn trng nhng ngi ph i tuyn tin lit.
Suy mch vnh: Cc thuc cng giao cm, bng cch kch thch cc th th
beta - 1 ca tim, lm tng nhp tim, tng tiu th oxy tim, v lm gim hi u sut sinh
895
nng lng. Do lm tng nhp tim nn cn trnh dng cc thuc ny nhng ngi suy
tim, tng nng tuyn gip, suy mch vnh, trong nhng ri lon nhp tim, bnh c tim
tc nghn.
Cc trng thi khc: Khng dng cc thuc cng giao cm trng hp va
x ng mch, lon nhp tim, bnh c tim tc nghn.
Tng huyt p: Cc thuc cng giao cm lm tng huyt p, do kch thch cc
th th alpha v gii phng noradrenalin. Do phi trnh dng cho ng i tng huyt
p.
Tng nng tuyn gip/ suy tim: Cc thuc cng giao cm, do kch thch cc
th th beta-1 ca tim, lm tng nhp tim, tng tiu th oxy tim v lm gi m hi u
sut sinh nng lng. Do lm tng nhp tim, nn phi trnh dng cho nhng ngi suy
tim, ngi tng nng tuyn gip, ngi suy mch vnh.
Cn theo di: mc 1
Thi k mang thai: Tnh khng c ca mt s thuc cng giao cm cha
c xc nh chc chn i vi ngi mang thai.
Tng tc thuc
Furazolidon
Phn tch: Furazolidon lm tng tnh nhy cm vi cc thuc cng giao cm gin
tip, c th gy tng huyt p. Cc thuc cng giao cm trc tip (nh dobutamin)
khng b nh hng. C ch cc thuc cng giao cm gin tip gii phng mt lng
ln noradrenalin khi monoaminoxydase b c ch, m furazolidon li l mt thuc c
ch MAO.
X l: Trnh dng ng thi hai thuc ny. Nu dng ng thi, phi theo di
ngi bnh: nu xut hin cn tng huyt p, th c th dng phentolamin (Regitine).
Procarbazin
Phn tch: Nguy c ri lon huyt p nghim trng (tng huyt p) v tch ly cc
amin tng huyt p do tc dng hip ng ca mt thuc cung cp cc amin tng
huyt p vi mt thuc c ch d ho cc amin . V cc thuc MAO chm o thi,
nn tng tc ny c th tn ti 15 ngy sau.
X l: V cc nguy c trn, nn trnh tng tc ny.
Bretylium
Phn tch: Cht chng lon nhp tim nhm III, bretylium gy gii phng cc
catecholamin trong thi gian u, sau , biu hin tc dng hu giao cm. Nh vy c
nguy c huyt p bin thin ln (tng huyt p) v ri lon nhp tim.
X l: Ch dng bretylium ti bnh vin, c theo di cht ch. Mc du c
khuyn nn trnh, phi hp ny vn c dng tu thuc bnh cnh lm sng.
896
Phn tch: Bromocriptin l cht ch vn dopaminergic. C nguy c gy co mch

v nhng cn tng huyt p.
X l: Nn trnh tng tc ny do nguy c ni trn.
Clonidin hoc tng t
Phn tch: Tnh ch vn dc l c th biu hin bng tng tc dng chng tng
huyt p ca clonidin (cht cng alpha) v ca cc thuc cng giao cm alpha.
X l: V mc tiu chnh ca iu tr l lm gim huyt p, nn khng phi hp
hai thuc ny, v tu theo gi dng thuc, c th huyt p bin thin c hi cho ngi
bnh nh hng ti s cn bng huyt p cn c.
Glycosid tr tim
Phn tch: Nguy c xut hin ri lon tnh t ng tim v tnh dn truyn nh -tht
v/hoc dn truyn trong tm tht.
X l: Nu cn phi hp thuc, phi tng cng theo di in tm , v phi
thn trng khi dng.
Phn tch: Do guanethidin phong b gii phng noradrenalin hu hch, nn tc
dng dc l c cng thm vi nguy c xut hin tng huyt p nghim trng v
lon nhp tim.
X l: Nn trnh phi hp thuc. Tt c tu thuc bi cnh iu tr, tnh tr ng
nguy ngp v trang thit b theo di ngi bnh. nh gi nguy c trong bi cnh
(theo dng bo ch ca thuc cng giao cm alpha 1 dng nh thuc dng t i
ch, ung hoc tim). Khuyn ngi bnh trc khi m thng bo cho bc s gy m
bit liu php ang thc hin.
Hormon tuyn gip
Phn tch: Nguy c tng tc dng cc hormon gip trng. Vi ngi c bnh
mch vnh, hormon gip lm tng nguy c suy mch vnh.
X l: Nu cn phi hp thuc, phi iu chnh liu lng chnh xc, c tnh n
nguy c ni trn.
Phn tch: i khng dc l (cc thuc cng giao cm c dng trong khi qu
liu cc cht chn beta).
X l: Tng tc dc lc ny, nu khng c theo di lin tc (in tm v
huyt p) c th gy tng huyt p, nhp tim chm qu mc, c th dn n sc tim.
Phn tch: Cc thuc gy m halogen ho bay hi lm c tim nhy cm vi tc
dng ca cc cht cng giao cm, c th gy lon nhp tht nghim trng trong mt
s him trng hp.
X l: Nn trnh phi hp ny. Nu c th, thay i chin lc iu tr. y l
mt liu php ch yu dng trong bnh vin, thc hin khoa gy m, hoc trc khi
897
phu thut, c theo di lin tc h hp v tim. Khi phi hp cc thuc, ngi ghi n
phi sn sng i ph nhng hu qu ni trn v phi tm cch trnh chng.
Phn tch: Nguy c ri lon huyt p nghim trng (tng huyt p) v tch lu amin
tng huyt p do tc dng hip ng: mt thuc cung cp amin tng huy t p, m t
thuc c ch d ho cc amin . Do cc thuc c ch MAO o thi rt chm, tng
tc ny c th tn ti 15 ngy sau .
X l: Ch phi hp thuc ny khi c s theo di cht ch ca cc cn b chuyn
khoa.
Phn tch: Tng cng tc dng hng thn, c th dn ti tnh d b kch thch,
mt ng, v i khi co git v lon nhp tim.
X l: Vi tt c cc thuc cng giao cm, phi theo di lm sng.
Dizoxyd; furosemid hoc thuc tng t; nitrat chng au tht ngc; thuc gin
mch h huyt p; thuc li tiu gi kali; thuc li tiu thi kali; thuc c ch enzym
chuyn i
Phn tch: Tc dng chng tng huyt p c th gim khi dng ng thi vi cc
thuc cng giao cm.
X l: Theo di huyt p phi lin tc. Tt c tu thuc bi cnh iu tr v dng
bo ch dng. Nu c th, trnh phi hp thuc ny ngn cc nguy c quan
trng trong bin ng huyt p. Hiu qu dc l s km i vi mt thuc cng giao
cm ch yu alpha so vi mt thuc cng giao cm alpha beta.
Reserpin
Phn tch: Reserpin c kh nng lm tng tc dng tng huyt p ca cc thuc
cng giao cm tc ng trc tip, dn n tng huyt p. Reserpin lm gim tc dng
tng huyt p ca cc thuc cng giao cm tc ng gin tip. Tng tc xy ra
nhanh. C ch Reserpin lm gim d tr catecholamin, lm tng tnh nhy cm ca cc
th th i vi thuc cng giao cm tc ng trc tip, trong khi li i khng tc
dng ca cc thuc cng giao cm tc ng gin tip (cc thuc ny lm nrn gii
phng noradrenalin).
X l: Nu phi phi hp, cn gim st huyt p. Tu theo thuc cng giao cm
dng, c th phi tng hoc gim liu.
Thuc chn alpha
Phn tch: Kh nng phong b tc dng tng huyt p ca thuc cng giao
cm, v lm gim huyt p nghim trng, tu theo liu dng.
X l: Khi iu tr bng thuc chn alpha-1, phi i n khi ht tc dng dc l
ca thuc cng giao cm, tr khi cn s dng tnh i khng gia hai thuc. nh
gi nguy c, phi ch n dng bo ch (dng dng ti ch, ung hay tim). Cc
dng thuc dng ti ch c th c tc dng ton thn, tu thuc vo vic dng nh th
no trong iu tr.
898

Phn tch: Thuc chng trm cm ba vng lm mnh ln cc p ng trn huyt
p gy ra do cc thuc cng giao cm tc dng trc tip: kt qu l hin tng lon
nhp xut hin. Ngc li, thuc chng trm cm ba vng li lm yu i cc p ng
trn huyt p gy ra do cc thuc cng giao cm tc dng gin tip. C ch ca hin
tng ny l do thuc chng trm cm ba vng c ch s ti thu hi cc cht cng
giao cm vo nrn, lm mnh ln hoc lm yu i nhy cm ca cc cht ny trn
th th ca chng.
X l: Nu phi dng ng thi hai loi thuc ny, cn phi hiu chnh liu lng
ca thuc cng giao cm. Theo di cht ch huyt p v s xut hi n tri u chng
lon nhp.
Phn tch: Tng tc dng kch thch h thn kinh trung ng (d b kch thch, mt
ng, nguy c co git v lon nhp tim).
X l: Theo di lm sng, v nu cn ghi in tm . C khi phi xem li liu
php da theo cc d liu trn. Ch ngay c vi nhng thuc dng
ti ch.
Thuc kim ho nc tiu
Phn tch: Kim ho nc tiu lm tng na i v lm gim s o thi ca
ephedrin hay pseudoephedrin. Nh vy tc dng dc l v c tnh ca cc thuc
cng giao cm trn s tng ln. Hin tng ny c nguyn nhn l khi pH ca nc
tiu tng, th s ti hp thu ng thn ca cc cht cng giao cm cng tng.
X l: Phi gim liu thuc cng giao cm khi dng cng vi thuc kim ho
nc tiu.
Amphetamin hay dn cht
Phn tch: Tng tc dng kch thch h thn kinh trung ng (tnh d kch thch,
mt ng, nguy c co git v lon nhp tim).
X l: Ghi nh nguy c ny, thng bo cho ngi bnh, iu chnh liu l ng,
theo di lm sng k c thuc dng ti ch.
Methyldopa
Phn tch: Methyldopa kch thch cc th th alpha-adrenergic, nh vy lm tng
tc dng ca cc thuc cng giao cm.
X l: Nu thm thuc cng giao cm alpha - 1, c kh nng lm gim tc dng
h huyt p mun c. Nu methyldopa c thm vo sau, th chnh tc dng tng
huyt p s b gim. Nu cn s phi hp hai thuc, hy bt u vi nhng li u thp.
Cn nh l dng dng ti ch c th c tc dng ton thn tu theo bi cnh s dng
c th.
Thuc c ch MAO typ B
899
Phn tch: S c ch c hiu monoamin oxydase typ B lm ko di tc dng ca

levodopa; iu ny gii thch vic ghi n ng thi vi thuc ny. Nh vy, cc tng
tc cng ging cc tng tc ca levodopa, v xin xem h thuc ny.
X l: Gim liu thuc cng giao cm, nu cn. Khuyn ngi bnh gp li
ngay bc s, nu thy tim p khng bnh thng.
thuc cng thn kinh giao cm beta
Cht
ch
vn
ca
cc
th
(Th th beta 1 ch yu tim, th th
Dobutamin c hiu cho th th beta 1
th
beta
adrenergic
beta 2 ph qun).
Cc thuc trong nhm

Dobutamin
Dobuject dung dch tim 250 mg/5 mL
Dobutamin Ebewe dung dch tim 250 mg/20 mL
Dobutamine dung dch tim 250 mg/20 mL
Dobutamine hydrochlorid dung dch tim 250 mg/2 mL
Dobutrex dung dch tim 250 mg/20 mL
DOPAMIN
Dopamine hydrochloride dung dch tim 40 mg/mL
Dopamin 200 mg/50 mL
Dopamin dung dch tim 50 mg/10 mL
FENOTEROL
Berodual dung dch phun m 0,5 mg vi 0,25 mg ipratropium Bc/1mL l 20mL
Berodual bm xt nh liu 0,05 mg vi 0,02 mg ipratropium Bc/1 liu xt
Berodud MDI dung dch phun m l 10 mL
Berotec bm xt 0,1 mg/liu, l 10 mL (200 liu)
ISOPRENALIN
Isuprel ng tim 0,2 mg/mL
Isuprel dung dch phun m 0,4 mg/liu
SALBUTAMOL
Apo-Salvent vin nn: 2 mg; 4 mg
Asthalin Inhaler dung dch phun m 100 mg/liu
Butovent dung dch phun m 100 mg/liu
Combivent bm xt nh liu 0,1 mg km 0,02 mg ipratropium Bc/1 liu xt
Combivent dung dch xng kh dung ng n liu 2,5 mg km 0,5 mg ipratropium
Bc.
900
Salbuvent dung dch phun m 0,1 mg/liu

Ventolin dung dch ht 0, 5g/100mL
Ventolin dung dch phun m 100 mg/liu
Ventolin kh dung 100 mg/liu
Salbutamol vin nn: 2 mg; 4 mg
Ventolin syrup (sugar free) siro 2 mg/5 mL
Volmax vin tc dng ko di: 4 mg; 8mg
TERBUTALIN
Terbutalin Stada retard nang tan chm 7,5 mg
Bricanyl vin nn 25 mg
Bricanyl kh dung 10 mg/mL
Ch khi ch nh thuc
Chng ch nh: mc 4
Suy mch vnh: Nguy c cn au tht ngc do tng nhp tim v tim tng tiu th
oxy (kch thch cc th th beta 1 tim).
Thi k mang thai: Phi thn trng khi cho thuc, thm ch khng nn cho, v
nhiu khi tng nhp tim thai.
Suy tim: Nguy c cn au tht ngc do tng nhp tim v tim tng tiu th oxy
(kch thch cc th th beta 1 tim).
Trng hp khc: Bnh tng nng tuyn gip.
Thn trng: mc 2
Tng huyt p: Cc thuc cng giao cm beta gy gin mch ton thn v
phi. Mu dn v cc chi v v no, c th lm cc bin chng mch ca tng huyt
p nng thm.
Tng nng tuyn gip: V tc dng lm nhp tim nhanh.
Cn theo di: mc 1
Tiu ng: Tng tiu glycogen c, i hi phi iu chnh liu cc thuc chng
tiu ng v tc dng tng glucose mu ny.
Tng tc thuc
Thuc chn alpha - beta
Phn tch: Phi hp khng hp l. i khng dc l, dng trong trng hp qu
liu thuc chn beta.
X l: y l i khng dc l cn bit trc khi lp k hoch iu tr.
901

Phn tch: Phi hp khng logic. i khng dc l, dng trong trng hp qu
liu thuc chn beta. Tng tc ny xy ra c vi thuc nh mt cha thuc chn
beta.
X l: Phi hp ny ch c th qun l ti c s bnh vin, c lu cc c tnh
cng thn kinh giao cm ni ti c hay khng ca cc thuc chn beta khc nhau.
Bretylium
Phn tch: Tng thm tc dng ca cc amin co mch, c bit cc catecholamin
gy nguy c bin ng huyt p do tnh cht cng thn kinh giao cm gin tip ca
bretylium.
X l: Khng nn phi hp, tr khi ti c s chuyn khoa c theo di in tm
thng xuyn.
Phn tch: Vi ephedrin, adrenalin v dopamin, c nguy c gy thiu mu cc b
mch ngoi bin v hoi t cng nh tng huyt p kch pht (mt s hi m tai bi n
mch mu no c m t) khi chng c phi hp vi ergotamin,
dihydroergotamin, methysergid...
X l: Trnh phi hp ny v c th dn n nhng hu qu nghim trng. Da
vo cc thuc dng v ng cho thuc nh gi nguy c.
Glycosid tr tim
Phn tch: S dng ng thi cc thuc c th gy tng nguy c ri lon nhp tim.
hp.
X l: Nu cn phi hp, phi theo di in tm . Tuy nhin, khng nn phi

Hormon tuyn gip
Phn tch: Nguy c tng tc dng ca cc hormon tuyn gip.Vi ngi bnh
mch vnh, hormon tuyn gip lm tng nguy c suy mch vnh.
X l: V c nguy c, nu cn phi hp, phi iu chnh liu mt cch chnh xc.
Phn tch: Phenytoin cho trong khi truyn dopamin c th dn n h huyt p
nng v c th lm ngng tim. Tng tc xy ra nhanh. C ch cha r. C th thi u
ht catecholamin do dopamin phi hp vi tc dng lm suy nhc c tim ca
phenytoin.
X l: Dng phenytoin ht sc thn trng cho ngi ang truyn dopamin. Nu
phi dng phenytoin, gim st huyt p cn thn v ngng phenytoin nu c h huyt
p.
Reserpin
Phn tch: i khng dc l v reserpin gy thiu ht catecholamin, do c
nguy c c ch tc dng lm h huyt p.
902
X l: Khng nn phi hp, do nguy c tht bi iu tr.

Phn tch: Do cc thuc chng trm cm nhm imipramin c tnh cht cng thn
kinh giao cm v c ch s ti thu nhn noradrenalin ti synp thn kinh, cn phng
tng mnh tc dng lm h huyt p ca cc thuc cng thn kinh giao cm. Cn ghi
nh tng tc ny vi adrenalin v noradrenalin (cng alpha v beta).
X l: Khng nn phi hp vi adrenalin v noradrenalin. Dng ti ch lm thuc
cm mu, cn theo di tc dng ton thn c th xy ra.
Thuc c ch ti thu hi serotonin (fluoxetin, fluvoxamin, sertralin...)
Phn tch: Tng nhy cm vi tc dng ca cc thuc cng thn kinh giao cm
v tng nguy c xy ra hi chng serotonin. Tng tc xy ra nhanh. C ch cha r.
X l: Nu phi phi hp, cn gim st tc dng gia tng i vi cc du hiu v
triu chng h thn kinh trung ng. iu chnh liu nu cn.
Thuc gy m halogen ho bay hi
Phn tch: Cc thuc gy m halogen ho bay hi lm c tim nhy cm vi tc
dng ca cc thuc cng thn kinh giao cm, c th gy ra trong mt s him trng
hp, ri lon nhp tht nng. Nguy c ny c thy ch yu vi isoprenalin, c
phn loi nh thuc ging beta 1 v beta 2.
X l: Bc s gy m phi bit r tng tn cc liu php ang tin hnh v tin
s ca ngi bnh, v phi c sn cc thit b theo di lin tc (i n tm , huy t
p...), v khuyn khng nn phi hp thuc. Bc s gy m phi tm cch thay i chin
lc iu tr.
Phn tch: Vi ephedrin, fenoterol, terbutalin, c tng tc dc lc gy tng tc
dng ln h tim mch, v thuc c ch MAO gy tch lu cc amin co mch, c nguy c
ri lon huyt p nng, nhc u, lon nhp tim, nn...
X l: Trnh k n cc thuc ny, trong t nht mi lm ngy sau khi ngng
thuc c ch MAO.
Phn tch: Tng tc dng hng thn, c th dn n d b kch thch, mt ng, v
trong s him trng hp, co git v lon nhp tim.
X l: Nn theo di lm sng vi tt c cc thuc cng thn kinh giao cm.
Biguanid; sulfamid h glucose mu
Phn tch: Ni chung, gim tc dng cc thuc chng tiu ng, v tnh cht
tng glucose mu ca cc thuc cng thn kinh giao cm (c bit r rt vi
ephedrin).
X l: Theo di cht ch glucose mu v thng bo cho ngi bnh. Lp mt k
hoch dng thuc u n.
903
Cafein
Phn tch: Vi ngi ung nhiu c ph, c th xut hin nguy c tng tc dng
hng thn, c th dn n d b kch thch, mt ng, v trong mt s him trng hp,
co git v ri lon nhp tim.
X l: Hi ngi bnh v mc tiu th c ph. nh gi nguy c tu thuc vo
dng bo ch dng.
Dn cht nitrat chng au tht mch vnh; guanethidin hoc thuc tng t;
thuc gin mch lm h huyt p; thuc li niu gi kali; thuc li niu thi kali; thuc
c ch enzym chuyn
Phn tch: Tng tc kiu i khng dc l. Cc thuc cng beta c tc dng
tng huyt p nn tc dng chng tng huyt p ca cc thuc phi hp c th b
gim.
X l: Theo di thng xuyn huyt p. Thng bo cho ngi bnh v nhng
nguy c bin ng huyt p, lp mt k hoch dng thuc u n v lu n dng
thuc dng nh gi mc nghim trng ca cc bin ng huyt p (s dng
thuc cng beta trong bnh hen hoc trong e do non). Nu cm thy bt
thng, nn i khm li.
Diazoxid
Phn tch: Tng tc kiu i khng dc l. Cc thuc cng giao cm beta c
tc dng tng huyt p nn tc dng h huyt p ca cc thuc phi hp, c th b
gim.
X l: Theo di thng xuyn huyt p. Thng bo cho ngi bnh v nhng
nguy c bin ng huyt p, lp mt k hoch dng thuc u n v lu n dng
thuc dng nh gi mc nghim trng ca cc bin ng huyt p (s dng
thuc cng beta trong bnh hen hoc trong e do non). Nu cm thy bt
thng, nn i khm li.
Insulin
Phn tch: Phi hp lm gim tc dng cc thuc chng tiu ng, v tnh cht
tng glucose mu ca cc thuc cng thn kinh giao cm beta nh ritodrin,
salbutamol v ephedrin.
X l: Theo di cht ch glucose mu v thng bo cho ngi bnh tng
cng t theo di. Lp mt k hoch dng thuc u n. Lu dng bo ch ca
thuc cng giao cm beta nh ga mc tng huyt p.
Khng histamin H2 (cimetidin)
Phn tch: Tng tc dng tng huyt p ca dobutamin. C ch cha r.
X l: Gim st huyt p. iu chnh liu dobutamin nu cn.
Levodopa
Phn tch: Dng ng thi hai thuc c th gy nguy c lon nhp tim.
X l: Nu cn phi hp, gim liu thuc cng thn kinh giao cm.
Methyldopa
904
Phn tch: Phi hp methyldopa vi thuc cng thn kinh giao cm c th lm

tng huyt p. Tng tc xy ra nhanh. C ch cha r.
X l: Gim st huyt p trong thi gian phi hp. Ngng thuc cng thn kinh
giao cm hoc c th cn phi cho phentolamin (Regitin).
Oxytocin
Phn tch: Phi hp c th gy tng huyt p. Tng tc xy ra nhanh.
C ch: C th c tc dng co mch hip ng.
X l: T l tng huyt p gim nu thuc cng thn kinh giao cm khng dng
trc khi c oxytocin. Clorpromazin c th lm gim huyt p khi c tng huyt p xy
ra do phi hp.
Thuc cng thn kinh giao cm alpha v beta
Phn tch: Tng tc dng kch thch h TKT nn d b kch thch, mt ng, nguy
c co git v ri lon nhp tim.
X l: Theo di lm sng v, nu cn theo di c in tm . Tu trng hp xt
li liu php, cn c vo nhng d kin ny. Thn trng c vi nhng dng dng t i
ch.
Phn tch: Tng tc dng hng thn, c th dn n d b kch thch, mt ng, v
trong mt s him trng hp, co git v lon nhp tim.
X l: Ch yu theo di lm sng, nu cn phi hp. nh gi nguy c ty thuc
vo cc dng bo ch dng.
Thuc gy m cc loi (ngoi halogen ho bay hi v barbituric)
Phn tch: Do tc dng vi tim ca cc thuc cng thn kinh giao cm beta.
X l: Khuyn ngi bnh sp phu thut, thng bo cho bc s gy m v nhng
thuc ang dng.
Thuc kim ho nc tiu (natri bicarbonat...)
Phn tch: Kim ho nc tiu c th lm tng na i v lm gim o thi
ephedrin hoc pseudoephedrin. C th tng tc dng iu tr hoc nhim c ca
thuc cng thn kinh giao cm. Tng tc xy ra mun. C ch ti hp thu thuc
cng thn kinh giao cm ng thn c th tng do pH nc tiu trong.
X l: C th phi gim liu thuc cng thn kinh giao cm trong khi phi hp
vi cc thuc kim ho nc tiu.
Thuc c ch MAO typ B
ca levodopa, iu gii thch vic k n cng vi cht ny. Tng tc nh v y
ging nh tng tc ca levodopa v xin xem h thuc .
X l: Khng nn phi hp, v c nguy c iu tr tht bi.
905

Phn tch: Tng tc dc lc do amphetamin l amin cng thn kinh giao cm.
Tng tc dng hng thn, c th dn n d b kch thch, mt ng, v trong mt s
him trng hp, co git v lon nhp tim.
X l: Theo di lm sng. Tc dng r rt nhiu hay t tu thuc vo cc d ng
thuc cng thn kinh giao cm c dng (thuc chng hen). Thay i chin lc
iu tr nu cn, hoc iu chnh liu.
Thuc din hot tng hp tc dng phi
Dn cht phosphatidylcholin, lm gim sc cng b mt ph nang, t o i u
kin
d dng cho s trao i kh phi, phng xp ph nang
Cc thuc trong nhm
COLFOSCERIL PALMITAT l bt ng kh 108 mg ( pha dch treo tim)
Surfexo-neonatal l bt ng kh 108 mg ( pha dch treo tim)
Survanta l bt ng kh 108 mg ( pha dch treo tim)
ch khi ch nh thuc
Chng ch nh: mc 4
qun.
Cc trng hp khc: Ph phi. Tit dch qu nhiu ph qun - tiu ph

thuc i khng morphin
Cc thuc ny c dng lm thuc chng ng c morphin v cc opiat khc

v khng c tc dng ging morphin ti cc th th
Cc thuc trong nhm
NALORPHIN ng tim 10 mg
Nalline ng tim 10 mg/2 mL
NALOXON ng tim 0,4 mg/1mL
Nalone ng tim 0,4 mg/1mL
Narcan ng tim 0,4 mg/1mL
Ch khi ch nh thuc
Cc trng hp khc: Cn phi thn trng nhng ngi bnh m li nghin
ma tu, c th nghin cc thuc ly t nha qu thuc phin v cc opiat tng hp v
bn tng hp (c th c cn cai nghin).
Cn theo di: mc 1
Thi k mang thai: V thn trng, do cha c d liu.
Suy tim/Suy mch vnh: ngi bnh suy tim nng, dng liu qu cao, c th
gy nhp nhanh tht v rung tht.
906
Tng tc thuc
Phn tch: i khng dc l, c bit i khng vi cc tc dng gim au, tc
dng c ch h hp v c ch h thn kinh trung ng ca cc thuc ch vn ca
morphin.
X l: C th dng lm thuc chng c. Khi dng cho ngi nghin ma tu, cn
ch n nguy c hi chng cai nghin.
thuc i khng th th HT3
Cc thuc i khng vi cc th th HT3 ca serotonin nh v cc n rn
ngoi bin v h thn kinh trung ng
Cc thuc trong nhm
GRANISETRON HCl thuc tim 3 mL (3,35 mg granisetron HCl + 27 mg NaCl)
Kytril ng tim 3 mL (3,35 mg granisetron HCl + 27 mg NaCl)
ONDANSETRON: ng tim 4 mg, 8 mg; vin nn 8 mg, 4 mg
Emeset: vin nn 4 mg; 8mg; dung dch tim 2mg/mL
Osetron: vin nn 4 mg; 8mg; dung dch tim 4mg/2mL, 8mg/4mL
Periset: vin bao phim 4 mg; 8mg
Setronax
Zophren ng tim 4 mg; 8 mg
Zophren vin nn 8 mg; 4 mg
TROPISETRON: ng tim 5 mg; vin 5 mg
Navoban ng tim 5 mg
ch khi ch nh thuc
Chng ch nh: mc 4
Cc trng hp khc: D ng vi mt thuc phi hp.
Thn trng: mc 2
Suy gan: Khi c thay i cc thng s dc ng hc, phi hiu chnh liu lng
(ondansetron).
Cn theo di: mc 1
Thi k cho con b / thi k mang thai : Do cha nghin cu ring v vn
ny.
thuc i quang c baryt
Cc thuc c dng gy i quang ng tiu ho khi xt nghim X quang
Cc thuc trong nhm
907
BARY SULFAT gi 140g

Bary sulfat gi 140g
Ch khi ch nh thuc
Chng ch nh: mc 4
Cc hi chng tc v thng ng tiu ho khi dng theo ng trc trng.
908
thuc i quang c iod

Cc thuc i quang trong X quang, mang 3 hay 6 nguyn t iod trong phn t ,
ion ho hoc khng ion ho, c cc chng ch nh v tng tc c th khc nhau.
Cn phi ch n cc tng tc bit ngi bnh thng bo cho bc s
X quang bit v tr liu mnh ang dng
Cc thuc trong nhm
ACID AMIDOTRIZOIC dung dch tim 60 ; 76 %
Urografin dung dch tim 60%
Urografin dung dch tim 76%
DIMEGLUMIN GADOPENTETAT dung dch tim 469 mg/mL
Magnevist dung dch tim 469 mg/mL
IOPROMID dung dch tim 240 mg iod/mL; 300 mg iod/mL; 370 mg iod/mL
Ultravist dung dch tim 240 mg iod/mL
MEGLUMIN AMIDOTRIOZOAT dung dch tim 0,65 g/mL
Angiografin dung dch tim 0,65 g/mL
MEGLUMIN TOXITALAMAT dung dch tim 30% ; 350 mg/mL; 25%
Telebrix dung dch tim 30%
Meglumine Telebrix dung dch tim 350 mg/mL
Telebix Hystero dung dch tim 25%
NATRI MEGLUMIN dung dch tim 30%; 32%; 35%
Telebrix dung dch tim 30%
Meglumine dung dch tim 35%
Hexabrix dung dch tim 32%
Ch khi ch nh thuc
Chng ch nh: mc 4
Qu mn vi ch phm.
Thi k mang thai: Cc thuc ny qua hng ro nhau thai. Khng mt tai bi n
no c m t ngi mang thai. Tuy vy, vi cc thuc i quang hu c c iod,
suy gip trng c m t bo thai.
Suy gan: Chng ch nh khi b suy gan nng v vng da lm sng.
Suy thn: Chng ch nh khi suy thn nng.
909
Trng hp khc: Dng theo ng di mng nhn c th gy co git v dn

n t vong.
Cn theo di: mc 1
Thi k cho con b: Ch phm qua c sa m. Trnh cho b trong 24 gi sau
khi xt nghim X quang c dng cc thuc ny.
Tr em; tr cn b: Khng cho dng tr cn b do thiu cc d liu lm sng.
Tng tc thuc
Phn tch: Khi b d ng, thuc chn beta (k c dng nh mt) lm gim b tr
tim mch, c bit trong trng hp h huyt p hay sc. Chnh thuc chn beta
ngn chn c th tit adrenalin p ng sinh l bnh thng trong trng hp
chong phn v.
X l: Hi ngi bnh v tin s: C phi ngi bnh dng ln u mt thuc
i quang c iod khng? Khi b sc, vic gim c ch b tr c th l nguy him nn s
phi hp ny l chng ch nh. Khng k n cho ngi bnh c tin s d ng.
Thuc chn calci
Phn tch: Tc dng h huyt p ca c liu thuc i quang ion ho tim tnh
mch ngay mt lc c th tng ln khi ngi bnh ang dng mt thuc chn calci
(ditiazem, nifedipin, verapamil). Khng c tng tc hoc tng tc rt t khi dng
thuc i quang khng ion ho. Mt trng hp nhp nhanh tht nng c bo co
mt ngi ang dng prenylamin khi c thm natri iotalamat (iothalamat). C ch
c hai thuc u c kh nng ko di khong QT.
X l: Phi hp nn trnh. Nu dng, phi ht sc thn trng. Cc nh sn xut
natri iotalamat cng khuyn co trnh dng thuc ny khi c gim kali mu, hoc phi
hp vi loi thuc nh procainamid v quinidin c khuynh hng ko di khong QT.
Biguanid
Phn tch: Nguy c nhim acid lactic, gy nn bi suy thn chc nng do cc ch
phm i quang, c bit l cc loi ba nguyn t iod v loi su nguyn t iod to ra.
X l: Ch ngi bnh b suy thn. Nn ngng iu tr bng metformin 48 gi
trc khi xt nghim X quang v ch iu tr li sau xt nghim ny 48 gi.
Ciclosporin
X l: Theo di chc nng thn ( thanh lc creatinin) trc v sau xt nghim X
quang. Cc ngi bnh dng ciclosporin phn ln trng hp l ngi c ghp thn,
cn trnh phi hp cc ch phm c vi thn nhng ngi ny. Yu cu ngi
bnh bo cho bc s X quang v vic mnh ang dng ciclosporin.
910
Phn tch: Cc ch phm i quang c iod, khi c dng gn ngay sau

interleukin, lm ti xut hin cc triu chng kinh in do interleukin (qu mn, au
khp, chng mt, h huyt p, bun nn...).
X l: Cc triu chng ny c v xut hin t hn, thm ch khng c, khi dng
cc ch phm i quang c iod v interleukin cch nhau khong 6 tun. Interleukin l
mt ch phm mi, kh s dng v ch c dng c s chuyn khoa vi s theo di
thng xuyn v cc tc dng khng mong mun. Cc tng tc cn c cn nhc
theo mc bnh v ngi k n phi lun nh gi tng quan nguy c/li ch.
Thuc li niu gi kali; thuc li tiu thi kali; furosemid hoc tng t
Phn tch: Tng nguy c suy thn cp, nu c th mt nc do thuc li tiu
(c bit vi cc ch phm i quang c ba nguyn t iod v 6 nguyn t iod ion ho ).
X l: Nn b nc cho ngi bnh trc khi cho dng ch phm i quang c
iod. Khuyn ngi bnh bo cho bc s X quang vic mnh dng thuc li ni u bc
s c nhng bin php cn thit.
911
Thuc gy mn cm nh sng
Cc thuc gy mn cm nh sng h psoralen
Cc thuc trong nhm
METHOXSALEN (9- Methoxypsoralen): vin nn 10mg; dung dch bi ngoi 0,1%;
0,75%
Meladinine
5-METHOXYPSORALEN
Psoraderm-5 vin nn 5mg
Ch khi ch nh thuc
Chng ch nh: mc 4
Thi k mang thai: Phi hp psoralen vi cc UVA (puva tr liu: chiu cc bc
x t ngoi A c bc sng trong khong 320-380 nanomet) l chng ch nh ph
n mang thai. Nn dng mt bin php nga thai.
Cc vim da b nng thm do nh sng mt tri (lupus ban , ri lon
chuyn ho porphyrin).
Cn theo di: mc 1
Tng huyt p, suy tim, suy gan, suy thn: Do tc dng khng mong mun ca
loi thuc ny.
Thuc gy x cng tnh mch
Cht gy x cng ni m tnh mch
Cc thuc trong nhm
POLIDOCANOL ng tim 0,5%; 2%; 3%
Aetoxisclerol ng tim 0,5%; 2%; 3%
QUININ ng tim 250 mg
Kinurea H ng tim 250 mg quinin v ure HCl
SODIUM TETRADECYL SULFAT ng tim 1%; 3%
Trombovar ng tim 1%; 3%
ch khi ch nh thuc
Trng hp: Ngi bnh ang iu tr vi thuc chng ng mu.
Thuc gin mch ngoi bin dng trong iu tr tng huyt p ng mch
v mt s loi suy tim
Cc thuc trong nhm
DIHYDRALAZIN MESYLAT: ng tim 25 mg/2mL; vin nn bc 25 mg
912
Depressan vin nn 25 mg
Nepresol dung dch tim 25 mg/mL
Trasipressol vin nn bc 25 mg
MINOXIDIL: dung dch bi ngoi 3%, 2%, 5%; vin nn 5 mg, 10 mg
Alopexy dung dch bi da u 2%
Baldmin dung dch bi ngoi 3%
Loniten vin nn 2,5 mg; 5 mg; 10 mg
Lonotan vin nn 5 mg; 10 mg
Neoxidil dung dch bi ngoi 2%
Regaine dung dch bi ngoi 2%; 5%
SODIUM NITROPRUSSID ng tim 50 mg/2mL
Nipride dung dch tim ng 50 mg
Nitropress dung dch tim ng 50 mg
Ch khi ch nh thuc
vt.
Cng tuyn gip: V nhp tim nhanh th pht do kch thch h thn kinh thc
Suy tim: Chng ch nh hydralazin trong suy tim c lu lng cao (tng rt ng
k tn s v lu lng tim ng thi vi gim huyt p). Tnh cht phn x ny c
s dng trong trng hp suy tim c lu lng thp khng vi cc cch iu tr kinh
in.
Suy mch vnh: Hydralazin c th gy cn au tht ngc bng cch tng gin
tip lu lng mu qua mch vnh do chnh tim tng tiu th oxy th pht do nhp tim
nhanh v tng lu lng mu tim. Nn trnh dng cc thuc ny sau nhi mu c tim
gn y.
Suy gan: Gim liu (hydralazin).
Suy thn: Hydralazin phi gim liu, nu thanh lc creatinin di 30mL/pht.
Cn theo di: mc 1
Thi k cho con b: Do thn trng, v thuc qua c sa m.
Thi k mang thai: Mc du cha chng minh c tc dng sinh qui thai.
Tng tc thuc
Zalcitabin
Phn tch: C th xy ra vim dy thn kinh ngoi bin.
X l: Theo di lm sng pht hin d cm.
913
Tng tc lm tng tc dng h huyt p

Ru
Aldesleukin
Alprostadil
Cht ch vn ca morphin; dextropropoxyphen
Dopaminergic: bromocriptin hoc thuc tng t; levodopa
IMAO khng chn lc; procarbazin
Moxisylyt
Thuc an thn kinh: clozapin; butyrophenon, phenothiazin; thioxanthen,
Thuc chng lon nhp tim: quinidin hoc dn cht
Thuc chng trm cm ba vng v tng t
Thuc chn calci: bepridil; dihydropyridin; diltiazem; verapamil
Thuc gy m, t: lidocain hoc thuc tng t
Thuc gin c: baclofen
Thuc h huyt p khc: guanethidin hoc thuc tng t; methydopa;
diazoxyd
Thuc li niu: li niu gi kali; li niu thi kali; li niu quai furosemid
hoc thuc tng t
Thuc c ch enzym chuyn
X l: Gim st huyt p trong khi phi hp. Tu theo thuc, huyt p c th gim
nhiu hay t. Nu cn, iu chnh liu ca mt hoc hai thuc. Lp mt k hoch dng
thuc u n. Tng cng ch n ngi bnh cao tui (nguy c ng) v khuyn h
chuyn dn dn, t t th nm hay ngi sang t th ng. Cn gp li bc s iu
chnh liu, nu thy chng mt khi dng thuc.
Tng tc lm gim tc dng chng tng huyt p (i khng)
Amphetamin hoc dn xut
Phn tch: Amphetamin l thuc cng giao cm trc tip v v vy lm tng
huyt p. Phi hp vi cc thuc h huyt p s dn n i khng tc d ng v kh
t c cn bng huyt p.
X l: i vi ngi bnh tng huyt p, trnh k cc thuc amphetamin.
Amphetamin; corticosteroid khong; dn cht ca pyrazol; estrogen hoc
progestogen, thuc ung nga thai; indometacin hoc dn cht; tetracosactid; thuc
914
cng giao cm alpha v beta; thuc cng giao cm beta; thuc chng lot d dy:
carbenoxolon; thuc chng vim khng steroid
Phn tch: Phi hp lm gim tc dng h huyt p do thuc phi hp c tnh
cht lm tng huyt p nh thuc cng giao cm alpha, beta hoc do thuc phi hp
c tnh gi nc nh corticosteroid.
X l: Phi thng xuyn theo di huyt p. Thng bo cho ngi bnh v nguy
c bin i huyt p trong v sau khi ngng mt trong hai thuc. C khi phi iu chnh
liu. Ch c bit n ngi bnh cao tui.
Baclofen; clozapin
X l: Gim st huyt p v iu chnh liu ca thuc h huyt p (dng cho mc
tiu iu tr chnh) trong v sau khi ngng phi hp. Ch c bit n ngi bnh cao
tui.
Butyrophenon
Phn tch: Tng tc dng h huyt p ca cc thuc .
X l: Nu cn phi hp, phi tng cng gim st huyt p ng mch, trong v
sau khi ngng mt trong hai thuc. iu chnh liu ty theo tnh hnh. Nhn mnh vi c
tun th k hoch dng thuc u n. Ch c bit n ngi bnh cao tui.
Corticoid khong
Phn tch: Hiu qu ca thuc h huyt p gim, c l do tc dng gi natri ca
cc steroid.
X l: Nu cn phi hp, tng cng gim st huyt p ng mch trong v sau
khi ngng mt trong hai thuc. Nu cn, iu chnh liu. Nhn mnh vic phi dng
thuc u n. c bit ch n ngi bnh cao tui.
Diazoxyd
Phn tch: Phi hp hai thuc c tnh cht lm h huyt p.
X l: V diazoxyd lm tng glucose mu, phi cnh gic khi phi hp hai thuc
theo mc tiu iu tr chnh. Gim st thng xuyn huyt p ng mch.
Phn tch: Phi hp vi bt c thuc gin mch no u c th tng nguy c h
huyt p i khi i ti chong.
X l: Gim st huyt p trong v khi ngng mt trong hai thuc. c bi t ch
n ngi bnh cao tui.
Phenothiazin
Phn tch: Tng tc dng h huyt p ca cc thuc ny. H huyt p l tc dng
khng mong mun r rt ca cc thuc an thn kinh dn xut t phenothiazin.
X l: Nu cn phi hp, tng cng gim st huyt p ng mch, trong v sau
khi ngng mt trong hai thuc. iu chnh liu nu cn. Nhn mnh vi c phi dng
thuc u n. c bit ch n ngi bnh cao tui, phng ng do h huyt p.
915

gy h huyt p th pht.
khi ngng mt trong hai thuc. Nu cn, phi iu chnh liu. Nhn mnh vi c dng
thuc u n. c bit ch n ngi bnh cao tui.
Phn tch: Tng tc kiu i khng dc lc. Cc thuc ging cng giao cm
beta c tc dng tng huyt p nn khi dng ng thi vi cc thuc lm h huyt p,
c th lm gim tc dng tng huyt p ca chng.
X l: Gim st huyt p u n. Thng bo cho ngi bnh v nhng nguy c
bin i huyt p, lp k hoch dng thuc u n v tnh n dng thuc cho dng
nh gi mc nghim trng ca cc bin i huyt p (s dng cc thuc cng
giao cm beta trong chng hen hoc khi do non).
Phn tch: Dng ng thi hai thuc ny c th dn n nhng bin i quan
trng v huyt p.
X l: Thuc c ch MAO him khi c s dng, c nhiu tng tc v do him
khi k n, nn c t nhn xt v cnh gic dc. Tuy nhin nn thn trng, ch k n
dng thuc c ch MAO sau khi ngng dng thuc h huyt p 2- 3 tun l.
Cc dn cht ca pyrazol; indometacin hoc dn cht; thuc chng vim khng
steroid
Phn tch: Gim tc dng chng tng huyt p; thuc chng vim khng steroid
c ch tng hp ti thn cc prostaglandin gin mch v/ hoc gy natri v nc.
X l: m bo ngi bnh c tip nc tt, gim st chc nng thn (
thanh lc creatinin), m bo huyt p ng mch n nh, c bit khi bt u i u
tr. Phi lu n cc nguy c trn khi k n thuc, c bit khi k n dng
indometacin. Khuyn ngi bnh theo di u n huyt p.
Glucocorticoid: tetracosactid
Phn tch: Tc dng chng tng huyt p c th b gim v natri v nc do
glucocorticoid.
X l: iu chnh liu trong v sau iu tr bng corticoid. Thng bo cho ngi
bnh tng cng t gim st trong khi iu tr bng corticosteroid. Khuyn c mt
k hoch dng thuc u n trong qu trnh iu tr. Khuyn gp li bc s, nu c
nhng bin i quan trng v huyt p.
dng khng mong mun ca cc thuc chng trm cm ba vng.
916

khi ngng iu tr mt trong hai thuc. Nu cn, iu chnh liu. Nhn mnh vic phi
dng thuc u n. c bit ch n ngi bnh cao tui.
thuc h lipid mu cc loi
Cc thuc h cholesterol mu hoc h lipid mu khng c quan h ho hc vi
cc fibrat, cc statin hoc cholestyramin
Cc thuc trong nhm
BENFLUOREX vin nn bao 150 mg
Mediator 150 vin nn bao 150 mg
TIADENOL vin nn 400 mg
Fonlipol vin nn 400 mg
Ch khi ch nh thuc
Cn theo di: mc 1
Thi k cho con b / mang thai: V thn trng, do khng c thng tin.
Suy tim: Trnh dng probucol trong trng hp bnh c tim hoc lon nhp tht.
Suy gan: Trnh k n tiadenol trong trng hp suy gan nng.
Suy thn: Trnh k n tiadenol trong trng hp suy thn nng.
Thuc khng acid ung, thuc bao nim mc v hp ph
Thuc bao d dy - rut c hot cht l cc mui nhm, calci v magnesi hay
than hot. Do tnh hp ph, chng lm gim hp thu qua ng tiu ho rt nhi u th
thuc dng ng ung. Natri bicarbonat dng trong iu tr
theo ng ung thuc nhm ny
Cc thuc trong nhm
ATTAPULGIT: gi bt pha hn dch ung 3 g; gi bt 2,5 g; vin nn 600 mg
Actapulgite gi bt pha hn dch ung 3 g
Gastropulgite gi bt pha hn dch ung 2,5 g
New Diatabs vin nn 600 mg
ALUMIN HYDROXYD: vin nn 400 mg; 300 mg
Topaal vin nn 300 mg
ALUMIN GEL (BOEHMITE) dch treo ung 11,6 g/ti
Rocgel ti dch treo ung 11,6 g/ti
ALUMIN PHOSPHAT dch treo ung 12,38 g /ti
Phosphalugel ti dch treo ung 12,38 g /ti
MAGNESI HYDROXYD
Magnesia S.Pellegrino Anis cm pha dung dch ung
917
CALCI CARBONAT + MAGNESI CARBONAT: vin nhai 0,680 g + 0,080 g; vin

nn 0,680 g + 0,080 g
Rennie vin nhai (0,680 g calci carbonat + 0,080 g magnesi carbonat)
Rencid vin nn (0,680 g calci carbonat + 0,080 g magnesi carbonat)
HYDROTALCID vin nn nhai 500 mg
Talcid vin nn nhai 500 mg
MAGNESI TRISILICAT vin nn 500 mg
Magnesi trisilicat vin nn 500 mg
DIOSMECTID gi thuc bt 3 g
Smecta gi thuc bt 3 g
NHM HYDROXYD V MAGNESI HYDROXYD: gel l 240 mL; vin nn 120 mg; 250
mg
Antacil gel l 240 mL
Gamaxcin vin nn 120 mg, 250 mg
Maalox vin nn (400 mg hydroxyd nhm v 400mg magnesi hydroxyd)
NATRI BICARBONAT gi 100 g
Vin nn 450 mg
Natri hydrocarbonat gi 100 g
Nabica vin nn 450 mg
Than hot vin nhai 400 mg
Carbophos vin nhai 400 mg (than hot, calci carbonat v tricalciphosphat)
ch khi ch nh thuc
Suy thn: Nguy c thay i ty theo cation c mt trong thuc khng acid. Natri:
nhim kim chuyn ho (tng o thi bicarbonat). Calci: c vi tim v gy si thn.
Nhm: mt phosphor v ri lon xng. Magnesi: c ch h thn kinh trung ng v c
ch dn truyn thn kinh- c.
tng tc thuc
Phn tch: Acid chenodesoxycholic gp phn lm tng t l: acid mt/ cholesterol
bng cch thit lp li cn bng gia cc thnh phn ca mt, n c th gp phn lm
nh li cc si mt cholesterol. Khi to phc acid chenodesoxycholic (vi cholestyramin
v cc khng acid), hoc khi lm tng bo ho ca mt (dng estrogen, progesteron,
fibrat, neomycin ung), c s gim hot tnh ca acid chenodesoxycholic.
918
X l: iu tr bng acid chenodesoycholic phi di ngy (t 6 thng n 1 nm).

Cn trnh tht bi trong iu tri, v khng c phi hp thm nhng thuc lm gim
hiu qu ca thuc c k n, tr trng hp ch dng phi hp trong thi hn
rt ngn.
Pentagastrin
Phn tch: C kh nng gim hp thu v gim tc dng ca pentagastrin.
X l: Khuyn ngi bnh dng mi thuc cch nhau t nht 4 gi.
Quinidin hoc dn cht
Phn tch: Mt s thuc khng acid (th d: cc loi cha natri bicarbonat) c tc
dng kim ho nc tiu. Trong trng hp ny, s o thi quinidin b chm li, nn
s tng tc dng. Trong mi trng kim, quinidin o thi di dng khng phn cc
v c ti hp thu. Nh vy trong trng hp ny, ty thuc vo pH m c th c
nguy c tng nng quinidin trong huyt tng v qu liu.
X l: Trong mt s hon cnh iu tr, theo di pH ca nc tiu s c ch. C
th o pH bng giy ch th kim tra tnh acid hay tnh kim ca nc ti u. Nu
nc tiu kim tnh, phi theo di in tm v nng quinidin trong huyt thanh, t
hiu chnh liu lng trong thi gian dng v lc ngng dng cht ki m ho n c
tiu. Cc thuc khng acid c th lm thay i pH bng cch kim ho nc tiu,
nhng tng tc yu do kim ho ny thng khng . Tuy vy vn phi theo di khi
dng phi hp ny.
Natri polystyren sulfonat
Phn tch: Vic dng ng thi cc thuc khng acid vi nha trao i ion natri
polystyren sulfonat c th gy nhim kim chuyn ho, c bit ngi bnh suy thn,
v lm gim s lin kt gia ion kali vi nha trao i ion. Thng thng cc cation kim
loi c trong cc thuc khng acid s trung ho bicarbonat rut non, lm cho
bicarbonat kh b hp thu. Khi c mt nha trao i ion natri polystyren sulfonat, c ion
kim loi trn s u tin lin kt vi nha trao i ion, lm cho bicarbonat c hp thu
d dng, gy ra nhim kim chuyn ho.
X l: Phi dng mi thuc cch thuc kia 2 n 3 gi.
Tacrolimus
Phn tch: C th gim nng tacrolimus trong d dy, do tnh khng bn ca
tacrolimus trong mi trng acid, hoc do hin tng hp ph, v iu ny xy ra trong
vng 2 gi. Tng tc dc ng hc v hp thu thuc m t vi cc sn phm
cha cc mui nhm ( hydroxyd v oxyd). S kim ho cng xy ra vi cc mui calci
v magnesi.
X l: Tt hn, nn trnh phi hp thuc ny v thay th thuc.
Phn tch: Gim hp thu alopurinol theo ng tiu ho, do gim tc dng ca
thuc ny.
919
X l: Phi ung thuc cch nhau t nht 1 n 2 gi. Cc thuc khng acid
thng c dng sau ba n 1 gi 30 pht, v n l nguyn nhn ca tng tit dch
d dy. Tng tc ny vi alopurinol cn cn khng nh thm.
Barbituric; benzamid; butyrophenon; cisaprid; diphosphonat; ethambutol; furosemid
hoc thuc tng t; glucocorticoid; glycosid tr tim; indomethacin hoc dn cht;
isoniazid hoc thuc tng t; lansoprazol; natri valproat hay cc dn cht; nitrofuran;
omeprazol; penicillin; phenothiazin; primidon hay cc dn cht; tetracyclin; thuc an
thn kinh cc loi; thuc chng lot d dy khng H 2 kiu cimetidin; thuc chng lot
d dy khng H2 kiu ranitidin; thuc chng nm dn xut ca imidazol; thuc ung
chng ng mu khng vitamin K
Phn tch: Thuc khng acid lm gim hp thu qua ng tiu ho, do gim
tc dng ca thuc dng phi hp.
X l: Phi ung mi thuc cch nhau t nht 1 n 2 gi. Cc thuc khng acid
thng c dng sau ba n 1 gi 30 pht, v n l nguyn nhn tng tit d ch d
dy.
Didanosin
Phn tch: Tng nguy c tc dng khng mong mun ca didanosin. Thc vy,
thuc khng acid lm tng pH ca d dy, nn lm chm s ging ho ca didanosin.
Nh vy, cht ny c hp thu nhiu hn, nng trong huyt tng tng.
X l: Theo di lm sng v sinh hc cc tc dng khng mong mun lin quan
n didanosin: theo di huyt hc (s lng v cng thc mu); theo di lm sng (tiu
chy, bnh v thn kinh ngoi bin); theo di tuyn tu (lipase huyt thanh).
Levothyroxin
Phn tch: Tc dng ca levothyroxin c th b gim. Tng nng huyt thanh
TSH (hormon kch thch tuyn gip). Tng tc xy ra chm. C ch sinh kh d ng
levothyroxin b gim do c cn tr hp thu.
X l: Cn gim st nng TSH huyt thanh ngi ung levothyroxin khi phi
hp vi thuc khng acid cha nhm hydroxyd.
Lincosamid
Phn tch: Kaolin lm gim hp thu lincosamid ng tiu ho, do gim tc
dng ca chng.
X l: Phi ung khng acid v lincosamid cch nhau t nht 1 n 2 gi. Thuc
khng acid thng c dng sau ba n 1 gi 30 pht, v n l nguyn nhn tng tit
dch d dy.
Macrolid
Phn tch: Nng nh ca azithromycin trong huyt tng gim r khi ung
cng thuc khng acid.
X l: Trnh k n thuc khng acid cng azithromycin. Nu phi hp, khuyn
ngi bnh ung thuc khng acid v azithromycin cch nhau t nht 2 gi.
920
Phn tch: Gim hp thu penicilamin do st (ti 35%) v do cc khng acid (t i

60%).
X l: Phi ung thuc khng acid v thuc c penicilamin hoc cht tng t
cch nhau t nht 2 gi. Thuc khng acid thng c dng sau ba n 1 gi 30 pht,
v n l nguyn nhn tng tit dch d dy.
Quinolon - sparfloxacin
Phn tch: Cc quinolon ni chung v cc fluoroquinolon ni ring, dng theo
ng ung, s to phc chelat vi cc cation ho tr 2 v 3, nh nhm, magnesi, calci,
st, km.
X l: Phi ung thuc khng acid v thuc phi hp cch nhau t nht 2 gi. Cc
thuc khng acid thng c ung sau ba n 1 gi 30 pht, v n l nguyn nhn
tng tit dch d dy.
St
Phn tch: Thuc khng acid lm gim hp thu st qua ng tiu ho, do lm
gim tc dng ca thuc phi hp vi chng. Tng tc ny c ngha c bi t khi
dng cc thuc khng acid c hot cht l mui, oxyd v hydroxyd magnesi, nhm,
calci.
X l: Ung cc khng acid v thuc cha st phi cch nhau t nht mt n hai
gi. Cc thuc khng acid thng c dng sau ba n 1 gi 30 pht, v n l nguyn
nhn tng tit dch d dy.
Sucralfat
Phn tch: Phi hp thuc ny c th c li trong s dng, nhng vic dng ng
thi hai thuc ny lm gim lin kt sucralfat vi nim mc.
X l: Phi ung cc thuc khng acid v sucralfat cch nhau t nht 2 gi. Cc
thuc khng acid thng c dng sau ba n 1 gi 30 pht, v n l nguyn nhn
tng tit dch d dy.
Thuc chn beta
Phn tch: Thuc khng acid lm gim hp thu ng tiu ho, do lm gim
tc dng ca thuc dng phi hp. Tng tc ny lin quan n cc thuc chn beta:
atenolol, metoprolol, propranolol.
X l: Phi ung mi thuc cch nhau t nht 2 gi. Cc thuc khng acid thng
c dng sau ba n 1 gi 30 pht, v n l nguyn nhn tng tit dch d dy.
Diacerhein
Phn tch: Gim hp thu diacerhein, nn c th lm gim tc dng.
X l: Khuyn ngi bnh ung mi thuc cch nhau t nht 2 gi.
Levodopa
Phn tch: Tc dng ca levodopa c th tng. C ch thuc khng acid lm d
dy chm tng thc n, nn hp thu levodopa rut nhanh hn v hon ton hn.
921
X l: Khng cn phi can thip.

Salicylat
Phn tch: Gim hp thu ng tiu ho v gim ti hp thu ng thn, do
nng ca salicylat trong huyt thanh b gim, nu cht khng acid c tnh cht lm
kim ho nc tiu.
X l: Phi ung cc thuc khng acid v salicylat cch nhau t nht 2 gi . Cc
thuc khng acid thng c dng sau ba n 1 gi 30 pht, v n l nguyn nhn
tng tit dch d dy.
Thuc c ch enzym chuyn dng angiotensin (captopril)
Phn tch: Tc dng h huyt p ca captopril c th b gim. C ch hp thu
captopril ng tiu ho b gim. Tng tc xy ra nhanh.
X l: Nu nghi ng c tng tc, ung cc thuc cch nhau 1-2 gi.
thuc khng cholinergic
Thuc lm lit ph giao cm, u bng l atropin
Cc thuc trong nhm
ATROPIN: vin nn 0,25 mg, 0,5 mg; dung dch nh mt 1%; ng tim 0,5
mg/1mL, 0,25 mg/1 mL
Atropin sulfat vin nn 0,25 mg; 0,5 mg
Atropin sulfat dung dch nh mt 1%
Atropin sulfat mnh ng tim 0,5 mg/1mL
Atropin sulfat dung dch tim 0,25 mg/1 mL
BIPERIDEN: vin nn 2 mg; ng tim 5 mg/1mL; vin bao ng 4 mg
Akineton vin nn 2 mg
Akineton ng tim 5 mg/1mL
Akineton retard vin bao ng 4 mg
Hyoscyamin v dn cht: ng tim 20 mg/2 mL; 20 mg/1mL; vin nn 10 mg; nang
10 mg; vin nn bao 10 mg
Buscomine ng tim 20 mg/2 mL
Duscobane vin nn 10 mg
Duscobane ng tim 20 mg/1mL
Fucon nang 10 mg
Fucon vin nn 10 mg
Hyoscine Butyl Bromide vin nn bao 10 mg
Scopolamin v dn cht: vin nn 10 mg; ng tim 20 mg/1 mL; cao dn 0,75 mg
Buscopan vin nn 10 mg
Buscopan ng tim 20 mg/1 mL
922
Buston ng tim 20 mg/1 mL

Kimite cao dn 0,75 mg
chng ch nh v thn trng khi dng
Tng nhn p: mt, atropin c ch cc kch thch cholinergic, lm gin ng t
(gin ng t th ng), v lit kh nng iu tit, lm tng nhn p, c th gy c n
tng nhn p cp tnh nhng ngi c t bm gc mng mt- gic mc hp
Ph i tuyn tin lit; ung th tuyn tin lit: Nguy c b i, do gim trng
lc co bp ca niu qun v do c ch mt phn co bp ca bng quang.
Thn trng: mc 2
Suy tim: Dng liu cao, atropin gy nhp tim nhanh do phong b lung thn kinh
cholinergic.
Cc trng hp khc: Ch trng hp hp mn v.
Cn theo di: mc 1
Thi k cho con b: Atropin qua c sa m v c ch tit sa.
Tr em: Tng nhy cm vi cc tc dng khng mong mun ca cht khng
cholinergic.
Thi k mang thai: c nhng trng hp nhim c atropin tr mi sinh,
vi lit rut gy tc, cht nhy c qunh kh ly ra trong kh ph qun, gin ng t ,
nhp tim nhanh, khi ngi mang thai dng lu di cc thuc khng cholinergic.
Suy thn: Ngi suy thn s nhy cm hn vi cc tc dng khng mong mun
ca thuc khng cholinergic.
Ngi bnh cao tui: Ngi bnh cao tui s nhy cm hn vi cc tc dng
khng mong mun ca thuc khng cholinergic.
Tng tc thuc
Benzamid
Phn tch: Dng ng thi cc thuc ny (nht l vi metoclopramid) c th dn
ti i khng tc dng trn nhu ng rut.
X l: Trnh phi hp thuc ny v c nguy c tht bi trong iu tr.
Thuc cholinergic
Phn tch: Phi hp thuc khng hp l, tr trng hp nhim c. C i khng
dc l.
X l: Xc nh mc tiu iu tr. Cn phn bit rnh mch cc tc dng khng
mong mun kiu khng cholinergic gp khi dng nhng thuc chng trm cm ba vng
v mt s hp cht phenothiazin (nh kh ming, gin ng t) vi tc dng chnh ca
cc thuc khng cholinergic m ta cn s dng vo mc ch iu tr.
923
Haloperidol
Phn tch: Tng tc thuc lm cho cc triu chng thn kinh phn lit nng ln,
lm gim nng haloperidol trong huyt thanh v lm xut hin lon ng mun. C
ch cha r. Tng tc xy ra mun.
X l: Ch dng cc thuc khng cholinergic cho ngi bnh ang dng
haloperidol khi tht cn. Phi theo di ngi bnh cht ch. Nu cn th hiu chnh liu
haloperidol hoc ngng dng thuc khng cholinergic.
Tacrin
Phn tch: Tc dng dc l i khng
X l: Nu c th, hon k n thuc khng cholinergic phi hp vi tacrin. C
nguy c tht bi hon ton trong iu tr
Bromocriptin v cc thuc tng t
Phn tch: Nguy c xut hin l ln, hay gp khi dng phi hp Lisurid vi cc
thuc chng Parkinson khng cholinergic.
X l: Dng phi hp ny cn phi theo di lm sng, nht l khi phi hp Lisurid
vi cc thuc chng parkinson c tnh cht khng cholinergic. Cn nhc nguy c theo
dng bo ch thuc.
Digoxin
Phn tch: Digoxin ung ho tan chm c th c nng tng trong huyt thanh
v tc dng tng. Tng tc xy ra chm. C ch: Cha r. Thuc khng cholinergic c
th lm gim co bp ng tiu ho, nn lm tng thi gian hp thu.
X l: Phi gim st ngi bnh dng thuc digoxin ung ha tan chm khi
thng xuyn phi hp vi thuc khng cholinergic. Theo di nng huyt thanh c
th gip iu chnh liu digoxin. C th trnh tng tc ny bng cch dng digoxin
elixir hoc nang.
Phn tch: Gluthetimid c tnh khng cholinergic v an thn. Nh vy phi hp
thuc ny lm tng tc dng khng cholinergic v an thn. Cc tc dng ny bi u hi n
s c ch h thn kinh trung ng v tng nguy c b i, kh ming, to bn.
X l: Cn ghi nh nhng tc dng c hi ca loi thuc ny. Nu phi hp
thuc l c ch, phi bo cho ngi bnh bit nhng tc dng c hi . Trnh dng
cho ngi ph i tuyn tin lit v ngi c nhn p cao. Ch n ngi li xe, ngi
ng my (tng tc dng bun ng). Thn trng c vi dng thuc nh mt.
Medifoxamin
Phn tch: Tng tc dng khng cholinergic (c bit vi cc thuc phenothiazin
khng H1), do hip ng cc tc dng khng mong mun. Cc tc dng ny bi u hi n
tng nguy c b i, kh ming v to bn.
X l: Cn lu n tc dng c hi ca phi hp thuc ny. Nu xt thy phi
hp thuc ny c ch, phi bo cho ngi bnh bit nhng tc dng c hi . Trnh
924
dng cho ngi ph i tuyn tin lit v ngi c nhn p cao. Thn trng vi ngi li
xe, ngi ng my (tng tc dng bun ng). Thn trng ngay c vi thuc nh mt.
Thuc chn beta (atenolol)
Phn tch: Sinh kh dng ca atenolol c th tng khi phi hp vi thuc khng
cholinergic. Tng tc xy ra nhanh. C ch thuc khng cholinergic gia thuc chn
beta lu trong d dy, nn lm tng thuc ho tan v tng sinh kh dng ca thuc.
X l: Nu nghi ng c tng thuc chn beta, gim dn liu nu cn.
Phn tch: Thuc khng cholinergic gy tng pH d dy - rut, do lm gim
hp thu ketoconazol.
X l: Khuyn ngi bnh dng cc thuc khng cholinergic hai gi sau khi dng
ketoconazol.
Phn tch: Tng nguy c to bn do hip ng cc tc dng khng mong mun.
X l: Nu cn phi hp thuc, phi tnh ti nhc im ny, bo cho ngi bnh
bit. Nu cn, phi d kin trc mt n thuc nhun trng dng ng tht.
Amantadin hoc thuc tng t; disopyramid; khng histamin khng H1 an thn;
phenothiazin; quinidin hoc dn cht; thuc chng trm cm ba vng hoc thuc tng
t
Phn tch: Tng tnh cht khng cholinergic do hip ng cc tc dng khng
mong mun. Cc tc dng ny biu hin tng nguy c b i, kh ming v to bn.
X l: Cn lu n cc tc dng khng mong mun ca cc thuc ny. Nu xt
phi hp thuc ny l c ch, phi bo cho ngi bnh bit nhng tc dng c hi .
Trnh dng cho ngi ph i tuyn tin lit v ngi c nhn p cao.
Metformin
Phn tch: Nng trong huyt thanh ca metformin c th tng, lm tng tc
dng iu tr v c tc dng khng mong mun. C ch thuc khng cholinergic c th
lm chm nhu ng ng tiu ho, lm tng hp thu metformin rut non.
X l: ngi bnh dng metformin, cn gim st lm sng khi bt u hoc lc
ngng iu tr thuc khng cholinergic. C th phi iu chnh liu metformin.
Levodopa
Phn tch: Tc dng iu tr ca levodopa c th b gim. C ch c kh nng
thuc khng cholinergic lm gim co bp d dy, nn lm tng bt hot levodopa d
dy v lm gim hp thu rut. Tng tc xy ra mun.
X l: Liu lng levodopa c th phi tng hoc liu lng thuc khng
cholinergic phi gim.
Thuc an thn kinh khc (thioxanthen)
925
Phn tch: Tng cng tnh khng cholinergic phn ln cc thuc an thn kinh
do hip ng cc tc dng khng mong mun. Cc tc dng biu hin tng nguy
c b i, kh ming v to bn.
X l: Cn lu cc tc dng khng mong mun ca loi thuc ny. Nu xt phi
hp thuc ny l c ch, phi bo cho ngi bnh bit nhng tc dng c hi . Trnh
dng cho ngi ph i tuyn tin lit v ngi c nhn p cao.
Thuc c dng trong cc
v thi k trc khi ct b tuyn gip
bnh
cng
gip,
bnh
Basedow
Cc thuc trong nhm

BENZYLTHIOURACIL vin nn 25 mg
Basdene vin nn 25 mg
CARBIMAZOL vin nn 5 mg
Anti-Thyrox vin nn 5 mg
Neo- Mercazol vin nn 5 mg
METHYLTHIOURACIL
MTU vin nn 50 mg; 100 mg; 250mg
PROPYLTHIOURACIL vin nn 25 mg; 50 mg
Propylthiouracil vin nn 25 mg; 50 mg
Thyrostatic vin nn 50 mg
Tiotil vin nn 25 mg; 50 mg
THIAMAZOL vin nn 5 mg
Metizol vin nn 5 mg
Ch khi ch nh thuc
Chng ch nh: mc 4
Trng hp: Tuyt i chng ch nh dng cc thuc ny khi c ung th tuyn
gip ph thuc hormon kch thch tuyn gip (TSH) v bnh huyt hc.
Thn trng: mc 2
Thi k cho con b: Cc thuc khng gip tng hp qua c sa m v c th
gy bu c v suy gip tr b m.
Thi k mang thai: Cc thuc khng gip tng hp i qua mng nhau thai v tc
ng ln tuyn gip thai nhi gy nguy c suy gim tr tu, bu gip. ng i bnh
cng gip v nu khng iu tr th nguy him, cc thuc khng gip t ng hp s
c phi hp vi thyroxin (T4), thuc ny s m bo nhu cu ca thai.
Tng tc thuc
926
Amiodaron
Phn tch: y khng phi l mt tng tc thuc tht s, v suy gip hoc cng
gip c th xut hin sau khi iu tr bng amiodaron. y l nhng tc dng khng
mong mun do c iod trong phn t amiodaron. Mc tiu i u tr ca mt li u php
bng thuc khng gip c th b amiodaron lm ri lon, v gy ra lon nng tuyn gip
trong thi gian ngn, trung bnh hay di.
X l: Nu nht thit phi phi hp, cn bit c th gp kh khn trong cn
bng chc nng tuyn gip. Suy hoc cng gip c th xy ra khi iu tr n thun
bng amiodaron. Phi cn nhc li ch v nguy c. Trong mi trng hp, cng gip
l chng ch nh dng amiodaron. Cn nh rng amiodaron c na i l 28 ngy, v
cc tc dng ca tng tc cn c th biu hin nhiu tun sau khi ngng i u tr .
Ch da vo lm sng nh gi cng gip do amiodaron l cha . Thyroxin
(T4) c th tng trong khi khng c cng gip. Do phi nh lng c triiodothyronin (T3), T4, v TSH (hormon kch thch tuyn gip). T3 v T4 tng trong khi
TSH rt thp hoc khng thy, chng t c nhim c gip v nhim c gip ny rt
kh iu tr, thng phi ngng amiodaron tm thi. iu tr bng carbimazol c k t
qu v c th tip tc iu tr amiodaron nu cn. Nu suy gip do amiodaron, c th
dng liu php thay th m khng ngng amiodaron nu cn.
Corticosteroid
Phn tch: Tng o thi prednisolon khi phi hp vi carbamazole hoc
thiamazol (methimazol). C ch cha c xc nh. C th thuc khng gip lm tng
chuyn ho prednisolon qua xc tc ca enzym gan.
X l: Cn theo di dng liu cao prednisolon cho ngi ang dng
carbimazole hoc thiamazol. C th ngi bnh Basedow cn prednisolon liu cao hn
bnh thng.
Digitalis glycosid
Phn tch: Digitalis tng i km tc dng khi c cng gip, nn khi iu tr
bng thuc khng gip (carbimazole, hoc thiamazole) tin trin tt, phi gim liu
digitalis. C ch mt cch gii thch v p ng thay i ca digitalis l tim thay i
p ng khi c tng hoc gim nng hormon tuyn gip. i vi carbimazole
(nhng khng i vi thiamazole), dc ng hc ca digoxin cng b thay i, nn
nng digoxin huyt thanh thp hn.
X l: Khi chc nng tuyn gip tr li bnh thng do iu tr, liu digoxin c th
phi iu chnh (gim dn) cho thch hp.
Heparin
Phn tch: Gim hiu qu chng ng mu ca heparin khi iu tr vi
Neomercazol do mt c ch cha r.
X l: iu chnh liu tu thuc vo thi gian Howell hoc thi gian cephalin kaolin
lc bt u, trong v sau khi iu tr bng thuc khng gip.
Lithi
Phn tch: Dng ng thi hai thuc tng nguy c suy gip v sinh bu c.
927
X l: Kim tra u n nng iod trong mu v TSH trong huyt tng trong
v sau khi iu tr bng lithi.
Sucralfat
Phn tch: Gim hp thu ca thuc khng gip c th dn n gim tc dng.
Tng tc kiu dc ng hc v hp thu thuc.
X l: Khuyn ngi bnh ung cc thuc cch nhau 2 gi.
Theophylin
Phn tch: Nng huyt thanh ca theophylin c th tng v gy c khi dng
cng vi thuc khng gip iu tr cng gip. C ch trng thi tuyn gip tc
ng n tc chuyn ho ca theophylin. Khi cng gip c tng chuyn ho
theophylin; khi suy gip chuyn ho theophylin gim.
X l: Ngay t u phi ngh trc n gim liu theophylin khi bt u iu tr
cng gip (th d bng iod phng x, carbimazol, thiamazol, propylthiouracil v.v...).
tnh trng tuyn gip n nh phi mt vi tun hoc c khi hng thng, cho nn c n
phi gim st liu lng theophylin trong sut thi gian .
Phn tch: Gim hiu qu ca thuc chng ng mu Neomercazol, do mt c
ch khng r.
X l: iu chnh liu dng ty thuc t l chun ha quc t - INR v/hoc thi
gian Quick lc bt u, trong v sau khi iu tr bng thuc khng gip.
928
thuc
khng
an thn gy bun ng
histamin
khng
H1
Thuc khng mang cu trc phenothiazin,

khng cholinergic v c ch h thn kinh trung ng
c
c
tc
nhng
dng
tnh
Cc thuc trong nhm

ANTAZOLIN dung dch nh mt 0,5 mg/1mL
Spersalerg dung dch nh mt 0,5 mg/1mL
CINNARIZIN vin nn 25 mg
Devomir vin nn 25mg
Stugeron vin nn 25 mg
Cinarizin vin nn 25 mg
Vinstu vin nn 25 mg
Vertizin vin nn 25mg
CHLORPHENIRAMIN: vin nn 4 mg; vin bao 4 mg
Chlorpheniramin vin nn 4 mg
Chlorpheniramin vin bao 4 mg
V cc bit dc phi hp vi paracetamol nh Decolgen, Rhumenol v.v
CYPROHEPTADIN HYDROCHLORID vin nn 4 mg
Peritol vin nn 4 mg
Ciplactin vin nn 4mg
Cyprodine vin nn 4 mg
Piriactone vin nn 4 mg
DEXCHLORPHENIRAMIN
Polaramine vin nn 2mg; 6mg
DIMENHYDRINAT: vin nn 50 mg; 100 mg
Apo- Dimenhydrinate vin nn 50 mg
Dimenhydrinate vin nn 50 mg
Vomina vin nn 100 mg
DIMETINDEN: vin nn 1 mg; gel bi 1 mg/1g; nang 4 mg
Fenistil vin nn 1 mg
Fenistil gel bi 1 mg/1g
Fenistil 24 nang 4 mg
Diphenhydramin v dn cht: vin nn 90 mg; ng tim 10 mg/1mL
Nautamine vin nn 90 mg
929
cht
Dimedrol ng tim 10 mg/1mL

Daiticol thuc nh mt 1mg/ml (phi hp vi km sulfat)
EMEDASTIN dung dch nh mt 0,05%
Emadine dung dch nh mt 0,05%
KETOTIFEN: vin nn 1 mg; siro 1 mg/5mL; siro 0,02%
Asthafen vin nn 1 mg
Broncast vin nn 1 mg
Broncast siro 1 mg/5 mL
Ketof siro 0,02% l 200 mL
Unilen vin nn 1 mg
PHENIRAMIN
Trimeton vin nn 75 mg
PIZOTIFEN
Sandomigran vin nn 0,5 mg
PROMETHAZIN: kem bi da 2%; siro 0,1%
Phenergan: kem bi da 2%, siro 0,1%
Pipolphen: vin nn 25 mg, ng tim 50mg/2ml
Promethazin kem bi da 2%
Promethazin siro 0,1%
Ch khi ch nh thuc
Ru: Tuyt i khng nn ung ru v cc ch phm c ru trong khi iu
tr, v lm tng tc dng c ch h thn kinh trung ng.
Tng nhn p: mt, nhng thuc ny c th c ch s kch thch tit
acetylcholin gy ra gin ng t (gin ng t th ng) v lit iu tit, km theo tng
nhn p, c th dn n tng nhn p cp tnh i tng c c a gc mng mt gic mc hp.
Thi k mang thai: Mc du mang thai khng phi l mt chng ch nh, cn
thn trng, trnh ung loi thuc ny trong 3 thng u ca thai k.
Ph i tuyn tin lit; u tuyn tin lit: Nguy c b i do gim trng lc co
bp niu o v c ch mt phn co bp bng quang.
Suy gan: Phi lu nhng tc dng khng mong mun ca mt s thuc khng
histamin.
Suy thn: Ngi suy thn c th nhy cm hn vi nhng tc dng khng mong
mun kiu khng cholinergic ca cc thuc ny.
Thn trng: mc 2
930
Cc trng hp khc: Ch trng hp hp mn v.

Cn theo di: mc 1
Thi k cho con b : Thuc khng histamin c th lm gim tit sa v qua
c sa m vi s lng thp.
Tr em: Tr em c th nhy cm hn vi cc tc dng an thn v khng
cholinergic ca cc thuc ny.
Ngi bnh cao tui: Ngi bnh cao tui c th nhy cm hn vi tc dng
khng mong mun kiu khng cholinergic ca cc thuc ny.
Tng tc thuc
Cn nhc nguy c/li ch: Mc 3
Ru
an thn bun ng. Mt s thuc c th c tc dng tm thn-vn ng, nht l trong
tun u iu tr. Tng tc kiu dc lc.
X l: Khng ung ru hoc ch phm c ru khi dng thuc ny. Nguy c an
thn bun ng c bit nguy him cho ngi li xe hoc vn hnh my.
Phn tch: Amantadin c th lm xut hin cc tc dng gy l ln v o gic ca
cc thuc khng cholinergic. Ketotifen v oxadomid hnh nh khng c tc dng khng
cholinergic.
X l: Khi xy ra cc tc dng khng mong mun nghi do tng tc, phi i u
chnh liu cc thuc khng cholinergic khi dng amantadin ng thi. Cho ng i bnh
bit cc tc dng khng mong mun c th xy ra iu chnh liu thch hp.
Amineptin
Phn tch: Tng c ch thn kinh trung ng, c ch h hp v h huyt p. Hn
na, nu bt u b ph thuc thuc, s phi hp hai thuc c th lm tng nhanh
nguy c ph thuc thuc.
X l: iu chnh liu ca hai thuc, nu cn phi phi hp. Ch n gim tnh
to khi li xe hoc vn hnh my.
Buspiron; procarbazin
Phn tch: Tng c ch h thn kinh trung ng, dn n tng an thn bun ng.
Tng tc kiu dc lc.
X l: Ch n s gim tnh to khi li xe hoc vn hnh my.
Clozapin; quinidin hoc dn xut
Phn tch: Tng tnh khng cholinergic do hip ng cc tc dng khng mong
mun, nh tng cc nguy c b i, kh ming v to bn.
931
X l: Cn lu nhng bt li ca loi thuc ny. Nu cn phi hp, bo cho

ngi bnh v nhng bt li ny. Trnh dng cho ngi b bnh tuyn tin lit hoc b
tng nhn p.
Estrogen hoc thuc nga thai estrogen- progestogen
Phn tch: Nguy c tit nhiu sa bt thng (ch thy vi flunarizin).
X l: Gim st lm sng. Thng bo cho ngi bnh.
Histamin hoc dn cht
Phn tch: Phi hp ny bnh thng khng hp l; c th c dng trong trng
hp qu liu thuc khng histamin.
X l: Nu mt trong hai thuc khng c s dng nh thuc gii c cho thuc
kia, th k hai thuc ny l khng hp l v c i khng dc l.
Medifoxamin
Phn tch: Tng cc tnh cht khng cholinergic (nht l vi cc khng H 1 loi
phenothiazin) do hip ng cc tc dng khng mong mun, nh tng nguy c b i,
kh ming v to bn. Ch l ketotifen v oxatomid hnh nh khng c tc dng khng
cholinergic. Vy tng tc ny khng xy ra vi cc thuc .
X l: Cn lu nhng bt li ca loi thuc ny. Nu cn phi hp, phi cho
ngi bnh bit nhng bt li . Trnh dng cho ngi ph i tuyn ti n lit ho c
tng nhn p. Nguy c tu thuc dng bo ch s dng (dng ti ch); thn trng khi
dng thuc nh mt.
Thuc cholinergic
Phn tch: Tnh cht khng cholinergic ca cc thuc khng histamin c th i
khng tc dng cholinergic mun c. Ch ketotifen v oxadomid c t hoc khng c
tc dng khng cholinergic.
X l: Lu nguy c tht bi hoc gim hiu qu iu tr nu mc tiu iu tr
chnh cn phi k n thuc cholinergic. Hi ngi bnh khi n lnh thuc theo n
ln sau v hiu qu iu tr. Tc dng khng cholinergic c th yu hoc va (dng
dng ti ch: thuc nh mt).
amphetamin.
ngi bnh gp li bc s nu thy kt qu iu tr khng n nh.
Baclofen; carbamazepin; cht ch vn ca morphin; metyldopa; oxaflozan;
primidon hoc dn xut; reserpin; viloxazin
Phn tch: Tng c ch h thn kinh trung ng, dn n tng gy bun ng.
Tng tc kiu dc lc hc.
X l: iu chnh liu ca hai thuc, nu phi phi hp. Ch n gim tnh to
khi li xe v vn hnh my.
932
Barbituric; benzamid; benzodiazepin; butyrophenon; carbamat hoc thuc tng

t; citalopram; dextropropoxyphen; ethosuximid; fluoxetin; fluvoxamin; interferon alpha
ti t hp; mianserin; paroxetin; phenytoin; thuc an thn kinh cc loi (nhm
thioxanthen); thuc c ch h thn kinh trung ng cc loi
Phn tch: Tng c ch h thn kinh trung ng, dn n tng tc dng gy bun
ng. Tng tc kiu dc lc hc.
X l: Ch ti gim tnh to khi li xe hoc vn hnh my.
Citalopram
him.
X l: Ch vic ung ru ng thi khin li xe v vn hnh my tr nn nguy

Phn tch: Tng c ch h thn kinh trung ng, dn n tng tc dng bun
ng. Tng tc kiu dc lc. Vi liu thng thng, rilmenidin khng lm tng tc
dng c ch h thn kinh trung ng ca cc thuc ny.
X l: Phi iu chnh liu lng ca hai thuc, nu cn phi hp thuc. Ch
n gim tnh to khi li xe hoc vn hnh my.
Disopyramid
Phn tch: Tng tnh khng cholinergic ca phn ln cc khng H1 (trong mt
s thuc nhm phenothiazin) biu hin kh ming, b tiu tin v to bn. Ketotifen v
oxadomid hnh nh khng c tc dng khng cholinergic. Cn theo di.
X l: Cn lu nhng bt li ca loi thuc ny. Nu phi phi hp, thng bo
cho ngi bnh v nhng bt li ny. Trnh dng cho ngi bnh tuyn tin lit hoc
tng nhn p. Nguy c tu thuc c dng bo ch (dng dng ngoi). Thn tr ng khi
dng thuc nh mt.
Gluthetimid v thuc tng t (114)
Phn tch: Gluthetimid c tnh khng cholinergic v an thn. Phi hp thuc dn
n tng cc tc dng khng cholinergic v an thn, lm c ch h thn kinh trung
ng v tng nguy c b i, kh ming v to bn.
X l: Cn lu nhng bt li ca loi thuc ny. Nu cn phi hp, phi thng
bo cho ngi bnh v nhng bt li ny. Trnh dng cho ngi bnh tuyn tin li t
hoc tng nhn p. Thn trng vi ngi vn hnh my hoc li xe (tng tc d ng an
thn gy bun ng). Nguy c cn tu thuc dng bo ch (dng ti ch); thn trng vi
thuc nh mt.
Methadon
Phn tch: Tng c ch h thn kinh trung ng km theo an thn mnh c hi,
c bit ngi li xe hoc vn hnh my.
X l: Phi lu n tng tc dng an thn. Khuyn ngi bnh khng li xe,
khng vn hnh my.
Phenothiazin
933
Phn tch: Tng tc kiu dc l. Tng tc dng c ch h thn kinh trung

ng, dn n tng tc dng an thn gy bun ng. Nhiu thuc khng histamin an
thn c cu trc phenothiazin.
X l: iu chnh liu hai thuc, nu cn phi hp. Ch n gim tnh to khi li
xe hoc vn hnh my.
Phn tch: Nguy c tng c ch h thn kinh trung ng.
liu.
X l: Nu phi phi hp hai thuc, cn lu nguy c ny khi gy m v khi chn

Thuc khng cholinergic; thuc chng trm cm ba vng v thuc tng t
Phn tch: Tng tnh khng cholinergic do hip ng cc tc dng khng mong
mun, nh nguy c b tiu tin, kh ming v to bn.
X l: Cn lu nhng bt li ca loi thuc ny. Nu v mc tiu iu tr phi
phi hp th thng bo cho ngi bnh v nhng bt li ny. Trnh dng cho ng i
bnh tuyn tin lit v tng nhn p.
Thuc c ch monoamino oxydase khng chn lc
Phn tch: Dng ng thi cc thuc c ch MAO c th ko di tc dng khng
cholinergic v c ch h thn kinh trung ng.
X l: Khng nn phi hp thuc. Nu c th, nn thay i thuc.
Thuc khng histamin H1 m tc dng an thn, gy bun ng yu
Cc thuc trong nhm
ASTEMIZOL vin nn 5 mg; 10 mg
Acenal vin nn 10 mg
Astelong vin nn 10 mg
Histalong vin nn 5 mg; 10 mg
Astemizol vin nn 10 mg
CETIRIZIN: vin nn bao 10 mg; vin nn 10 mg; thuc git ung 10 mg/mL; dung
dch ung 1 mg/1mL
Allercet vin nn 10 mg
Cerlergic vin nn bao 10mg
Cetrine vin nn bao 10 mg
Rhinil vin nn 10mg
Utizine vin nn bao 10 mg
Zyrtec vin nn 10 mg
Zyrtec thuc git ung 10 mg/mL
934
Zyrtec dung dch ung 1 mg/1mL x 75 mL

FEXOFENADIN vin nn bao 60 mg
Altiva vin nn bao 60 mg
Fexofast vin nn bao 120 mg; 180mg
Telfast BD 60 mg
Telfast HD vin bao 180 mg
LORATADIN: siro 5 mg/ 5 mL; vin nn 10 mg
Clarityne siro 5 mg/ 5 mL
Clarityne vin nn 10 mg
Eftilora vin nn 10 mg
Histalor vin nn 10 mg
Loratin vin nn 10 mg
Lorfast v Lorinol vin nn 10 mg
MIZOLASTIN vin bao phim gii phng chm 10 mg
Mizollen vin bao phim gii phng chm 10 mg
OLOPATADIN dung dch nh mt 0,1%
Patanol dung dch nh mt 0,1% l 5 mL
TERFENADIN: vin nn 60 mg; 120 mg; hn dch ung 30 mg/ 5 mL; vin nn tan
chm 60 mg
Tafedine vin nn 60 mg
Teldane vin nn 60 mg; 120 mg
Teldane hn dch ung 30 mg/ 5 mL x 120 mL
Tenadine vin nn 60 mg
Terfenadine vin nn 60 mg
Trexydin vin nn tan chm 60 mg
Ch khi ch nh thuc
Chng ch nh: mc 4
Suy thn: Khng c dng cetirizin khi suy thn. Nu suy thn va, gim na
liu thng thng.
Thi k cho con b: Ph n thi k cho con b khng nn dng.
Thi k mang thai: Thn trng, khng nn dng v cha thi gian theo di i
vi mt s thuc ny.
Tng tc thuc
935

Macrolid; khng sinh khc: quinoprestin/dalfopristin; telithromycin
Phn tch: Trong tnh hnh hiu bit hin nay ca chng ta v cc macrolid:
erythromycin tim tnh mch v josamycin c th d gy xon nh khi phi hp v i
astemizol (gim d ho cc thuc khng histamin gan).
X l: Chng ch nh phi hp ny. Chn mt khng sinh tim khc hoc mt
thuc khng histamin khng H1 khng an thn khc khng c tc dng c hi nh vy
(cetirizin hoc loratadin).
Moxifloxacin, sparfloxacin (nhm quinolon): tng nguy c lon nhp tht khi phi
hp vi mizolastin hoc terfenadin.
Phn tch: Tng tc c m t vi astemizol, mt khng histamin H 1 khng an
thn v sparfloxacin. Tng nguy c xon nh. i khi tin trin thnh rung tht gy t
vong.
X l: Khng nn phi hp. Chn hoc mt fluoroquinolon khc, hoc mt thuc
khng histamin khng an thn khc khng gy xon nh (cetirizin hoc loratadin).
Phn tch: Nguy c lon nhp tht, c bit xon nh, do hip ng cc tc dng
in sinh l. Tng tc kiu dc lc hc.
X l: Trnh phi hp ny. Tm thuc thay th.
Thuc chng nm dn xut t imidazol
Phn tch: Gim chuyn ho astemizol gan, gy ra bi ketoconazol, itraconazol,
c th d gy xon nh. Khng c m t vi cetirizin v loratadin.
X l: V nguy c, khng nn phi hp vi astemizol. Chn mt thuc khng
histamin khng gy bun ng khc khng c nhng bt li ny.
Thuc chng virus: amprenavir, efavirenz, indinavir; nelfinavir; ritonavir v
saquinavir: lm tng nguy c lon nhp tht khi phi hp vi terfenadin.
Phn tch: Cc thuc chng virus ny c i lc mnh vi isoenzym 3A 4 ca cc
cytochrom P450, dn n gim chuyn ho cc thuc c chuyn ho ch yu bi
isoenzym bi hin tng cnh tranh v v vy lm tng nng trong huyt tng
v c tnh ca chng. Tng c tnh vi tim vi s ko di khong QT v c th xut
hin xon nh. Tng tc dc ng hc v chuyn ho thuc. Amprenavir c kh
nng lm tng nng huyt tng ca loratadin.
X l: Trnh phi hp ny. Tm thuc thay th.
Thuc c kh nng ko di khong QT: amiodaron; benzamid; bepridil; bretylium;
disopiramid; halofantrin; pentamidin; quinidin hoc dn cht; sotalol; vincamin; flecainid;
mexiletin; procainamid; propafenon
Phn tch: Tng tc ch c m t vi astemizol, terfenadin l cc thuc khng
histamin H1 c coi nh khng an thn. Tng nguy c xut hin xon nh. i khi
tin trin thnh rung tm tht gy t vong.
936
X l: Chng ch nh phi hp. Chn mt thuc khng histamin khng gy bun

ng khc khng gy ra xon nh (cetirizin, loratidin).
Amphotericin B
Phn tch: Tng tc ch thy vi mt thuc khng histamin khng gy bun ng
l astemizol. Amphotericin B tim gy h kali mu. H kali mu (nhng c tiu chy ko
di, cng c th gy mt nc v in gii) l mt yu t d gy xon nh. Nguy c
tng khi cc thuc lm gim kali mu c phi hp vi nhng thuc c kh nng gy
xon nh.
X l: Khng nn phi hp. Chn cc thuc khng gy xon nh. Nu vn phi
duy tr phi hp, th gim st kali mu v nu cn, b sung kali.
Thuc li niu h kali mu; furosemid hoc thuc tng t; glucocorticoid; thuc
nhun trng kch thch; corticoid khong; tetracosactid
Phn tch: Tng tc c ghi vi thuc khng histamin khng an thn: astemizol
hoc terfenadin. H kali mu (nhng c tiu chy ko di cng c th gy mt nc v
in gii) l mt yu t d gy xon nh. Nguy c tng khi cc thuc lm h kali mu
c phi hp vi nhng thuc c kh nng gy xon nh.
X l: Khng nn phi hp. Chn cc thuc khng gy xon nh. Nu vn phi
phi hp, th gim st kali mu v nu cn, b sung kali.
Histamin hoc dn cht
Phn tch: Phi hp thng thng khng hp l, c th s dng trong trng hp
qu liu histamin.
X l: Nu khng histamin khng c s dng nh thuc gii c cho thuc kia,
vic k n hai thuc ny l khng hp l v c i khng dc l.
937
Thuc kim ho nc tiu

L nhng thuc lm tng pH nc tiu
Cc thuc trong nhm
NATRI V KALI CITRAT thuc cm ung 4%
Foncitril 4000 thuc cm ung 4%
Ch khi ch nh thuc
Chng ch nh: mc 4
Cc trng thi khc: Nguy c h calci trong mu.
Suy thn: Nguy c ri lon kali mu v nhim kim mu. Theo di in gii trong
mu.
Tng tc thuc
Acid ascorbic
Phn tch: Acid ascorbic l cht acid ho nc tiu, dng di dng vitamin C.
Vi cc cht kim ho nc tiu, s c s trung ho pH nc tiu nu dng vitamin C
liu cao (vt qu 2g).
X l: Trong mt s hon cnh iu tr, theo di pH ca nc tiu s c ch. o
pH nc tiu bng giy ch th. Tt c ph thuc vo mc ch ca iu tr. Khi cn
kim ho nc tiu, khng ghi n dng vitamin C ng thi v nhc ngi bnh khng
t dng vitamin C.
Ephedrin hoc pseudoephedrin
Phn tch: Kim ho nc tiu lm tng na i v lm gim s o thi ca
ephedrin v pseudoephedrin, do tc dng iu tr v c tnh tng ln. L do l khi
pH ca nc tiu tng, s ti hp thu ca thuc ng thn cng tng ln.
X l: Phi gim liu ephedrin, pseudoephedrin khi dng cng vi cc thuc kim
ho nc tiu.
Lithi
Phn tch: Kim ho nc tiu lm gim nng lithi trong huyt tng, nh vy
kt qu iu tr s gim. C ch l do kim trong nc tiu lm tng s thanh lc
lithi thn.
X l: Trnh dng nhng thuc kim ho nc tiu vi liu cao (nh cc thuc
khng acid cha natri bicarbonat) i vi nhng ngi bnh dng lithium.
Tetracyclin (cc cyclin)
Phn tch: Dng ng thi cc tetracyclin vi cc thuc kim ho nc tiu c th
lm tng mnh s o thi tetracyclin v lm gim nng thuc ny trong mu, lm
938
gim p ng cha bnh ca thuc. C ch c th do mi trng kim trong nc tiu

lm gim kh nng ti hp thu thuc ng thn.
X l: Dng hai loi thuc ny cch nhau t nht 3 n 4 gi. Nh vy vn c th
cha trnh c tng tc thuc, phi dng tetracyclin vi liu cao hn.
Cht acid ho nc tiu
Phn tch: Trung ho ho- l
X l: Kt hp hp l hay bt hp l tu theo s trung ho ho-l ph hp hoc
khng ph hp vi mc ch iu tr (trung ho tnh base).
Phn tch: Thuc cho liu kim ho nc tiu c th lm tng ti hp thu
amphetamin ng thn. Cc cht acid ho nc tiu lm tng thi amphetamin (pH
khong 5). Amphetamin l mt base c thi qua thn. Trong mi trng acid, c t
amphetamin dng khng b phn cc Ngc li, cc cht kim ho nc tiu (pH
khong 8) lm gim rt nhiu s o thi amphetamin qua nc tiu. Trong y vn,
thng bo nhiu trng hp lon tm thn do amphetamin b gi li ngi bnh c
nc tiu kim tnh (tng tc c xc nh r).
X l: Acid ho nc tiu c li khi dng amphetamin qu liu nhm to iu kin
o thi cht ny (tng tc c li). Ngc li, liu php dng amphetamin c th b
tht bi nu o thi amphetamin xy ra qu nhanh (v acid ho nc tiu), hoc gy ra
lon tm thn do amphetamin (v kim ho nc tiu).
Methenamin
Phn tch: Hot tnh ca methenamin l do b thy phn trong nc tiu to thnh
formol (tc dng st khun) v amoniac. S thy phn ny ch xy ra khi nc tiu c
pH acid. Do vy, nn phi hp cht ny vi mt cht acid ho nc ti u t o i u
kin cho s thy phn; pH nc tiu tng trn 5 s c ch hot tnh ca methenamin.
X l: Trnh ghi n ng thi mt cht kim ho nc tiu vi methenamin.
Cng trnh k n nhng thuc khng acid c cc hydroxyd nhm, calci, magnesi v
chng lm tng pH nc tiu. Vi methenamin, pH nc tiu thch hp l thp hn
hoc bng 5.
Methotrexat
Phn tch: Natri bicarbonat lm tng thi methotrexat qua thn.
X l: Tnh cht trn to iu kin tng thi methotrexat khi dng liu cao v
trnh kt ta methotrexat trong ng thn.
Mexiletin
Phn tch: Kim ho nc tiu c th lm gim o thi mexiletin qua thn.
Tng tc ny, ghi trong y vn, cho thy c thay i tc dng lm sng khi ph i h p
thuc.
X l: Nu cn phi hp hai th thuc, phi theo di nhng kt qu lm sng v
phi thc c nhng thay i c th c v tc dng dc l ca mexiletin.
939
Quinidin hoc dn cht

Phn tch: Trong mi trng acid, phn ln lng quinidin c thi qua thn
di dng phn cc. Trong mi trng kim, quinidin ti thn di dng khng phn
cc v c ti hp thu. Nh vy trong trng hp sau, ty theo gi tr ca pH, c nguy
c tng nng ca quinidin trong huyt tng, gy qu liu.
X l: Trong mt s hon cnh iu tr, theo di pH nc tiu l c ch. C th o
pH bng bng giy ch th kim tra tnh acid hay tnh kim ca nc ti u. Trong
trng hp nc tiu kim tnh, cn theo di in tm v nng quinidin trong
huyt thanh. T , hiu chnh li liu lng trong thi gian iu tr v lc ngng iu
tr vi cht kim ho nc tiu. Thuc khng acid c th lm thay i pH v lm kim
ho nc tiu, nhng trng hp ny, tng tc xy ra yu hn do kim ho thng
khng . Tuy nhin vn phi theo di vic phi hp thuc ny.
Salicylat hay dn cht
Phn tch: Kim ho nc tiu s lm tng thanh lc cc salicylat v dn cht
(nh aspirin) thn, lm gim nng cc cht ny trong huyt thanh. S thanh l c
cc salicylat tng ln t ngt khi pH ca nc tiu tng n gi tr 7 tr ln.
X l: Khi ngi bnh dng salicylat ng thi vi mt thuc kim ho nc tiu,
th phi dng salicylat vi liu cao hn khi khng dng thuc kim ho nc tiu ng
thi. Vic xc nh liu dng da vo kt qu vic nh lng salicylat trong mu v o
pH ca nc tiu. Mt khc, s kim ho nc tiu s lm gim c tnh ca salicylat
khi dng liu qu cao. Khi phi dng salicylat cng vi thuc khng acid d dy, phi
dng hai loi thuc ny cch nhau t nht hai gi.
Sulfonylurea: clorpropamid
Phn tch: Kim ho nc tiu bng mt thuc nh natri bicarbonat c th lm
tng o thi clorpropamid. Tng tc ny c th c ch trong iu tr nhim c
clorpropamid. Nhng nu ung natri bicarbonat v l do khc, c th lm gim tc dng
iu tr ca clorpropamid. Tng tc xy ra mun. C ch clorpropamid s tng thi
qua thn khi pH nc tiu tng.
X l: Kim ho nc tiu c th gip ch trong iu tr nhim c clorpropamid.
Liu clorpropamid c th cn phi tng nu ngi bnh thng xuyn dng natri
bicarbonat. Phi gim st glucose mutrong khi phi hp.
Thuc lm tan cc mu ng dng trong giai on cp cu nhi mu c tim
(trong vng 6 gi)
Cc thuc trong nhm
ALTEPLASE l tim 10 mg; 20 mg; 50 mg
Actilyse l tim 10 mg; 20 mg; 50 mg
ANISTREPLASE l tim 30 IU
Eminase l tim 30 IU
UROKINASE dung dch tim 250.000 IU/l; 500.000 IU/l
Urokinase- KGCC dung dch tim 250.000 IU/l; 500.000 IU/l
940
KD - Unase bt pha dung dch tim 500.000 IU/l

ch khi ch nh thuc
Chng ch nh: mc 4
Thi k mang thai: Chng ch nh trong 18 tun u thai k (nguy c bong nhau
thai) sau thi gian ny, cn nhc tng quan nguy c / li ch.
Thi k cho con b: V thn trng
Tng huyt p: Khi bnh nghim trng, khng kim sot c.
Suy gan: Khi nghim trng.
Cc trng hp khc: Vim mng trong tim do vi khun, vim ty cp, c tin s
tai bin mch mu no hay phu thut no ty trc y khng qu hai thng, ch y
mu ni nghim trng, nhng bin i th tng hoc mc phi v cm mu. Chn
thng nghim trng hay mi phu thut.
Cn theo di: mc 1
Tr em, tr cn b: Do cha c nhng nghin cu vn ny.
Tng tc thuc
Nhn ny c tnh cht nh mt dn cht coumarin, c tc dng chng ng mu (khng
vitamin K), nh vy s b sung tnh cht chng ng mu vo tnh cht hoc khng
vitamin K, hoc chng kt tp tiu cu ca cc cht ang xt.
mu. Cn cnh gic khi dng liu cao cc khng sinh ny.
Heparin; indometacin hoc dn cht; pentoxyfilin; pyrazol
Phn tch: Phi hp vi mi thuc c tc dng chng kt tp tiu cu hoc chng
X l: Thng thng, k n v dng cc thuc lm tan huyt khi phi do cc
bc s c o to chuyn khoa (bc s tim mch v bc s ca cc i cp cu) m
nhim, v thuc c phm vi iu tr hp v cch dng thuc tinh vi. Nu cn phi hp
thuc ny, phi theo di qua nhng xt nghim ng mu thch hp nh thi gian
Howell v thi gian cephalin kaolin. Tt nht, nu c th, tm liu php khc.
Phn tch: Natri valproat c th gy gim tiu cu, gim prothrombin mu v gim
kt tp tiu cu. Nh vy, c th gy chy mu nhng ngi bnh dng thuc chng
ng mu ung, heparin hay cc thuc lm tan huyt khi.
941
X l: Khi phi hp thuc, v tu theo thuc chng ng mu dng, tng cng

theo di s lng tiu cu, thi gian Howell, thi gian chy mu, t l prothrombin, t l
chun ha quc t- INR, test th ng mu ton phn TCA.
Dipyridamol; salicylat; ticlopidin; thuc chng vim khng steroid
Phn tch: Phi hp vi tt c cc thuc chng kt tp tiu cu hoc chng ng
mu u lm tng nguy c chy mu.
X l: Thng thng k n v dng cc thuc lm tan huyt khi, phi do bc s
chuyn khoa (bc s tim mch, v bc s i cp cu) m nhim v thuc c phm vi
iu tr hp, v cch dng thuc tinh vi. Nu cn phi hp thuc ny, bt buc phi theo
di cc test th ng mu thch hp nh thi gian Howell, thi gian cephalin kaolin. Nu
c th, dng mt liu php khc.
Dextran
mu v chng kt tp tiu cu, phi trnh hoc kim sot c nguy c chy mu.
X l: Trnh phi hp thuc ny v kh qun l c mc gim ng mu mong
mun v nguy c chy mu km theo.
Phn tch: Tng nguy c chy mu. Cn c mt bc s chuyn khoa qun l.
X l: Thng thng k n v dng cc thuc lm tan huyt khi, phi do bc s
chuyn khoa (bc s tim mch, v bc s i cp cu) m nhim v thuc c ph m vi
iu tr hp, v cch dng thuc tinh vi. Kim tra chc chn ngi bnh khng iu tr
bng thuc chng ng mu. Nu c, phi tnh n tng tc ny.
thuc lm thay i cht nhy ph qun
Thuc tiu cht nhy v iu ho cht nhy lm d long m
Cc thuc trong nhm
BM PRU, cn cnh kin trng, cn khuynh dip, MENTHOL, tinh du
lavande, THYM
Balsofumine Menthol 1 % dng xng hng
Balsofumine Menthol 4 % dng xng hng
BROMHEXIN
Bisolvon vin nn 8 mg
Bisolvon ng tim 4 mg
Dosulvon vin nn 8mg
Paxirasol vin nn 8mg
Zedex-siro (phi hp vi dextromethorphan)
942
CARBOCYSTEIN: vin nang 375 mg; siro

Bronchathiol dung dch ung 7,5 g/150 mL; 2,5g/125 mL
Bronchokod siro 2g/100 mL; 5g/100 mL
Bronchocyst siro 7,5g/150 mL
Fluditec siro 2 v 5%
Solmux Broncho nang 500 mg vi 2 mg salbutamol
CLORHEXIN
Drill vin ngm
BROMOFORM, CODEIN, CINEOL, GAIACOL, PHENOL, long no nang mm;
SIRO, thuc n
Eucalyptine vin n
Eucalyptine siro
Eucalyptine nang mm
ACETYLCYSTEIN: ng kh dung; gi thuc cm; vin nn 100 mg,

200 mg
Acemuc gi thuc cm 200 mg
Exomuc vin 100mg; 200 mg
Fluimucil thuc tim 5 g
Mucomyst gi thuc cm 200 mg
Muxystine gi thuc cm 200 mg
CH KHI CH NH THUC
Cn thn trng: mc 2
Lot d dy - t trng; vim d dy: Vi cc dn cht ca acetylcystein.
943
THUC GY M BARBITURIC
L nhng thuc gy m, dn cht ca acid barbituric, dng trong phu thut thi
gian ngn. Mt s tng tc xy ra do tc dng cm ng enzym ca barbituric,
tc dng ny ch biu hin sau nhiu ln dng thuc
Cc thuc trong nhm

THIOPENTAL NATRI thuc tim 0,5 g; 1 g
Nesdonal thuc tim 0,5 g; 1 g
Pentothal thuc tim 0,5 g; 1 g
CH KHI CH NH THUC
Chng ch nh: mc 4
Ri lon chuyn ho porphyrin: ngi c t bm mc bnh ny, c nguy c ri
lon chuyn ho porphyrin do cm ng tng hp ALA - synthetase, ko theo tng hp
cc porphyrin km au bng, nn, ri lon tm thn v thn kinh (lit mm hai chi di
ngoi bin), nht l khi ri lon chuyn ho porphyrin tng cn cp tnh.
Thi k mang thai: Nghi ng gy d tt thai nhi.
Cn theo di: mc 1
Suy tim: Do tc dng lm gim trng lc v lm gim co c tim, vi liu gy
ng, cc barbituric gy ra c ch c tim khng ng k, tr trng hp suy tim.
Suy gan: Phn ln cc barbituric chuyn ho gan, v vy suy gan lm chm bt
hot chng v lm tng c tnh ca chng.
Suy thn: Phenobarbital c o thi mt phn di dng cn hot tnh qua
thn, cho nn hin tng suy thn lm tng c tnh ca n.
Suy h hp, hen: Barbituric c ch cc trung tm h hp hnh no.
TNG TC THUC
Benzamid
X l: Tnh ti tng nguy c suy h hp khi gy m.
Bepridil
Phn tch: Dng ng thi cc thuc chng tng huyt p hay cc thuc gy h
huyt p vi cc thuc gy m barbituric c th gy h huyt p nghim trng.
944
X l: Khuyn ngi bnh phi phu thut, cn bo cho bc s gy m bit cc

thuc ang dng.
Viloxazin
Phn tch: y l trng hp phi hp hai thuc c ch h thn kinh trung ng.
Bc s gy m phi lu ti hip ng cc tc dng dc l.
X l: Khuyn ngi bnh phi phu thut cn thng bo cho bc s gy m cc
thuc ang dng.
Benzodiazepin; butyrophenon; carbamat hoc thuc tng t;
dextropropoxyphen; fluoxetin; gluthetimid hoc thuc tng t; khng histamin
khng H1 an thn; medifoxamin; mianserin; oxaflozan; primidon hoc dn cht;
procarbazin; reserpin; ru; thuc an thn kinh cc loi; thuc chng trm cm
ba vng hoc cc thuc tng t; thuc ch vn ca morphin; thuc c ch h
thn kinh trung ng
Phn tch: Nguy c tng tc dng c ch h thn kinh trung ng
X l: Nu cn phi hp hai thuc, phi tnh ti nguy c ny khi gy m v khi
chn liu dng.
Diazoxid; dihydropyridin; diltiazem; furosemid hoc thuc tng t; guanethidin
hoc thuc tng t; levodopa; methyldopa; nitrat chng au tht ngc; thuc chn
beta; thuc li tiu gi kali; thuc li tiu thi kali; thuc c ch enzym chuyn i
Phn tch: Dng ng thi cc thuc chng tng huyt p hoc cc thuc c th
lm h huyt p vi thuc gy m barbituric c th gy tt huyt nghim trng.
X l: Khuyn ngi bnh phi phu thut cn thng bo cho bc s gy m bit
cc thuc ang dng.
Fluvoxamin
X l: Khi phi phu thut, khuyn ngi bnh ang dng nhiu thuc thng bo
cho bc s gy m cc thuc dng.
Sotalol
Phn tch: Dng ng thi cc thuc chng tng huyt p hay cc thuc c th
gy h huyt p vi cc thuc m barbituric c th gy h huyt p nghim trng.
X l: Thuc gy m c dng ti bnh vin di s theo di cht ch. Bc s
gy m, trong cuc khm bnh trc khi phu thut, phi lu cc yu t ny tnh
liu thuc m cn thit.

X l: Nu cn phi hp hai thuc, phi lu nguy c ny khi gy m v khi xc
nh liu dng. Khuyn ngi bnh thng bo cho bc s gy m bit mnh ang dng
thuc c ch MAO.
945
THUC GY M V TIN M
Ngoi hai loi barbituric v halogen ho bay hi, tnh a dng ca cc thuc gy
m
dn ti yu cu ch r cc nhm c th gy nguy c, ng i bnh cnh gic
v bo cho ngi gy m nhng thuc mnh ang dng
Cc thuc trong nhm

ETOMIDAT nh dch tim 20 mg/10 mL
Etomidate Lipuro nh dch tim truyn 20 mg/ng10 mL
KETAMIN dung dch tim l 500 mg/10mL
Calypsol dung dch tim l 500 mg/10mL
Ketalar: dung dch tim 500 mg/10mL; l 250 mg/20 mL
MIDAZOLAM ng tim 5 mg/1mL
Hypnovel dung dch tim 5 mg/1mL
Fulsed dung dch tim 1 mg/1mL
PROPOFOL ng tim 200 mg/20 mL
Recofol Lipuro 1% nh dch tim truyn 1%
PROFOL dung dch tim 200 mg/20 mL
Proprofol lipuro 1% nh dch tim truyn 1%
TNG TC THUC

Phn tch: Tng tc phi tnh n, do aminosid phong b c ch ni thn
kinh-c.
X l: Khuyn ngi bnh sp phu thut, cn thng bo cho bc s gy m cc
thuc ang dng.
Amphetamin hoc cc dn cht

Phn tch: Tng tc phi tnh n, tu theo tc dng cng giao cm gin tip.
X l: Khuyn ngi bnh sp phu thut, cn thng bo cho bc s gy m bit
cc thuc ang dng.
946
Benzamid; benzodiazepin; fluvoxamin; glycosid tr tim; guanethidin hoc thuc

tng t; levodopa; mianserin; medifoxamin; thuc an thn kinh cc loi; oxaflozan;
phenothiazin; procarbazin; reserpin; theophyllin hoc dn cht; viloxazin
thuc ang dng.
Cc thuc li tiu gi kali

Phn tch: Do c th c ri lon v nc v in gii.
thuc ang dng.
Thuc chn alpha

Phn tch: C th c nguy c gim tc dng co mch.
thuc ang dng.
Thuc chn beta - sotalol

Phn tch: Tng tc phi tnh n, tu theo tc ng n tim v lm chm nhp
tim ca mt s thuc chn beta.
X l: Khuyn ngi bnh sp phu thut cn thng bo cho bc s gy m cc
thuc ang dng.

Phn tch: Do nhng tc dng trn tim ca cc thuc ging beta.
thuc ang dng.
Thuc c ch MAO typ B

Phn tch: c ch c hiu monoamin oxydase typ B dn ti ko di tc dng ca
levodopa, v iu ny gii thch vic k n cng vi cht ny. Nh vy, t ng tc
ging nh nhng tng tc ca levodopa, v ngh bn c xem mc h thuc .
nhng thuc ang dng.
Barbituric; thuc ch vn ca morphin

X l: Nu cn phi hp hai thuc, phi lu nguy c ny khi gy m v khi xc
nh liu dng. Khuyn ngi bnh sp phu thut, cn thng bo cho bc s gy m
nhng thuc ang dng.
947
Thuc chng trm cm ba vng hoc cht tng t

Phn tch: Ch n tng tc dng trn tim mch vi lon nhp tim, nhp tim
nhanh hay tng huyt p nghim trng.
nhng thuc ang dng.

Phn tch: Tng tc dng c ch h thn kinh trung ng, ko theo tng cng
nhng thuc ang dng.
948
THUC GY M BAY HI CHA HALOGEN

(Cc thuc m dng ng h hp)
CC THUC TRONG NHM

DESFLURAN dung dch chai 240 mL
Suprane dung dch chai 240 mL
ENFLURAN chai 250 mL
Alyrane chai 250 mL
HALOTHAN dung dch
Fluothane chai dung dch phun m 250mL
Halothane M&B chai dung dch ht 20 mL
ISOFLURAN dung dch
Aerrane dung dch 100 mL
Forane dung dch chai 100 mL; 200 mL
Isoflurane dung dch chai 100 mL
SEVOFLURAN dung dch ht 99,9%
Sevorane dung dch ht 99,9% chai 250 mL
CH KHI CH NH THUC
Cn theo di: mc 1
Thi k mang thai: c bit khi tr d
Suy gan: Do cc thuc ny c vi gan.
Cc trng hp khc: Nguy c ri lon huyt p (h huyt p, tng catecholamin
trong mu).
TNG TC THUC

nng.
Phn tch: Tng nhy cm vi cc hp cht halogen. Nguy c try tim mch
X l: Ngng dng cc thuc c ch MAO khng chn lc 15 ngy trc khi phu
thut. Khuyn ngi bnh sp phu thut, cn thng bo cho bc s gy m nhng
thuc ang dng.
949

Ketamin
Phn tch: Ngi bnh dng halothan m dng thm ketamin s c hin tng h
huyt p, gim hiu sut tim. C ch cha r.
X l: Nu cn kt hp thuc, phi theo di cn thn v huyt p. Nu tng tc
thuc xy ra, phi dng liu php h tr (bao gm c vic dng atropin).
Procarbazin
Phn tch: Nguy c ri lon huyt p nghim trng, do hot tnh c ch MAO ca
cc thuc ny.
nhng thuc ang dng.

Phn tch: Cc thuc gy m bay hi cha halogen lm c tim nhy cm vi tc
dng ca cc thuc cng giao cm, nn trong mt s him trng hp c th gy
lon nhp tht nghim trng.
X l: Cn trnh phi hp thuc. Nu c th, thay i chin lc iu tr. y l
mt liu php bnh vin, thng c thc hin khoa gy m, hay trc khi phu
thut, c theo di lin tc v h hp v tim mch. Ngi k n phi sn sng trc
cc hu qu m t trong trng hp phi hp thuc, v tm cch trnh chng. Theo
di ngi bnh lin tc s gip cho qun l nguy c v can thip bt k lc no (ph i
lu c dng bo ch nh gi nguy c: dng ung, dng ti ch hay tim).

Phn tch: Thuc gy m bay hi cha halogen lm c tim nhy cm vi tc dng
ca cc thuc cng giao cm, nn trong mt s him trng hp c th gy lon nhp
tht nghim trng. Nguy c ny ch yu c ghi nhn vi isoprenalin, c xp vo
loi cng giao cm beta 1 v beta 2.
X l: Ngoi vic phi bit y cc liu php ang tin hnh v tin s ca
ngi bnh, bc s gy m phi sn sng cc my mc theo di lin t c (in tm
, huyt p). Nn trnh phi hp thuc ny, do nn c gng thay i chin l c
iu tr.
Thuc cholinergic
Phn tch: Ch yu y l neostigmin. Khi phi hp vi thuc c tnh cht
phong b thn kinh - c, th c th c tc dng i khng
X l: Liu php thng c thc hin ti c s chuyn khoa su. Phi tnh ti
tng tc ny khi thc hin liu php v theo di iu tr. Tc d ng cng r khi li u
lng chng nhc c cng cao.
950

Amineptin
Phn tch: Phi hp hai thuc c tim nng c vi gan (hip ng cc tc dng
khng mong mun).
gan (ASAT, ALAT, phosphatase kim, bilirubin) hoc nu c th th hon dng mt
trong hai th thuc. Kim tra chc chn l ngi bnh khng thng xuyn ung ru
v khng c tin s vim gan virus. Cc triu chng lm sng chnh, khng c hiu l
bun nn, st, vng da... S xut hin ng thi pht ban ngoi da, nga, hch to ni
ln bnh nguyn l do thuc. Cn phn bit r, theo cc kt qu xt nghim sinh hc,
nguy c xut hin vim gan tiu t bo khng hi phc c vi vim gan mt hi
phc c sau khi ngng iu tr.
Aminosid tim hoc dng ti ch; khng sinh polypeptid; thuc loi
cura; lincosamid
Phn tch: Nguy c phong b thn kinh - c tng ln, c th ko theo yu c, suy
h hp, thm ch lit, c bit khi dng enfluran v isofluran.
X l: Ngi gy m c trch nhim trnh nguy c ny v chun b sn thuc
khng cholinesterase v mui calci tim gii to s phong b thn kinh - c. Nguy
c ny gim thiu khi c h tr h hp; phi ch khi ngi bnh tnh li.
Amiodaron
Phn tch: Tng nguy c h huyt p v tng nguy c nhp tim chm khng l i
atropin.
X l: Tt c ph thuc vo mc ch iu tr chnh v thi gian iu tr vi thuc
ny hay thuc kia. C th c tht bi trong iu tr.

Phn tch: Halothan, enfluran, isofluran, methoxyfluran lm cho c tim nhy cm
vi tc dng ca cc thuc cng giao cm, nh vy lm tng nguy c xut hin lon
nhp tht nghim trng.
X l: Bc s gy m hoc bc s chuyn khoa yu cu ngi bnh ngng dng
amphetamin t nht hai ngy trc khi phu thut, hoc hiu chnh li li u dng cho
thch hp.
Benzodiazepin; mianserin; medifoxamin; methyldopa; thuc an thn kinh
cc loi; oxaflozan; phenothiazin; viloxazin
nhng thuc ang dng.
951
Bepridil
Phn tch: C kh nng ri lon dn truyn nh - tht, c bit vi halothan v
ethran.
nhng thuc ang dng.
Carbamazepin
Phn tch: Dng carbamazepin di ngy c nguy c to thnh nhng cht chuyn
ho c vi gan t cc thuc gy m halogen ho (enfluran, halothan, methoxyfluran).
nhng thuc ang dng.
Dihydropyridin; diltiazem; verapamil

Phn tch: C th tng hin tng h huyt p, mc du cc thuc i khng
calci c th c ch d phng nhp nhanh trn tht, tng huyt p v co tht mch
vnh trong khi phu thut.
X l: y l tng tc m bc s gy m phi qun l tu thuc cc thng s
theo di thu c khi phu thut.
Doxapram
Phn tch: Ngng dng thuc gy m lm c tim nhy cm vi cc catecholamin,
m doxapram li tng gii phng cc catecholamin.
X l: Phi ch t nht 10 pht sau khi ngng thuc m, ri mi dng doxapram.
Guanethidin hoc thuc tng t; reserpin

nhng thuc ang dng.
Levodopa
Phn tch: Halothan lm c tim nhy cm vi tc dng ca cc thuc cng giao
cm, c bit vi cc catecholamin; iu ny c th dn n nhng nguy c nghim
trng v lon nhp tht.
nhng thuc ang dng.

Phn tch: Tng nguy c h huyt p ch khi dng liu cao.
nhng thuc ang dng. Trnh hin tng gim th tch mu.
952
Phenytoin
Phn tch: Dng phenytoin lu di c th lm tng chuyn ho ca thuc gy m,
dn n phi tng liu, t s c hu qu l c vi gan v vi thn.
X l: C th gp phi hp ny ti bnh vin. Bc s gy m phi lu tng tc
ny. Khuyn ngi bnh thng bo cho bc s gy m nhng thuc ang dng.
Primidon hoc dn cht

Phn tch: Primidon lm tng chuyn ho cc thuc gy m, lm tng thm c
tnh vi gan, do phi dng liu thuc gy m cao hn.
nhng thuc ang dng.
Rifampin
Phn tch: c tnh vi gan v bnh no do gan c bo co khi rifampin v
isoniazid c dng sau khi gy m bng halothan. Tng tc xy ra chm. Phi hp
rifampin v halothan c th lm tng c tnh ca isoniazid i vi gan.
X l: Ngng iu tr chng lao v cho iu tr chng nhim c gan. Sau khi gy
m bng halothan, trnh dng rifampin - isoniazid mt thi gian ngn.
Ru
Phn tch: Say ru cp tnh (ngi bnh vo cp cu): tng cng tc dng gy
ng do c ch enzym. Nghin ru mn tnh: i khng vi tc dng gy ng do cm
ng enzym, i hi phi tng liu thuc gy m.
nhng thuc ang dng.
Sotalol
Phn tch: C th ko di h huyt p, v phong b p ng phn x tim, do kch
thch cc th th beta adrenergic. Nhc im ny c th khc phc bng cch dng
dobutamin, dopamin, isoproterenolvi y s thn trng
X l: Bc s gy m cn b tr y phng tin theo di (theo di lin tc
bng my) c th can thip bt k lc no.

Phn tch: Tng nguy c lon nhp tim, c bit khi dng halothan.
X l: Phi hp thuc ny c thc hin ti bnh vin. Khuyn ngi bnh
thng bo cho bc s gy m nhng thuc ang dng.
Thuc chn alpha

Phn tch: Nguy c h huyt p nghim trng.
nhng thuc ang dng.
953
Thuc chn beta

Phn tch: Thuc chn beta, k c dng thuc nh mt, c th ko di h huyt
p, do phong b p ng phn x tim gy ra bi s kch thch cc th th beta
adrenergic. C th khc phc nhc im ny bng cch dng dobutamin, dopamin,
isoproterenol vi y s thn trng.
X l: Bc s gy m phi sn sng mi phng tin theo di (gim st lin tc
bng my), cho php can thip bt k lc no.
Thuc li tiu gi kali; thuc li tiu h kali mu; furosemid hoc

thuc tng t
X l: Theo di huyt ng v iu tr cc ri lon chuyn ho. Khuyn ng i
bnh sp phu thut, cn thng bo cho bc s gy m nhng thuc ang dng.
Thuc c ch MAO typ B

Phn tch: c ch c hiu monoamin oxydase typ B lm cho tc dng ca
levodopa ko di thm, iu ny gii thch hai cht ny c k n cng nhau. V vy
cc tng tc cng ging nh tng tc vi levodopa, nn bn c c th tm c h
thuc ny.
nhng thuc ang dng.

Fluvoxamin; glycosid tr tim; thuc ch vn ca morphin
X l: Nu cn phi hp thuc, phi tnh ti nguy c ny khi gy m v khi chn
liu dng. Khuyn ngi bnh sp phu thut, cn thng bo cho bc s gy m nhng
thuc ang dng.

Phn tch: C th tng to thnh cc hp cht fluor v c c vi thn, nht l khi
isoniazid c dng vi enfluran.
nhng thuc ang dng.

Phn tch: Tng tc dng c ch h thn kinh trung ng, ko theo tng cc tc
nhng thuc ang dng.
954

Phn tch: C th c tc dng trn h tim mch, kiu lon nhp v tng huyt p.
nhng thuc ang dng.
THUC NHUN TRNG KCH THCH

Thuc nhun trng kch thch rut bi tit nc v cht in gii,
v lm tng nhu ng rut
CC THUC TRONG NHM

BISACODYL vin nn bao 5 mg
Dulcolax vin nn bao 5 mg
Bisacodyl vin nn bao 5 mg
v ht cy isapgol; GM STERCULIA, SENNA,CASCARA gi bt ung 3,6g/gi
6g/gi; cm hp 375g; vin nn bao
Igol gi bt ung 3,6g/gi; 6g/gi
Normacol cm hp 375g
Mucinum vin nn bao
CH CH NH THUC
Chng ch nh: mc 4
Bnh i trng: Do tc dng ca cc thuc nhun trng, mi bnh i trng tc
hay vim (vim trc i trng, bnh Crohn...) u chng ch nh dng thuc ny.
Cc trng hp khc: Trng hp mt nc nghim trng. Hi chng au bng
cha r nguyn nhn.

Thi k cho con b: Cc thuc nhun trng ny qua c sa m, gy nguy c
hi chng tiu chy tr b m.
Tr em: Trnh dng loi thuc nhun trng ny cho tr em, v nguy c mt i n
gii v gy tn thng rut.
Thi k mang thai: Bnh thuc nhun trng gy nhng ri lon (suy nhc,
trng thi bun nn, ri lon tm thn...) v tng nguy c tetani ngi mang thai. Phi
ch nhng bit dc cha cht podophyllin, gy qui thai.
TNG TC THUC
955

Amiodaron
nhp tim chm v khong QT di c t trc (ch thy trn in tm ) l nhng yu t
to iu kin xut hin xon nh. Xon nh l mt dng nhp tht c bi t, c th
xut hin thnh cn rt ngn (vi giy, mt thu: c cm gic ng t nhng khng mt
thc).
X l: Tt nht ngng thuc nhun trng. Nu cn phi hp thuc, phi d phng
h kali mu bng tng cng theo di, v phi theo di in tm . Khi xut hin xon
nh, khng dng cc thuc chng lon nhp. Khuyn ngi bnh gp li bc s nu
thy mi mt, yu c, chut rt.
Bepridil; pentamidin
Phn tch: Nguy c xut hin xon nh khi dng phi hp thuc ny. H kali
mu, nhp tim chm v khong QT di t trc (ch bit trn in tm ) l nhng yu
t to iu kin xut hin xon nh. Xon nh l mt dng nhp tht c bit, c th
thc) pht trin thnh rung tht.
X l: Nn trnh phi hp thuc ny. Dng cc thuc khng gy xon nh. Nu
cn phi hp thuc ny, nn theo di lin tc khong QT v kim tra u n kali mu.
Cn ch cc du hiu bo trc h kali mu: mt mi, yu c, chut rt.
Cc benzamid
Phn tch: Nguy c xut hin xon nh khi phi hp hai thuc ny (c bit vi
sultoprid). H kali mu, nhp tim chm v khong QT di c t trc (ch thy trn in
tm ) l nhng yu t to iu kin xut hin xon nh. Xon nh l mt dng nhp
tht c bit, c th xut hin thnh cn rt ngn (vi giy, mt thu: c cm gic ngt
nhng khng mt thc). Cc thuc gy h kali mu s to iu ki n cho cc ch t
khng chng lon nhp gy xon nh.
X l: Nn trnh phi hp thuc. Dng cc thuc khng gy xon nh. Nu cn
phi hp thuc, phi theo di khong QT v kim tra u n kali mu. Cn ch cc
du hiu lm sng bo hiu h kali mu: mi mt, yu c, chut rt.
Disopyramid
Phn tch: Khi phi hp thuc ny, c nguy c xon nh do cng hp cc tc
dng in sinh l. H kali mu, nhp tim chm v khong QT di t trc (ch bit trn
in tm ) l nhng yu t to iu kin xut hin xon nh. Xon nh l mt dng
nhp tht c bit, c th xut hin thnh cn rt ngn (vi giy, mt thu: c cm gic
ngt nhng khng mt thc).
956

cn phi hp thuc, phi theo di lin tc khong QT v kim tra u n kali mu.
Cn ch cc du hiu lm sng bo hiu h kali mu: mi mt, yu c, chut rt.
Halofantrin
Phn tch: Khi dng phi hp thuc ny, c nguy c xon nh, do h kali mu to
iu kin. H kali mu, nhp tim chm v khong QT di t trc (ch bit c trn
in tm ) l nhng yu t to iu kin xut hin xon nh. Xon nh l mt kiu
Macrolid
Phn tch: Tng nguy c xon nh do cng hp cc tc dng, mi ch c m
t vi erythromycin tim tnh mch. H kali mu, nhp tim chm v khong QT di t
trc (ch bit c trn in tm ) l nhng yu t to iu kin xut hin xon
nh. Xon nh l mt kiu nhp tht c bit, c th xut hin thnh cn rt ngn (vi
giy, mt thu: c cm gic ngt nhng khng mt thc). Trong h macrolid, ch c
erythromycin, c bit di dng tim tnh mch c th gy ri lon nhp tim (ko di
on QT, ngoi tm thu tht, xon nh, blc nh-tht).
X l: Phi hp thuc c tim nng gy t vong ny l chng ch nh v khng
c k n. Ngay khi dng mt mnh, erythromycin tim tnh mch cng gy lon nhp
tim. Do khng nn tim nhanh c liu, m phi truyn tnh mch lin t c hay gin
on, thi gian truyn mi ln phi hn 60 pht.
Sparfloxacin
Phn tch: Tng tc thuc ny ch ng vi sparfloxacin (Zagam). Tng nguy c
xon nh do cng hp cc tc dng in sinh l. H kali mu, nhp tim chm v
khong QT di t trc (ch bit c trn in tm ) l nhng yu t to iu kin
xut hin xon nh. Xon nh l mt dng nhp tht c bit, c th xut hin thnh
cn rt ngn (vi giy, mt thu: c cm gic ngt nhng khng mt thc).
Phn tch: Tng tc ch thy vi mt khng histamin khng an thn l astemizol
(Hismanal). H kali mu (v c nhng trng hp tiu chy dai dng c th gy mt
nc v in gii) l mt yu t to iu kin xut hin xon nh. Nguy c ny l i
tng ln khi cc thuc gy h kali mu li c phi hp vi nhng thuc khc c th
gy xon nh. Xon nh l mt dng nhp tht c bit, c th xut hin thnh cn
rt ngn (vi giy, mt thu: c cm gic ngt nhng khng mt thc).
957
X l: Nn trnh phi hp thuc. Thay i chin lc iu tr v chn nhng

thuc khng gy xon nh. Nu cn phi hp thuc ny, phi theo di kali mu, v khi
cn b sung kali.
Vincamin
Phn tch: Nguy c xut hin xon nh khi phi hp hai thuc ny. H kali mu,
nhp tim chm v khong QT di t trc (ch bit c trn in tm ) l nhng yu
thc) c th i khi pht trin thnh rung tht.

Amphotericin B
Phn tch: Tc dng h kali mu, khi dng dng tim. Amphotericin B rt t c
hp thu khi ung hay dng ti ch trong iu kin bnh thng.
X l: Theo di kali mu. Phi nh gi cc nguy c theo ng dng
amphotericin B.
Cc thuc loi cura

Phn tch: Nguy c tng phong b thn kinh-c do gim kali mu, nht l vi cc
X l: Cn nh lng kali mu trc khi dng thuc loi cura khng kh cc.
Corticoid khong; furosemid hoc thuc tng t; glucocorticoid;
tetracosactid; thuc li tiu thi kali
Phn tch: Phi hp hai thuc h kali mu, ko theo tng nguy c h kali mu,
nht l khi dng lu di thuc nhun trng.
X l: Kim tra kali mu, v khi cn, hiu chnh nng bng mui kali. H
kali mu th hin trn lm sng qua mi mt, thm ch chut rt v i khi lo n nhp
tim. Cn phi ch trng hp mt nc qu nhiu (khi gng sc, tr i nng, ho c
tiu chy dai dng), lm cho mt kali cng thm nghim trng.
Glycosid tr tim
Phn tch: H kali mu c th xy ra do dng cc thuc nhun trng kch thch v
c th lm cc thuc digitalis d gy c.
X l: Theo di ngi bnh trn lm sng. Nu c th, ngng k n thuc nhun
trng kch thch ngi bnh cao tui ang dng cc thuc h digitalis. Kim tra kali
mu u n ngi bnh dng thuc nhun trng di ngy. Nu cn, kim tra in
958
tm . Theo di lm sng (mi mt, chut rt, lon nhp tim). Khuyn ngi bnh ang
dng thuc digitalis khng t dng thm thuc nhun trng.
Quinidin hoc dn cht

Phn tch: Nguy c xut hin xon nh khi phi hp mt thuc c tc dng h
kali mu vi mt thuc chng lon nhp thuc nhm 1 theo Vaugham - Williams. H kali
mu, nhp tim chm v khong QT di t trc (ch bit c trn in tm ) l
nhng yu t to iu kin xut hin xon nh. Xon nh l mt dng nhp tht c
bit, c th xut hin thnh cn rt ngn (vi giy, mt thu: c cm gic ngt nhng
khng mt thc).
X l: Nu cn phi hp mt thuc nhun trng kch thch vi mt thuc chng
lon nhp, phi phng nga h kali mu bng cch b sung thm mt lng kali
c tnh ton, v nu cn, phi lm in tm . Khi thy xut hin xon nh, khng
dng thuc chng lon nhp. Khuyn ngi bnh gp li bc s nu thy mt mi, yu
c, chut rt.
Sotalol
nhp tim chm v khong QT di t trc (ch bit c trn in tm ) l nhng yu
thc).
X l: Tt nht, ngng thuc nhun trng. Nu cn phi hp, phi d phng h
kali mu bng cch tng cng theo di v phi lm in tm . Cn ch cc d u
hiu bo trc h kali mu: mi mt, yu c, chut rt. Khi thy xut hin xon nh,
khng dng thuc chng lon nhp.

Phn tch: Dng cc thuc ny phi hp vi cc thuc nhun trng kch thch
(mc du trong mt s bit dc c phi hp ny) c th v lu di lm cc thu c
nhun trng kch thch b hp thu v gy c cho gan.
X l: Tm hiu nguyn nhn to bn, trnh dng cc thuc nhun trng di ngy.
Trnh phi hp cc thuc nhun trng vi nhau.
959
THUC NHUN TRNG LM MM

Cc sn phm c tnh tm t v gy nh ho ng tiu ho
CC THUC TRONG NHM

NATRI DOCUSAT thuc tht hu mn (phi hp vi glycerin v carboxy-metylcellulose)
Norgalax thuc tht hu mn (phi hp vi glycerin v carboxy-metyl-cellulose)
CH KHI CH NH THUC

Bnh i trng: Do tc dng ca thuc nhun trng, mi bnh i trng, nht l
do tc nghn, l mt chng ch nh.
Cn theo di: mc 1
Tr em: tr di 6 tui, kh chn on cc bnh ng tiu ho, v cc thuc
ny ch c pht theo n bc s.
TNG TC THUC

Quinidin hoc dn cht
Phn tch: Dng lu di cc thuc nhun trng c th gy h kali mu. C nguy c
xut hin xon nh.
X l: D nguy c ny nh, cng vn cn phi bit.
Thuc loi cura

thuc loi cura khng kh cc, v nhng ngi bnh dng thuc nhun trng thi
gian di.
X l: Nguy c trn tng i thp. Hi ngi bnh xem c dng rt thng
xuyn cc thuc nhun trng khng? Cn nh lng kali mu trc khi dng thuc loi
cura khng kh cc.

Phn tch: Phi hp vi cc thuc nhun trng kch thch (ngay c khi phi hp
ny c sn trong mt s bit dc) lu di c th dn ti hp thu cc thu c nhu n
trng kch thch v gy c vi gan.
X l: Cn tm hiu nguyn nhn to bn v trnh dng thuc nhun trng di
ngy. Trnh phi hp cc thuc nhun trng vi nhau.
960
THUC NHUN TRNG LM TRN

Cc sn phm ny ch yu c cht nn l cc du khong (du parafin)
CC THUC TRONG NHM

du parafin gel ung
Lubentyl gel ung
CH KHI CH NH THUC
Chng ch nh: mc 4
Cc bnh i trng: Do tc dng ca cc thuc nhun trng, tt c cc bnh i
trng gy tc nghn u chng ch nh dng thuc ny.
Cc trng thi khc: Hi chng au bng cha r nguyn nhn, hay do vim
(vim trc i trng lot, bnh Crohn...).
Thn trng: mc 2
Tr em; tr cn b m: Khng nn dng cho tr di 6 tui (nguy c gy bnh
phi dng trp).
Thi k mang thai: Dng lp li nhiu ln cc loi du khong ngi mang thai
lm gim hp thu thc n, c bit cc vitamin tan trong du; h thrombin huyt v cc
bnh xut huyt tr mi sinh.
TNG TC THUC

Amiodaron
nhp tim chm, v khong QT ko di c t trc (ch nhn thy trn in tm ) l
nhng yu t to iu kin thun li cho xut hin xon nh. Xon nh l mt dng
X l: Nn ngng dng cc thuc nhun trng. N u c n ph i h p thu c ny,
phi d phng h kali mu bng cch tng c ng theo di v ph i theo di i n tm
. Khi thy xon nh, khng dng cc thu c ch ng lo n nh p. Khuyn ng i b nh
gp li bc s khi thy mi mt, yu c , th m ch chu t rt.
Bepridil; disopyramid; glucocorticoid; thuc li tiu thi kali

Phn tch: Dng lu di cc thuc nhun trng lm trn (cng nh khi tiu chy
nng) c th gy h kali mu.
961
X l: Khi phi hp thuc ny, phi d phng h kali mu b ng cch cung c p

thm kali, v tu theo tnh hnh lm sng, theo di i n tm (nguy c h kali mu
thp hn khi dng cc thuc nhun trng kch thch). Khuyn ng i b nh g p l i bc
s khi thy mi mt, yu c, thm ch chu t rt.

Cc thuc loi cura
Estrogen hoc thuc nga thai estrogen-progestogen

Phn tch: Dng du khong cng vi cc estrogen-progestogen lm gim hp thu
v gim hot tnh cc estroprogestogen.
ngi bnh dng hai thuc cch nhau nhiu gi (dng estrogen-progestogen trc
hai gi hoc bn gi sau khi dng du khong).

Phn tch: Phi hp hai thuc gy h kali, lm tng nguy c h kali mu v nguy
c xut hin xon nh.
X l: Theo di kali mu, v nu cn, khc phc h nng kali trong mu bng
cc mui kali. H kali mu biu hin lm sng bng mt mi, thm ch c th c co
cng c v i khi ri lon nhp tim. Cn ch trnh mt nc qu nhi u (nh khi
hot ng th lc, nng nc, hoc tiu chy dai dng), lm mt thm kali.
Glycosid tr tim
Phn tch: Dng du khong cng glycosid tr tim lm gim hp thu v hot tnh.
ngi bnh dng hai thuc cch nhau nhiu gi (dng estrogen-progestogen trc
hai gi hoc bn gi sau khi dng du khong).
Quinidin hoc dn cht

Phn tch: Thuc nhun trng lm trn dng lu di c th gy h kali mu, nh
vy lm tng nguy c xut hin xon nh khi dng phi hp vi quinidin. H kali mu,
nhp tim chm, v khong QT di c t trc (ch bit c trn in tm ) l nhng
yu t to iu kin xut hin xon nh. Xon nh l mt dng nhp tht c bit, c
th xut hin thnh cn rt ngn (vi giy, mt thu: c cm gic ngt nhng khng mt
thc).
X l: Phi hp thuc ny cn c theo di. C l nn ngng dng cc thuc
nhun trng, hoc dng cc thuc khng gy xon nh. Khuyn nn dng ch n
thay thuc nhun trng. Nu khng, phi ch n cc du
hiu lm sng bo hiu h kali mu nh lon nhp tim, mt mi, yu c, chut rt.
962
Sotalol; vincamin
Phn tch: Cc thuc nhun trng lm trn c th gy h kali mu khi dng lu
di, nh vy lm tng nguy c xut hin xon nh khi dng phi h p v i cc ch t
trn. H kali mu, nhp tim chm v khong QT di c t trc (ch bi t c trn
in tm ) l nhng yu t to iu kin xut hin xon nh. Xon nh l m t
dng nhp tht c bit, c th xut hin thnh cn rt ng n (vi giy, mt th u: c
cm gic ngt nhng khng mt thc).
X l: Khi dng phi hp thuc ny phi theo di. Nn ngng cc thuc nhun
trng, hoc nn dng nhng thuc khng gy xon nh.

Phn tch: Dng cc du khong cng vi cc thuc khng vitamin K lm gi m
hp thu, nn lm gim hot tnh cc thuc khng vitamin K.
X l: C th trnh c hu qu ca tng tc ny bng cch khuyn ngi
bnh dng hai thuc ny cch nhau nhiu gi (dng thuc khng vitamin K trc hai gi
hay bn gi sau khi dng du khong).
Vitamin A; vitamin nhm D

Phn tch: Dng cc thuc ny cng du khong lm gim hp thu v do lm
gim hot tnh ca cc thuc do tng tc dc ng hc v hp thu thuc.
X l: Khuyn ngi bnh trnh dng ng thi hai thuc, v dng vitamin hoc
trc hai gi, hoc bn gi sau khi ung thuc nhun trng. Cn hi ngi bnh v
cc thuc t dng (c bit vi ngi bnh cao tui).
THUC NHUN TRNG NHY V THM THU

Thuc nhy lm tng lng phn. Thuc thm thu c th l mui
hoc ng hoc dn cht alcoyl; chng ht nc vo ng rut
to ra mt gradien p sut thm thu
CC NHM TRONG THUC

LACTIOL cm pha hn dch ung ti10 g
Importal cm pha hn dch ung ti 10 g
LACTULOSE siro 667 g/100 mL
Duphalac siro 667 g/100 mL
963
NATRI LAURYL SULFOACETAT gel tht hu mn

Microlax gel tht hu mn 3,75 g
Microlax bb gel tht hu mn 0,027 g
GLYCEROL gel tht hu mn
Microclismi gel tht hu mn 9 g (6,75 mg glycerol)
MACROGOL 4000 dung dch ung ti 10 g; bt pha dung dch ung gi 64 g
Forlax dung dch ung ti 10 g
Fortrans bt pha dung dch ung gi 64 g
MANNITOL gi 5g
Mannitol gi 5 g
SORBITOL gi 5 g
Sorbitol gi 5 g
Bibonlax ng tht trc trng 3.572 g (dung dch 70% sorbitol)
CH KHI CH NH THUC
Chng ch nh: mc 4
Bnh i trng: Do tc dng ca thuc nhun trng, tt c cc bnh i trng tc
u chng ch nh dng thuc ny.
Cc trng hp khc: Hi chng au bng khng r nguyn nhn. U phn.
Cn thn trng: mc 2
Tr em: i vi tr em di 6 tui, v bnh l tiu ho kh chn on, nn ch
c pht cc thuc ny theo n bc s.
Suy thn: Cc thuc mui (thuc c c cht l natri v magnesi) phi dng rt
thn trng cho ngi bnh suy thn.
TNG TC THUC

Bepridil
Phn tch: H kali mu, nhp tim chm v khong QT di c t trc (ch bit
c trn in tm ) l nhng yu t to iu kin xut hin xon nh. Xon nh l
mt dng nhp tht c bit, c th xut hin thnh cn rt ngn (vi giy, mt thu: c
cm gic ngt nhng khng mt thc).
X l: Nu cn phi hp, phi theo di lin tc khong QT v kim tra u n
kali mu. Cn ch n cc du hiu lm sng bo hiu h kali mu nh mt mi, yu
c, chut rt.
964
Cc thuc loi cura

thuc loi cura khng kh cc, khi dng thuc nhun trng thng xuyn.
Glycosid tr tim; phenothiazin; salicylat; thuc ung chng ng mu
khng vitamin K;
Phn tch: Dng thuc nhun trng nhy v thm thu cng vi cc thuc trn s
lm gim hp thu v hot tnh cc thuc .
gi.
X l: C th trnh c tng tc ny nu dng hai thuc cch nhau t nht 2

Quinidin hoc dn cht
Phn tch: Dng thuc nhun trng lu di c th gy h kali mu. Nguy c xut
hin xon nh.
X l: Mc du nguy c ny thp, nhng cng cn phi bit ti. Thng bo ngi
bnh bit trnh t dng thuc gy nguy c.
THUC NGA THAI DIT TINH TRNG

Thuc c tc dng dit tinh trng, dng ti ch
CC THUC TRONG NHM

BENZALKONIUM CHLORID vin nn 25 g
Pharmatex vin nn 25 g
CH KHI CH NH THUC
Cn theo di: mc 1
Trng hp khc: Trnh k n nhng thuc ny cho nhng ngi khng hiu s
cn thit phi tun th tt vic iu tr.
965
THUC ST KHUN DN CHT AMONI BC BN

Thuc chng nhim khun amoni bc bn lm gim tm thi s lng
CC THUC TRONG NHM

BENZALKONIUM: vin ngm 5 mg; vin trng t 18,9 mg
Bradosol vin ngm 5 mg
Pharmatex vin trng t 18,9 mg
BENZETHONIUM
Cenasert vin t m o
CETRIMID
Cetavlon dung dch cn 0,5% kem bi da
Burnol plus kem bi da
Drapolene kem bi da
DEQUALINIUM vin ngm 0,25 mg
Dequadin vin ngm 0,25 mg
CH KHI CH NH THUC
Cn theo di: mc 1
Trng hp khc: Khng bi ln nim mc hoc da b tn thng, di lp bng
bt.
THUC ST KHUN C IOD

Thuc c dng v c ph rng dit khun, dit nm v dit virus
CC THUC TRONG NHM

Thnh phm c iod
Cn iod 3%; 1%
POVIDON - IOD: dung dch 1%, 7,5%, 10%; vin t 200 mg
Abodine dung dch dng ngoi 10%
Arodin thuc m 5%
966
Betadin dung dch dng ngoi 10%

Betadine dung dch sc ming 1%
Betadine dung dch tht ra m o 10%
Betadine Scrub dung dch sc ming 4%
Frekacid thuc xt bt 1,35 g/30 g
Povidin thuc m 10%
Povidin dung dch dng ngoi 10 %
Povid vin t 200 mg
Wokadine dung dch dng ngoi 5%
Wokadine thuc m 10%
CH KHI CH NH THUC
Chng ch nh: mc 4
Trnh dng cc thuc ny cho ngi mn cm vi iod.

Thi k cho con b: V thn trng v bo v tr s sinh.
Tr em: C nhiu nguy c thuc thm vo ton thn. Trnh dng cho tr s sinh
di mt thng tui; trn mt thng tui, cn thn trng cho n t nht 30 thng.
Thi k mang thai: Trong c thai k, v cha c d liu.
TNG TC THUC

Thuc st khun c thy ngn
Phn tch: Mt s dn cht thy ngn t nhiu vng bn c th kt ta vi cc
ch phm c iod hoc hp cht c iod, dn n kt ta thy ngn I iodid n da, gy
bng v da phng nc nng.
X l: Trnh k n dng ng thi hoc dng xen k hai thuc ny v gy bng.
THUC ST KHUN MUI KIM LOI

CC THUC TRONG NHM

Bc (dn cht) SULFADIAZIN kem bi da 1%; thuc nh mt 1%
Bc nitrat thuc nh mt 1%
967
Silvirin kem bi da 1%
Sulfadiazin bc kem bi da 1%
ng sulfat
Trapha 1 g/30 g thuc bt
Gynocal dung dch dng ngoi
Gynoxa dung dch dng ngoi
Gyno OPC dung dch dng ngoi
Sanofar OPC dung dch dng ngoi
Gynosol OPC dung dch dng ngoi
Hadophar thuc bt
Gynapax dung dch dng ngoi
Cotaformin dung dch dng ngoi
ng sulfododeCanoat natri dung dch dng ngoi 2%
Gynofar dung dch dng ngoi 2%
KALI PERMANGANAT
Thuc tm - Thuc bt dng ngoi
KM OXYD
Aloplastine - Bt nho, kem bi da
Brulex thuc m
H nc dng ngoi da
Km sulfat dung dch nh mt 0,5 %; 0,002 %
Daigaku dung dch nh mt 0,002 %
Km sulfat dung dch nh mt 0,5 %
CH KHI CH NH THUC

Tr em: Tu thuc mui kim loi v tu theo dng bo ch. Chng ch nh cho
tr cn b v tr nh (da hp thu hot cht thuc nhanh hn).
THUC ST KHUN C THU NGN

c dng st khun cc vt thng trn b mt hoc trn da lnh
(trc khi phu thut)
968
CC THUC TRONG NHM

MERBROMIN dung dch dng ngoi 1%
Thuc 1% dung dch dng ngoi
MERCUROBUTOL
Mercryl Lauryl dung dch dng ngoi
PHENYL thy ngn borat dung dch nh mt 3%
Lacrypos dung dch nh mt 3%
CH KHI CH NH THUC
Chng ch nh: mc 4
Cc trng hp khc: Mn cm vi cc thuc c thy ngn.
TNG TC THUC

Thuc st khun c iod
Phn tch: Mt s dn cht thy ngn t nhiu vng bn c th kt ta vi cc
ch phm c iod hoc hp cht mang iod, dn n kt ta thu ngn I iodid n da, gy
bng v da phng nc nng.
X l: Trnh k n dng ng thi hoc dng xen k hai thuc ny v gy bng.
THUC ST KHUN KHC

CC NHM TRONG THUC

ACID BENZOIC V ACID BORIC
AMINACRIN
BICLOTYMOL
Hexapneumine vin nn 30 mg
Hexaspray dung dch phun m 0,75 g/30 g
969
BLEU METHYLEN
Xanh methylen dung dch 2 %
Mictasol bleu vin bao 0,02 g
Mekoblue dung dch nh mt 1 mg/10 mL
HEXAMIDIN
HEXETIDIN
Givalex dung dch sc ming 1 mg/mL
HYDRO PEROXYD
NATRI CLORID
Natri clorid dung dch nh mt, mi 0,9 %
POLICRESULEN
Albothyl dung dch bi ngoi 36 %
THYMOL
Lixusine dung dch xc ming 0.64
TRICLOSAN
Sicorten plus kem bi da 1%
CH KHI CH NH THUC

Khng c bi cc thuc ny trn nim mc hoc da b tn thng, d i lp
bng bt.
970
THUC ST DNG TRONG IU TR
CC THUC TRONG NHM

St sulfat vin nn 200 mg, vin nn phi hp c 80 mg Fe2+
St sulfat vin nn 200 mg
Tardyferon vin nn phi hp c 80 mg Fe2+
St aminoat
Adofex nang 60 mg Fe2+
St oxalat vin nn 0,05 g
St oxalat vin nn 0,05 g
St fumarat vin nn 200 mg
Ferronat vin nn 200 mg
St gluconat vin nn 300 mg
Ferral vin nn 300 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Bnh v mu: Trong trng hp qu ti st (bnh thalassemia, thiu mu kh
cha, thiu mu do suy ty.

n ung: Ung nhiu nc ch c th c ch hp thu st.
TNG TC THUC
Tng tc cn trnh: mc 3
Phenicol
Phn tch: Gim p ng huyt hc (tht bi iu tr ca phi hp st v/hoc
vitamin B12) vi cc mui st, do nh hng ca cc phenicol trong s to hng cu.
Nn nh tc dng c ch ty xng ca cloramphenicol.
X l: Thay hoc ngng khng sinh trong khi iu tr thiu mu bng mui st.

Phn tch: S gim hp thu qua ng tiu ha bi cht khng acid s lm gim
tc dng ca thuc phi hp. Tng tc ny c bit c ngha vi cc khng acid c
mui oxyd v hydroxyd magnesi, nhm v calci.
971
X l: Cn mt khong thi gian t nht t mt n hai gi gia khi ung cht

khng acid v thuc. Nn nh rng cc khng acid thng c ung
1 gi 30 pht sau ba n, v n ung lm tng tit dch d dy.
Cholestyramin
Phn tch: Gim hp thu st ng tiu ho
X l: Nu hai thuc ny c k n, khuyn ung cc mui st trc 2 gi
hoc sau 4 gi khi ung cholestyramin.
Bisphosphonat
Phn tch: Gim hp thu bisphosphonat ng tiu ho
X l: Cn lu tng tc v khuyn ngi bnh ung hai thuc cch xa nhau t
nht 2 gi.
Hormon tuyn gip
Phn tch: Vi cc mui st, c kh nng gim hp thu thyroxin ng tiu ho.
X l: Khuyn ngi bnh dng mui st v hormon tuyn gip cch xa nhau t
nht 2 gi.
Phn tch: Gim hp thu penicilamin bi st (ti 35%) v bi cc khng acid (ti
66%). Cch xa cc ln ung (khong 2 gi ). Cn theo di.
X l: Cn lu tng tc v khuyn ngi bnh ung hai thuc cch nhau t
nht 2 gi.
Quinolon; sparfloxacin
Phn tch: Cc quinolon ni chung v cc fluoroquinolon ni ring, dng ng
ung chelat ho cc cation ho tr hai hoc ba nh nhm, magnesi, calci, st, km. Phi
nht thit tn trng khong cch hn 2 gi gia cc ln ung thuc. Cn theo di
X l: Cn lu tng tc v khuyn ngi bnh ung hai thuc cch xa nhau t
nht 2 gi.
Tetracyclin
Phn tch: Tng tc kiu l - ho. l s chelat ho cc cation (Fe, Al, Ca) bi
tetracyclin, dn n gim hp thu tetracyclin v nguy c tht bi iu tr
X l: Nguy c quan trng hn nhiu vi cc tetracyclin th h mt (terramycin)
c ch hp thu 75%. Vi cc tetracyclin th h 2, gim hp thu khong 20% v c th
khng c bt k ngha lm sng no.
Phn tch: Tc dng ph khi tim st tnh mch, gm c st, au khp v h
huyt p. Ung sulfat st c th lm gim nng trong mu ca captopril. Tng tc
xy ra nhanh. C ch: thuc c ch enzym chuyn dng c th lm gim d ho kinin,
nh vy c th lm tng tc dng ton thn ca st tim tnh mch. St (II) sulfat c
th thc y hnh thnh mt nh phn captopril disulfid bt hot.
972
X l: Do tnh cht nghim trng ca phn ng ny, nn dng mt thuc khc

thay th. Khng c ung cng mt lc captopril v st (II) sulfat, phi ung hai thuc
cch nhau t nht t 2 gi tr ln.
Levodopa
Phn tch: Tc dng dc l ca levodopa c th b gim. C ch: Levodopa
chelat ho cc mui st, nn lm gim hp thu v lm gim nng huyt thanh ca
levodopa. Tng tc xy ra chm.
X l: Ung hai thuc cng cch xa nhau cng tt. Theo di p ng lm sng v
tng liu levodopa nu cn.

Khng histamin H2 (cimetidin...)
Phn tch: Hp th st qua ng tiu ho b thuc khng histamin H2 lm gim.
Tng tc xy ra chm. C ch: gim ho tan ca st do pH dch d dy tng.
X l: Cho ung st t nht 1 gi trc khi cho khng histamin H2. Nu vn nghi
cn tng tc, gim liu khng histamin H2 hoc cho tim thm st.
973
THUC TNG XY NO
Cc ch phm c tnh cht chng thiu oxy m,
cho php ci thin oxy no
CC THUC TRONG NHM

MECLOFENOXAT: vin nn 250 mg; bt pha dung dch tim 250 mg, 1000 mg
Lucidril vin nn 250 mg
Lucidril bt pha dung dch tim 250 mg
Lucidril Mille bt pha dung dch tim 1000 mg
PIRACETAM: vin nang 400 mg; vin nn bao phim 800 mg; dung dch ung 20
%; dung dch tim 1 g/5mL
Medotam nang 400mg
Nootropyl vin nn bao phim 800 mg
Nootropyl vin nang 400 mg
Nootropyl dung dch ung 20%
Nootropyl dung dch tim 1 g/5 mL
Piracetam vin nang 400 mg
Pirapyl dung dch tim 200 mg/ml
Setam vin nang 400 mg
Ucetam vin nang 400 mg
CH KHI CH NH THUC

Suy thn: Chng ch nh s dng khi suy thn nng.
Cn theo di: mc 1
Thi k mang thai: Do thn trng, do khng c c liu.
THUC TIU LP SNG

Thuc dng ngoi, c tnh cht lm tiu lp sng
974
CC THUC TRONG NHM

Nha hc n kem bi da
Alphosyl kem bi da
CH KHI CH NH THUC
Cn theo di: mc 1
Cc trng hp: Khng dng trong trng hp bnh da chy nc, nt n, hoc
vim.
975
CC THUC TR , DN CHT CA NM CA G
Dn cht ca nm ca g c cc tnh cht tng trng lc t cung mnh
CC THUC TRONG NHM

METHYLERGOMETRIN ng tim 0,2 mg/mL; 0,25 mg/mL
Methergyn ng tim 0,2 mg/mL; 0,25 mg/mL
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai: Trong khi mang thai, trnh dng thuc ny.

Qu mn vi cc dn cht ca nm ca g; ngi mng hoc bt thng cho ti
khi s thn ca tr; nhim c thai nghn; cc bnh mch mu tc nghn; nhim
khun nng.
Cn theo di: mc 1
Thi k cho con b: Methylergometrin qua c sa m. Ch c dng cho ph
n cho con b trong trng hp c ch nh r rng v v nguyn tc trong thi gian
khng qu 3 ngy.
TNG TC THUC

Phn tch: Phi hp cc thuc co mch km vi nguy c xut hin t kch pht
tng huyt p do dng cc alcaloid nm ca g c tnh cht co mch.
X l: Cn trnh phi hp; thay i chin lc iu tr.
THUC TR H HP
L nhng thuc kch thch cc trung khu h hp.
(Cht doxapram thuc mt nhm thuc khc)
CC THUC TRONG NHM

ALMITRIN vin nn 250 mg
976
Duxil vin bao 30 mg phi hp vi 10 mg raubasin

Vectarion vin nn bc 50 mg
CH KHI CH NH THUC

Cc trng hp khc: Cn hen cp tnh
977
THUC TR TIM BUPYRIDINIC

Cc cht c ch phosphodiesterase, c tc dng tng lc co c
v tc dng gin mch
CC THUC TRONG NHM

AMRINON ng tim 100 mg/20 mL
Inocor ng tim 100 mg/20 mL
ENOXIMON ng tim 100 mg/20 mL
Perfane ng tim 100 mg/20 mL
MILRINON ng tim 10 mg/10 mL
Corotrope ng tim 10 mg/10 mL
CH KHI CH NH THUC
Chng ch nh: mc 4
Trng hp khc: Bnh c tim v bnh van tim tc nghn nghim trng, gi m
mnh lu lng mu, lon nhp nhanh trn tht, phnh tm tht.

Thi k cho con b: Cha chng minh c tnh v hi tr em.
Tr em: Cha chng minh c tnh v hi tr em.
Thi k mang thai: Do thn trng, tuy khng c tc dng gy qui thai sc v t,
nhng ch c dng nu tng quan nguy c/ li ch c cn nhc.
THUC TR SU CLOR HU C
Thuc tr su tc dng ln loi tit tc. Do o thi lu di v do tch lu,
vic s dng b hn ch
CC THUC TRONG NHM

LINDAN hn dch bi ngoi 10%
Scaboma hn dch bi ngoi 10%
CH KHI CH NH THUC
978

Tr em: tr em di 30 thng tui.
Cn theo di: mc 1
Thi k mang thai: Do thn trng, cha xc nh l khng c c tnh.
Trnh bi ln da b tn thng: Nguy c chuyn vo ton thn.
THUC C CH ENZYM CHUYN DNG ANGIOTENSIN

Cc cht c ch enzym chuyn angiotensin 1 thnh angiotensin 2. Angiotensin 2
l mt cht co mch rt mnh, lm tit aldosteron (hormon khng niu)
CC THUC TRONG NHM

BENAZEPRIL vin nn 10 mg
Briazide vin nn (10 mg benazepin HCl + 12,5 mg hydroclothiazid)
Briem vin nn bc 5 mg; 10 mg
Cibacen vin nn 5 mg; 10 mg
Cibadrex vin nn (10 mg benazepril + 12,5 mg hydrochlothiazid)
CAPTOPRIL
Apo-Capto vin nn 6,25 mg; 12,5 mg; 25 mg; 50 mg; 100mg
Captohexal vin nn 25 mg; 50 mg
Captopril Domesco vin nn 25 mg
Captopril stada vin nn 12,5 mg; 25 mg; 50 mg
Epsitron vin nn 12,5 mg; 25 mg; 50 mg
Lopril vin nn 25 mg; 50 mg
Ropril vin nn 25 mg
Tensiomin vin nn 25 mg; 50mg
CILAZAPRIL
Justror vin nn bao phim 0,5 mg; 1 mg; 2,5 mg
ENALAPRIL
Apo-Enalapril vin nn 2,5 mg; 5 mg; 10 mg; 20mg
Benalapril vin nn 5 mg
979
Ednyt vin nn 5 mg; 10 mg

Enalapril Stada vin nn 5 mg; 10mg
Enam vin nn 5 mg; 10mg
Nuril vin nn 5 mg; 10mg
Renitec vin nn 5 mg; 10 mg; 20mg
IMIDAPRIL
Tanatril vin nn 5 mg; 10mg
LISINOPRIL
Linopril vin nn 10 mg; 20mg
Linoritic forte vin nn 20 mg + 25 mg hydrochlorothiazid
Lisoril vin nn 5 mg; 10 mg
Listril vin nn 2,5 mg; 5 mg; 10mg
PERINDOPRIL
Coversyl vin nn 2 mg; 4 mg
Coversyl plus vin nn 4 mg + 1,25 mg indapamid
QUINAPRIL
Aceupril vin nn 5 mg; 20 mg
RAMIPRIL
Corpril nang 2,5 mg; 5 mg
Hopace nang 2,5 mg; 5 mg
Triatec nang 1,25 mg; 2,5 mg; 5 mg
TRANDOLAPRIL
Gopten nang 0,5 mg; 2 mg
Odrik nang 0,5 mg; 2mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai: Tc dng gy qui thai th v ri lon gy t vong tr s
sinh.
Trng hp khc: Qu mn cm vi thuc.

Thi k cho con b: Mt lng nh captopril vo sa, c nguy c tch lu tr b.
Nn trnh.
Trng hp khc: Hp ng mch thn hai bn hoc hp ng mch thn qu
thn duy nht.
980
Thn trng: mc 2
Suy thn: Nguy c ri lon chc nng thn (protein niu, bnh cu thn, hi
chng thn h...). Theo di protein niu, creatinin huyt thanh v kali mu.
Cn theo di: mc 1
Bnh mu: Nguy c gim bch cu v mt bch cu ht.
Suy tim: thy nhng ri lon tun hon v gim th tch mu, cn iu chnh
liu cn thn khi suy tim sung huyt.
TNG TC THUC

Kali
Phn tch: Thm kali cho mt thuc c th gy tng kali mu. C ch gi kali ny
l do c ch angiotensin 2, lm gim aldosteron mu.
X l: Trnh k n ng thi hai thuc ny v c nguy c tng kali mu v r i
lon dn truyn tim, c bit vi ngi bnh cao tui, suy thn v suy tim.

Lithi
Phn tch: Tng nng lithi c th dn n hi chng l ln, biu hin qu liu
do gim bi tit lithi qua thn.
X l: Thay i chin lc iu tr. Chng ch nh phi hp ny.
Thuc li tiu gi kali
Phn tch: Phong b h renin-angiotensin ko theo tch lu renin tun hon, h
ny ph thuc vo natri. C nguy c tng kali mu nghim trng.
X l: Nn thay i phi hp v c nguy c tng kali mu.
Phn tch: Amphetamin l cht cng giao cm tc dng trc tip, nn c tnh
cht tng huyt p. Phi hp vi cc thuc chng tng huyt p dn n i khng tc
dng v rt kh t c cn bng huyt p.
X l: Vi ngi bnh tng huyt p nn trnh k amphetamin.
Baclofen
X l: Theo di huyt p v iu chnh liu thuc chng tng huyt p trong v
sau khi iu tr bng baclofen. Thn trng c bit ngi bnh cao tui.
981
Benzamid; butyrophenon; thuc an thn kinh

gy tc dng h huyt p th pht.
X l: Nu cn phi hp, phi tng cng theo di huyt p trong v sau khi iu
tr bng mt trong hai thuc. C th phi iu chnh liu. Nhn mnh cn c k hoch
s dng thuc v ngi bnh cn tun th. c bit cnh gic ngi bnh cao tui.
Corticoid khong
Phn tch: Hiu qu ca cc thuc chng tng huyt p c th gim do tc ng
ca cc steroid ln s lu gi natri.
X l: Nu cn phi hp thuc, phi tng cng theo di huyt p trong v sau
khi ngng dng mt trong hai thuc. C th phi iu chnh liu. Nhn mnh n k
hoch dng thuc v s tun th. c bit cnh gic vi ngi bnh cao tui.
Clozapin
X l: Trong v sau khi phi ngng iu tr bng clozapin, cn theo di huyt p
v iu chnh liu thuc chng tng huyt p. Thn trng c bit vi ngi bnh cao
tui.
Dn cht nitrat chng au tht ngc
X l: Theo di huyt p v iu chnh liu ca thuc chng tng huyt p trong
v sau khi ngng iu tr bng dn cht nitrat chng au tht ngc. Thn trng c bit
ngi bnh cao tui.
Dn cht phenothiazin
dng khng mong mun r rt ca cc thuc an thn kinh, dn xut t phenothiazin.
X l: Nu phi phi hp thuc, cn tng cng theo di huyt p trong khi iu
tr v sau khi ngng mt trong hai thuc. Tu tnh hnh, iu chnh liu l ng. Nh n
mnh v k hoch dng thuc v s tun th. c bit cnh gic ng i bnh cao
tui, phng ng do h huyt p.
Dextropropoxyphen
Phn tch: Dextropropoxyphen c tc dng h huyt p nh. Dng cng vi cc
thuc h huyt p khc s lm tng tc dng h huyt p v tng nguy c h huyt p
th ng.
X l: Cn theo di huyt p trong khi phi hp hai thuc (trong v sau khi ngng
mt trong hai thuc). Ty theo thuc dng, huyt p c th h nhiu hay t. C th phi
iu chnh liu mt trong hai thuc. Lp mt k hoch dng thuc u n. Khuyn
ngi bnh, nu thy chng mt khi bt u iu tr, nn gp li bc s iu tr v c
th phi iu chnh liu mt trong hai thuc. Tng cng theo di ngi bnh cao
tui (nguy c ng) v khuyn nn i t th t nm hay ngi sang ng mt cnh t t.
982

Phn tch: Tng tc c m t vi captopril v elanapril. Phi hp thuc ny c
th hn hu dn n gim glucose mu ngi bnh tiu ng ang iu tr bng
insulin hay sulfamid h glucose mu.
X l: Phi hp ny l c in v la chn dng cc thuc c ch enzym chuyn
cho ngi tiu ng l ph bin. Bt n do h glucose mu xy ra hu nh rt him
hoi. Nn thng tin cho ngi bnh h tng cng t theo di glucose mu nu cn.
Methyldopa
Phn tch: Phi hp cc thuc chng tng huyt p c th thc hin; tng nguy
c h huyt p th ng quan trng.
X l: Khuyn ngi bnh tng cng t theo di v phn chia cc ln dng
thuc u n trong ngy. Ch ngi bnh cao tui h hiu cn phn chia li u
thuc trong ngy.
Nicorandil
Phn tch: Phi hp vi cc thuc c tnh cht chng tng huyt p c th lm gia
tng nguy c h huyt p, i khi dn n sc.
X l: Theo di huyt p trong khi iu tr v khi ngng dng mt trong hai thuc.
Rifampin
Phn tch: Tc dng dc l ca enalapril c th b gim, lm gim tc dng. C
ch cha r.
X l: Cn gim st huyt p ngi dng phi hp ny. Nu vn tng huyt p,
c th phi thay thuc chng tng huyt p khc.
Thuc ch vn morphin
ng.
Phn tch: Tng tc dng chng tng huyt p v tng nguy c h huyt p th
X l: Theo di huyt p trong khi phi hp thuc. Tu theo thuc dng, gim
huyt p c th nng hay nh. iu chnh liu ca mt hay c hai thuc. Tu trng
hp, lp k hoch dng thuc u n. Khuyn ngi bnh, nu lc u iu tr thy
chng mt, nn gp bc s iu tr xem c cn iu chnh mt hoc c hai th thuc
khng. Tng cng theo di i vi ngi bnh cao tui (nguy c ng) v khuyn nn
i t th t nm hay ngi sang ng mt cch t t.
Phn tch: Tc dng chng tng huyt p c th gim khi s dng ng thi vi
cc cht cng giao cm.
X l: Phi theo di lin tc huyt p. Tt c ph thuc vo bi cnh iu tr v
dng bo ch c dng. Nu c th, nn trnh phi hp thuc ngn nga nguy c
quan trng v bin ng huyt p.
983

Phn tch: Tng tc i khng dc lc. Cc thuc ging beta c tc dng tng
huyt p, gii thch tc dng chng tng huyt p c th b gim, khi s dng ng thi
vi cc thuc cng giao cm.
X l: Theo di huyt p u n. Thng bo cho ngi bnh nguy c bin ng
huyt p. Lp k hoch s dng thuc u n v tnh n c dng thuc dng
nh gi mc bin ng huyt p (s dng cc thuc cng giao cm beta trong
cha hen v trong e do non). Khuyn ngi bnh i khm li, nu thy bt
thng.
huyt p quan trng.
X l: Cc thuc c ch MAO t c dng, tng tc nhiu nhng n k t nn
c rt t nhng nhn xt v cnh gic thuc. D sao cng nn thn trng, i khong 2
n 3 tun sau khi ngng dng thuc hy k n thuc c ch MAO.
Thc n
Phn tch: Thc n c th lm gim tc dng chng tng huyt p ca captopril.
Tng tc xy ra nhanh. C ch: Hp thu captopril qua ng tiu ho c th b gim
do thc n.
X l: Cho captopril 1 gi trc ba n.
X l: Cn iu chnh liu, c k hoch dng thuc v nhn mnh vi ngi bnh l
cn tun th. Khi bt u iu tr, khuyn ngi bnh o (hay yu cu o) huyt p thng
xuyn cho n khi t c huyt p cn bng n nh.
Phn tch: Nguy c h huyt p nghim trng v/ hoc suy thn cp trong trng
hp gim natri mu. Mt nhiu nc v natri hoc hp ng mch thn dn n tng
cng kch thch h renin-angiotensin; phong b h ny, thuc c ch enzym chuyn
dng c th ngay sau ln dng u tin, gy cn tt huyt p t ngt v him hn suy
thn cp.
X l: Nu ang iu tr bng thuc li tiu, ngng thuc li tiu hai ba ngy trc
khi bt u iu tr bng thuc c ch enzym chuyn, v sau , li dng thuc li tiu,
nu cn. Khi iu tr bng thuc c ch enzym chuyn, bao gi cng bt u vi liu
thp v tng dn, nu cn. Nhng iu phng nga ny c gi tr cho c iu tr tng
huyt p ln iu tr suy tim. Theo di chc nng thn trng trong nhng tun u iu tr
bng thuc c ch enzym chuyn. Thn trng c bit khi dng ngi bnh cao tui.
984

Digoxin
Phn tch: Nng trong huyt tng ca digoxin c th tng hoc gim. C ch
cha r. thanh lc digoxin qua thn c th b thay i.
X l: Khng cn phi thn trng c bit, ngoi gim st nhim c digoxin nh
thng l. Theo di nng trong huyt tng ca digoxin.
Phn tch: Glucocorticoid gi nc v natri, lm cho tc dng ca cc thuc
chng tng huyt p c th b gim.
X l: iu chnh liu trong v sau khi iu tr bng corticoid. Thng bo cho
ngi bnh cn tng cng t theo di trong khi iu tr bng corticoid. Khuyn nn c
k hoch dng thuc u n trong qu trnh iu tr. Khuyn ngi bnh gp li bc
s nu c bin ng huyt p quan trng.
Indometacin hoc cht dn cht; dn cht pyrazol; dn cht salicylat;
thuc chng vim khng steroid
steroid c ch tng hp prostaglandin thn gin mch v/ hoc ko theo s l u gi
nc v natri.
X l: m bo chc chn ngi bnh c tip nc y ; theo di chc
nng thn ( thanh lc creatinin) v n nh ca huyt p. Nguy c suy thn cp
ngi bnh mt nc. Khuyn ngi bnh t theo di u n huyt p.
Phn tch: Dng ng thi cc thuc chng tng huyt p hoc thuc c kh
nng gy h huyt p vi cc thuc gy m barbituric c th dn n h huyt p
nghim trng.
X l: Khuyn ngi bnh phi phu thut bo cho bc s gy m bit cc thuc
ang dng.
Phn tch: Tng tc dng gim huyt p ca cc thuc ny. Gim huyt p l mt
X l: Nu cn phi hp, phi tng cng theo di huyt p trong v sau khi ngng
mt trong hai thuc. C th phi iu chnh liu. Nhn mnh k hoch dng thuc v s
tun th. c bit cnh gic vi ngi bnh cao tui.
985
THUC C CH HMG-COA REDUCTASE (CC STATIN)

Cc thuc h cholesterol mu, tc ng bng cch c ch tng phn
3-hydroxymethylglutaryl-Coenzym A reductase, l enzym xc tc mt trong
cc giai on u ca sinh tng hp cholesterol.
CC THUC TRONG NHM

ATORVASTATIN
Atocor vin nn 10 mg; 20 mg
Atovast vin nn 20 mg
Lipitor vin nn 10 mg; 20 mg; 40 mg
Lipovas vin nn 10 mg; 20 mg
Zyatin vin nn 10 mg; 20 mg
CERIVASTATIN
Cholstat vin nn bao phim 0,1 mg; 0,2 mg; 0,3mg
Liprobay vin nn bao phim 0,1 mg; 0,2 mg; 0,3mg
Stallor vin nn bao phim 0,1 mg; 0,2 mg; 0,3mg
FLUVASTATIN
Lescol nang
LOVASTATIN
Apo-Lovastatin vin nn 20 mg; 40 mg
Lovastatin Domesco vin nn 20 mg
PRAVASTATIN
Elisor vin nn 10 mg
Pravachol vin nn 10 mg
Vasten vin nn 10 mg
ROSUVASTATIN
Crestor 10 mg, 20 mg, 40 mg
SIMVASTATIN
Simvastatin Domesco vin bao phim 20 mg
Simvastatin vin bao phim 20 mg
CH KHI CH NH THUC
986
Chng ch nh: mc 4
Thi k cho con b: chut, cc thuc ny qua c sa m, chng ch nh
dng cc thuc ny.
Thi k mang thai: D dng xng ca chut nht c thng bo. Chng
ch nh cc thuc ny trong thi k mang thai.
Trong trng hp khc: Qu mn vi thuc.

n ung; ru: Cn tnh n cch tc ng ca thuc ny. Trnh k n cho cc
ngi bnh nghin ru c chc nng gan km.
Suy gan: Cn tnh n tc ng chnh trn gan v cc tc dng khng mong
mun. Transaminase tng ko di.
Cn theo di: mc 1
Trng hp khc: D thng nhn khoa: nguy c c thy tinh th.
TNG TC THUC

Carmustin hoc dn cht; cisplatin hoc dn cht; cyclophosphamid hoc
thuc tng t; dactinomycin; dn cht pyrazol; doxorubicin hoc dn cht;
fluoro-5-uracil; mercaptopurin; methotrexat; thiotepa
Phn tch: S dng ng thi ng thi vi cc thuc gim min dch lm tng
nguy c xut hin tiu c vn v suy thn.
X l: Mc du cc trng hp c thng bo ch ni n lovastatin, nhng
c nguy c tim tng vi c simvastatin. Phi hp ny cn trnh.
Fibrat
Phn tch: Tng nguy c vim c, c bit vi gemfibrozil. Theo di nng
creatinin phosphokinase trong huyt thanh.
X l: Trnh phi hp cc thuc c th c cng tnh cht tr liu v sinh hc. Tng
tc dng khng mong mun v c nguy c tiu c vn, ngi k n nn c chin lc
iu tr khc.
Macrolid
Phn tch: Bnh c hoc tiu c vn nghim trng c th xy ra do tng nng
thuc c ch HMG-CoA reductase. Tng tc xy ra chm. C ch: nghi c c ch
chuyn ho (CYP3A4).
X l: Nu c th, thay liu php khc. Khuyn ngi bnh ang dng thuc c
ch HMG-CoA reductase thng bo cho bc s bit bt c au c hoc yu c no m
khng gii thch c.
987

Ciclosporin
Phn tch: Nguy c tiu c vn v suy thn tng r rt. Nguy c ny ph thuc
vo liu. Gim chuyn ho gan ca thuc gim cholesterol mu.
X l: iu chnh liu tu theo nguy c ny v c bit l h liu thu c gi m
cholesterol mu. Nhc ngi bnh thng bo cho bc s iu tr ngay, nu thy au c.
Cholestyramin, colestipol
Phn tch: Tc dng dc l ca thuc c ch HMG-CoA reductase c th b
gim. Tng tc xy ra chm. C ch: Thuc c ch HMG-CoA reductase c th hp
ph resin gi acid mt (cholestyramin), lm gim hp thu thuc c ch HMG-CoA
reductase ng tiu ho.
X l: Ung 2 thuc cch nhau cng xa cng tt (>4 gi trc khi ung thuc c
ch HMG-CoA reductase), nn ung cc resin gi acid mt trc ba n v thuc c
ch HMG-CoA reductase vo bui chiu ti.
Diltiazem
reductase c th tng, lm tng nguy c nhim c nh tiu c vn, vim c. Tng tc
xy ra chm. C ch: c th chuyn ho bc u (CYP3A 4) ca thuc c ch HMGCoA reductase b c ch.
X l: Nu phi hp khng th trnh, khuyn ngi bnh cn thng bo cho bc
s bit bt c au c hoc yu c no m khng gii thch c. Pravastatin c v t c
tng tc v c th l mt thuc thay th.
Khng sinh chng nm azol
Phn tch: C th tng nng huyt tng v tc dng ph ca thuc c ch
HMG-CoA reductase. Tiu c vn xy ra. Tng tc xy ra nhanh. C ch: khng
sinh chng nm azol (fluconazol, c bit vi liu trn 200mg/ngy, c th c ch
chuyn ho bc u gan thuc c ch HMG-CoA reductase (cytochrom P4503A4)
X l: Nu tht cn thit phi phi hp, phi gim liu thuc c ch HMG-CoA
reductase v theo di cn thn p ng ca ngi bnh. iu chnh liu nu cn.
Rifamycin
Phn tch: Nng trong huyt tng ca thuc c ch HMG-CoA reductase c
th b gim, lm gim tc dng dc l. Tng tc xy ra chm. C ch: Rifamycin c
th gy cm ng chuyn ho bc u (CYP3A 4) ca thuc c ch HMG-CoA
reductase rut v gan.
X l: Theo di p ng lm sng ca ngi bnh. Nu nghi c tng tc, phi
thay cch iu tr. Pravastatin c v t tng tc vi rifamycin v c th l thuc thay
th thch hp.
988
Sildenafil
Phn tch: C th tng nguy c tiu c vn v vim c. Tng tc xy ra chm.
C ch: nghi c c ch chuyn ho (CYP3A4) ca mt s thuc c ch HMG-CoA
reductase.
X l: Khuyn ngi bnh cn thng bo cho bc s bit bt c au c hoc yu
c no m cha gii thch c.
Thc n (nc p qu bi)
Phn tch: Tng nng huyt tng v tng tc dng ph (nh tiu c vn) ca
mt s thuc c ch HMG-CoA reductase. Tng tc xy ra nhanh. C ch: c ch
chuyn ho bc u (CYP3A4) ca mt s thuc c ch HMG-CoA reductase rut
non.
X l: Trnh phi hp thuc c ch HMG-CoA reductase vi nc p qu bi
(hoc cc sn phm c bi). V fluvastatin v pravastatin c chuyn ho bng cc
enzym khc, nn c th l nhng thuc c dng thay th.
Verapamil
reductase c th tng, lm tng nguy c nhim c nh tiu c vn, vim c. Tng tc
xy ra chm. C ch: c th c ch chuyn ho bc u (CYP3A4) ca thuc c ch
HMG-CoA reductase.
X l: Nu phi hp khng th trnh c, dng mt liu va phi thuc c ch
HMG-CoA reductase v khuyn ngi bnh cn phi thng bo cho bc s bit bt c
au c hoc yu c no m khng gii thch c. V CYP3A 4 khng phi l isozym
chnh cho chuyn ho ca fluvastatin v pravastatin, nn cc thuc ny c th t
tng tc v c th l thuc thch hp thay th.
989
THUC C CH MAO typ A

Thuc chng trm cm, c ch c hiu mono aminoxydase typ A
CC THUC TRONG NHM

MOCLOBEMID vin nn 100 mg; vin nn bao phim 300 mg
Aurorix vin nn 100 mg; vin nn bao phim 300 mg
TOLOXATON nang 200 mg
Humoryl nang 200 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
Cc trng hp khc: Mn cm vi mt trong cc thuc.

Thi k cho con b: V thn trng, do cc tc dng dc l ca thuc.
Tr em: Thiu thng tin.
Thi k mang thai: Tnh khng c cha c chng minh ph n mang thai.
Thn trng: mc 2
n ung; ru: Trnh dng ru trong khi iu tr.
Cn theo di: mc 1
Cc trng hp khc: Trng thi hng cm v hoang tng.
TNG TC THUC

Cht ch vn morphin
Phn tch: Trong h ny, tng tc c m t vi pethidin (Dolosal) mt thuc
gim au loi morphin tc dng ngn v nhanh, thng dc dng trong cn au s i
thn. Phi hp vi mt thuc c ch MAO typ A (moclobemid v toloxaton) hoc typ B
(selegilin), l cc thuc c ch MAO chn l c v thun nghch, c nguy c tch lu
serotonin vi s xut hin st cao, cng c thm ch m sng.
X l: Chng ch nh phi hp ny. Thay i chin lc iu tr v c bit nn
chn mt thuc gim au khc hn l thay i t ngt thuc chng trm cm hoc
thuc b tr cho iu tr chng Parkinson (selegilin).
990
Citalopram; fluoxetin; fluvoxamin; paroxetin; thuc chng trm cm ba

vng hoc cc thuc tng t
Phn tch: Qu liu serotonin, v tc dng dc lc do cng hp ca cc thuc.
C th xut hin hi chng serotonin vi mc nghim trng khc nhau nhng c th
dn n t vong.
X l: Hi chng serotonin c nhiu v khc nhau, vi cc triu chng tm thn
(l ln, bn chn, thm ch hn m...), vn ng (git rung c, run, tng ho t ng,
cng ...), thc vt (h hoc tng huyt p, nhp tim nhanh, rt run, m hi...), tiu
ho (tiu chy...). Cn trnh phi hp ny.
Sumatriptan
Phn tch: Tng tc dc lc do cng hp cc tc dng serotoninergic vi nguy
c xut hin l ln, bn chn, st cao, co git, co mch v tng huyt p nng.
X l: Do nguy c tng tc dc lc, phi thn trng khng phi hp cc thuc
ny v ch t nht l 24 gi sau khi ngng thuc c ch MAO mi dng sumatriptan.
THUC C CH MAO typ b

Cc cht c ch c hiu monoamin oxydase typ B
CC THUC TRONG NHM

SELEGILIN vin nn 5 mg
Jumex vin nn 5 mg
CH KHI CH NH THUC

Suy tim: Selegilin c th gy nhp tim nhanh kch pht v nht l h huyt p th
ng c hi cho cc bnh tim mch mt b. Vic b sung iu tr bng mt thuc c
ch dopa decarboxylase ngoi vi cho php m rng ch nh cho ngi bnh suy tim
mc va.
Thn trng: mc 2
Thi k mang thai: Tt hn, khng nn k n selegilin trong nhng thng u
ca thai k.
Cn theo di: mc 1
Trm cm: Selegilin dn n cc ri lon tm thn (cn l ln, m sng vi o
gic) nht l trong trng hp c tin s tm thn. Cc hi chng trm cm thng
991
n ng thi vi bnh Parkinson b nng thm bi selegilin do thuc ny lm tng lo

u ngi bnh.
Glocom: Selegilin b kh carboxyl thnh dopamin, l amin cng giao cm, c th
dn n gin ng t v lm nng thm glocom gc ng.
Suy mch vnh: Lon nhp tht c m t ngi bnh c ri lon dn truyn
c tim hoc ngi bnh c tin s au tht ngc.
Ngi cao tui: Do tnh nhy cm, c bit ngi bnh cao tui, vi mt s tc
dng khng mong mun.
Lot d dy, t trng; vim d dy: Nguy c bin chng lot d dy, t trng v
tn s ri lon ng tiu ho quan st c l cao (bun nn, nn, chn n) khi
selegilin khng c phi hp vi mt cht c ch dopa - decarboxylase.
TNG TC THUC

Cht ch vn morphin
Phn tch: Tng tc gia cc thuc c ch MAO khng chn lc v pethidin c
th dn n l ln, bn chn, st cao,co git, co mch v tng huyt p n ng (hi
chng serotonin). Cc nguy c vi cc cht ch vn khc ang c tranh ci v mc
nng nh ca chng.
X l: Cc nguy c ny vi pethidin c ni n nhiu. Vi cc thuc khc, nu
phi hp l cn thit, th lm mt test vi liu thp pht hin tng tc v nh gi
mc nghim trng. Nu khng, nn cn trng ch hai tun sau khi ng ng thuc c
ch MAO typ B mi dng cc cht ch vn morphin.
Benzamid; butyrophenon; phenothiazin; thuc an thn kinh cc loi
Phn tch: c ch c hiu monoamin oxydase typ B d n n ko di tc d ng
ca levodopa, iu gi i thch vi c k n ng th i v i thu c ny. Do v y, cc
t ng tc ging nh ca levodopa. Phi hp levodopa v i m t s thu c c tc d ng
i khng dopamin c th dn n cc tc d ng i khng.
X l: Chng ch nh phi hp tr khi tm kim mt s i khng d c l
(thc hin c s chuyn khoa).
Citalopram; fluvoxamin; paroxetin
Phn tch: gp hi chng serotonin khi phi hp mt hot cht serotoninergic
v mt thuc c ch MAO. Bng cch ngoi suy, phi hp mt thuc chng trm cm
serotoninergic thun tu vi mt thuc c ch MAO ngay c trng hp thuc c ch
MAO c hiu, c nguy c dn n l ln, bn chn, st cao, co git, co mch ngoi vi
v tng huyt p nng.
X l: Phi ch sau khi ngng dng thuc c ch MAO hai tun mi bt u iu
tr bng thuc chng trm cm serotoninergic v t nht mt tun sau khi ngng thuc
chng trm cm mi bt u iu tr bng thuc c ch IMAO.
992
Fluoxetin
Phn tch: Gp hi chng serotonin khi phi hp mt hot cht serotoninergic v
mt thuc c ch MAO. Bng cch ngoi suy, phi hp mt thuc chng trm cm
serotoninergic thun tu vi mt thuc c ch MAO ngay c trng hp thuc c ch
MAO c hiu, c nguy c dn n l ln, bn chn, st cao, co git, co mch ngoi vi
v tng huyt p nng.
X l: Phi ch sau khi ngng dng thuc c ch MAO B hai tun mi bt u
iu tr bng thuc chng trm cm serotoninergic, v t nht mt tun sau khi ngng
thuc chng trm cm mi bt u iu tr bng thuc c ch MAO. V im ny, v
fluoxetin c na i di, nn phi tn trng khong cch nm tun gia hai thuc
(tng ng vi nm na i).
L - tryptophan
Phn tch: Kt hp thuc gy hi chng serotonin gm: d kch ng, co c v
run, vn ng yu, thc b nh hng, khng nhanh, nhy. Tc dng serotoninergic
ca thuc c ch MAO v L-tryptophan c hip ng cng lc vi nhau.
X l: Chng ch nh dng thuc c ch MAO cng vi L-tryptophan.
Meperidin
Phn tch: Kt hp thuc gy nhng tc dng ph nh bn chn, kch ng, co
git, nhiu m hi, st, c th dn ti hn m, ngng th v t vong. Nhng phn ng
ph ny c th xut hin sau khi ngng dng thuc c ch MAO trong nhiu tun.
C ch cha r.
X l: Trnh kt hp thuc ny.
Pyridoxin
ca levodopa, iu gii thch vic k n ng thi vi thuc
ny. Do vy, cc tng tc ging nh ca levodopa, ngi c nn xem h thuc
ny.
X l: Nu khng c cht c ch dopadecarboxylase ( cho php mt lng
levodopa ln hn vo c trong no) phi hp ny l chng ch nh. Phn ln
levodopa bn trn th trng c phi hp vi cht c ch dopa decarboxylase
(benserazid hoc carbidopa), nn khi khng chng ch nh phi hp vi pyridoxin.
Sumatriptan
Phn tch: Tng tc dc lc do cng hp cc tc dng serotoninergic, vi nguy
c xut hin l ln, co git, tng nhit , bn chn, co mch v tng huyt p nng.
X l: Do c nguy c tng tc dc lc, nn phi thn trng khng phi hp cc
thuc ny, v ch sau khi ngng thuc c ch MAO t nht l 24 gi mi dng
sumatriptan.
993

Phn tch: Nguy c lon nhp tim trm trng. c ch c hiu mono aminoxydase
typ B dn n ko di tc dng ca levodopa cho php gii thch vic k n ng thi
vi thuc ny. Bn c nn xem h thuc ny.
X l: Tt hn, nn chn mt chin lc iu tr khc.
ca levodopa, iu gii thch vic k n ng thi vi thuc ny. Do vy, cc tng
tc ging nh ca levodopa. Bn c nn xem h thuc ny. Papaverin c th chn
cc th th dopamin, do vy c ch tc dng chng Parkinson ca levodopa (tin cht
ca dopamin).
X l: Cn trnh phi hp; hy chn mt phng thc iu tr khc.
Procarbazin, reserpin
ca levodopa iu gii thch vic k n ng thi vi thuc ny. Do vy, cc tng
tc ging nh ca levodopa. Bn c nn xem h ny. Procarbazin c tc dng c
ch MAO khng chn lc.
X l: Cn trnh phi hp; hy chn mt phng thc iu tr khc.
Phn tch: Nguy c tng huyt p kch pht do tch t cc catecholamin trong no.
X l: Phi hp phi cm; chn phng thc iu tr khc. Phi hp levodopa vi
mt cht c ch dopa decarboxylase c th lm gim kh nng xy ra tng tc ny.
tc ging nh ca levodopa. Bn c nn xem v h thuc ny. Phi hp ny c th
dng trong iu tr bnh Parkinson, nhng cn trnh ngi bnh tm thn hoc c
tin s tm thn.
X l: Cn trnh phi hp ny cho ngi bnh c tin s tm thn. Nn hi ngi
bnh hoc ngi nh bnh nhn v vn ny.
Phn tch: Do tc dng ca c ch MAO typ B, thuc ny ko di tc d ng ca
dopamin (levodopa l tin cht sinh l ca dopamin), phi hp c th dn n tch lu
dopamin.
X l: V hip ng tc dng dc lc, nn gim liu ca bromocriptin (cht ch
vn dopamin).
994
Clonidin hoc thuc tng t; dextropropoxyphen; thuc cng giao cm

beta
Phn tch: c ch c hiu monoamin oxydase typ B dn n ko di tc dng ca
levodopa, iu gii thch vic k n ng thi vi thuc ny. Do vy, cc tng tc
ging nh ca levodopa. Bn c nn xem h thuc ny.
K n: Cn trnh phi hp, v nguy c tht bi iu tr.
Methyldopa; furosemid hoc thuc tng t; thuc li tiu gi kali; thuc

li tiu thi kali mu
Phn tch: c ch c hiu monoamin oxydase typ B dn n ko di tc dng ca
levodopa, iu gii thch vic k n ng thi vi thuc ny. Do vy, cc tng tc
ging nh ca levodopa. Bn c nn xem h thuc ny.
X l: Cn phi iu chnh liu, thit lp mt k hoch dng thuc v nhn mnh
v s tun th. Khi bt u iu tr, khuyn ngi bnh o huyt p u n cho n
khi t c s cn bng iu tr.
Phn tch: S c ch c hiu monoamin oxydase typ B dn n ko di tc dng
tc ging nh ca levodopa. Bn c nn xem h thuc ny.
X l: Khuyn ngi bnh trc khi phu thut, thng bo cho ngi gy m
nhng thuc ang dng.

tc ging nh ca levodopa. Bn c nn xem h thuc ny.
X l: Nu cn phi hp, nn gim liu ca thuc cng giao cm. Khuyn ngi
bnh gp li bc s iu tr ngay, nu h cm thy tim p bt thng.
THUC C CH MAO KHNG CHN LC

Cc cht c ch monoamin oxydase.
Cc cht hng tm thn chng trm cm
Ch : Mt s ln cc thuc nh hng n cc thuc ny m cha c c ch chnh
xc no gii thch c. Nhng thy thuc phi kim tra khng c tng tc ny.
995
CC THUC TRONG NHM

IPRONIAZID vin nn 50 mg
Marsilid vin nn 50 mg
CH KHI CH NH THUC
Chng ch nh: mc 4
n ung; ru: Cc thuc c ch MAO ngn chn s phn gii tyramin (amin
cng giao cm), do khuyn nn loi b tt c cc thc n c cha tyramin (ph
mt ln men, chocolat, chui...) v c ru v c ph, v l do cc cn tng huy t p
xy ra vi tn sut hnh nh c nh gi qu cao.

Thi k mang thai/cho con b: Cc thuc c ch MAO hnh nh khng gy qui
thai, nhng nn trnh s dng chng cho ph n mang thai hoc cho con b, v c
nhiu tng tc vi cc thuc hay dng khi mang thai hoc cho con b (cc thuc m).
Suy gan: Suy gan lm tng c tnh ca thuc c ch MAO, do lm chm
s bt hot km vi nguy c ri lon huyt p (h huyt p th ng, cn tng huyt
p). Mt khc, nhiu trng hp vim gan tiu t bo c thng bo.
Cc trng hp khc: U t bo a crom.

Suy tim: V nguy c h huyt p th ng v tng huyt p.
Cn theo di: mc 1
ng kinh: Cc thuc c ch MAO lm gim ngng gy ng kinh v c th
khi ng mt cn ng kinh.
Tng huyt p: Kh trnh hon ton mi t kch pht tng huyt p ngi
dng thuc c ch MAO.
Suy thn: Chc nng thn phi c kim tra u n.
TNG TC THUC

Phn tch: Sau khi phi hp vi thuc c ch MAO, tng tc c th dn n
tng huyt p. C ch cn cha gii thch c.
X l: Nu phi hp ny c k n, cn thn trng v liu dng v thng bo
cho trung tm cnh gic thuc mi bt thng cho php khng nh mt s nhn xt.
996
Amineptin; thuc chng trm cm 3 vng hoc thuc tng t

Phn tch: Nguy c kch pht tng huyt p gy cht ngi, bnh no, co git, st
cao, t vong.
X l: Chng ch nh phi hp ny, ngay c khi c mt s ngi dng n ti c
s chuyn khoa cho cc ngi bnh khng thuc.
Carbamazepin
Phn tch: C s ging nhau v cu trc gia carbamazepin v cc thuc chng
trm cm ba vng, do vy, ngi ta e rng vic dng ng thi hai thuc d n n cc
cn tng huyt p v co git nng c th gy t vong. Sau khi ngng dng thuc c
ch MAO, cn phi tun th khong cch t nht hai tun trc khi dng carbamazepin
v ngc li.
K n: Cm dng phi hp.
Citalopram
Phn tch: Nguy c xut hin hi chng serotonin kinh in, th hin bng cc ri
lon tm thn (bn chn, l ln, thm ch hn m), vn ng (rung git c, run, tng
hot ng...), thc vt (h hoc tng huyt p, rt run, st cao, m hi), tiu ho
(tiu chy).
X l: Tun th khong cch hai tun gia khi ngng thuc c ch MAO v khi
bt u iu tr bng thuc chng trm cm, v ngc li, khong cch mt tun gia
khi ngng thuc chng trm cm v khi bt u dng thuc c ch MAO.
Dextromethorphan
Phn tch: Phi hp thuc c th gy st cao, c ng ca c bt thng, h
huyt p, hn m, t vong. l biu hin ca hi chng serotonin do gi m chuyn
ho serotonin do cht c ch MAO v gim ti thu nhn serotonin synap do
dextromethorphan.
X l: Do tnh nghim trng ca phn ng, trnh dng kt hp thuc ny.
Fluoxetin
Phn tch: Tng ti nhp serotonin c th ci thin p ng vi iu tr, nhng
thi gian sau , li lm tng cc tc dng c nghim trng (h nhit, co git...).
X l: Tun th khong cch t nht hai tun gia khi ngng thuc c ch MAO
v khi bt u iu tr bng thuc chng trm cm serotoninergic. Khi ngng iu tr
bng fluoxetin, phi ch nm tun mi c dng thuc c ch MAO (v fluoxetin c
na i di).
Fluvoxamin
Phn tch: Tng ti nhp serotonin c th ci thin p ng vi iu tr, nhng
thi gian sau lm tng cc tc dng c nghim trng (h nhit, co git...).
997
bng fluvoxamin, ch mt tun trc khi dng thuc c ch MAO.
Levodopa
Phn tch: Tng tc dc lc. Cc thuc c ch MAO c ch s phn gii ca
adrenalin; levodopa l mt tin cht ca dopamin. Adrenalin v dopamin l hai amin co
mch. Phi hp c th gy tng huyt p trm trng.
X l: Khng phi hp cc thuc ny, tun th khong cch 15 ngy gia hai
thuc trnh tai bin.
L-tryptophan
Phn tch: Phi hp thuc gy hi chng serotonin gm nhng biu hin: d kch
ng, co c, run, vn ng yu, thc khng nhanh nhy. Tc dng serotoninergic ca
thuc c ch MAO v L-tryptophan c hip ng cng lc vi nhau.
X l: Chng ch nh dng thuc c ch MAO cng vi L-tryptophan.
Meperidin
Phn tch: Kt hp thuc gy nhng tc dng ph nh: bn chn, kch ng, co
git, nhiu m hi, st, c th dn ti hn m, ngng th v t vong. Nhng phn ng
ph ny c th xut hin sau khi ngng dng thuc c ch MAO trong nhiu tun.
C ch cha r.
X l: Trnh dng kt hp thuc ny.
Mianserin
Phn tch: Cc thuc c ch MAO c ch s phn gii ca cc catecholamin,
chng c tnh cht cng giao cm v c nguy c tai bin tng huyt p khi c phi
hp vi cc thuc c tc dng khu cc amin co mch.
X l: Chng ch nh phi hp ny. i hi phi bo m khong cch 3 ngy
gia khi ngng thuc c ch MAO v khi bt u iu tr bng mianserin.
Oxaflozan
Phn tch: Tc dng hip ng c ch h thn kinh trung ng. Oxaflozan l
thuc chng trm cm serotoninergic. Phi hp vi thuc c ch MAO, c nguy c gy
hi chng serotoninergic bn chn, l ln, run, cng , nhp tim nhanh, rt run, m
hi.
X l: Khng phi hp. Thay i chin lc iu tr. Ch 15 ngy sau khi ngng
thuc c ch MAO mi dng li oxaflozan.
Reserpin
Phn tch: Gia tng nghim trng tc dng c ch h thn kinh trung ng.
Reserpin lm tng thiu ht cc catecholamin v serotonin ni d tr, c th dn n
tng huyt p nng.
X l: Chng ch nh phi hp ny. Tun th khong cch t nht mt tun sau
khi ngng thuc c ch MAO v trc khi iu tr bng reserpin cho ngi bnh.
998
Sibutramin
Phn tch: Phi hp thuc gy hi chng serotonin gm: d kch thch, vn ng
yu, co c, run, thc khng nhanh nhy. Tc dng serotoninergic ca thuc c ch
MAO v sibutramin c hip ng vi nhau.
X l: Chng ch nh phi hp hai thuc. Ch sau khi ngng dng thuc c
ch MAO c t nht hai tun l mi bt u dng sibutramin, hoc l ch sau khi
ngng dng sibutramin t nht hai tun l, mi bt u dng thuc c ch MAO.
Sumatriptan
Phn tch: Tng tc dc lc do hip ng cc tc dng serotoninergic, vi nguy
c xut hin l ln, bn chn, st cao, co git, co mch v tng huyt p nng.
X l: V c nguy c c tnh, khng nn phi hp cc thuc ny v ch t nht
hai tun sau khi ngng thuc c ch MAO khng chn lc mi dng sumatriptan.
Thuc ch vn mophin
Phn tch: Vi pethidin (Dolosal), kh nng xut hin cc triu chng nng v khng
on trc c, gi l hi chng serotonin vi cc ri lon tm thn (bn chn, l ln,
thm ch hn m), vn ng (rung git c, run, cng , tng hot ng), thc vt (h
hoc tng huyt p, nhp tim nhanh, st cao, m hi v rt run). Vi cc thuc gim au
khc thuc loi morphin, nn thn trng v nu phi hp l cn thit, nn lm mt test vi
1/4 liu thuc gim au v theo di hng gi sau cc phn ng ca ngi bnh.
X l: Trnh dng phi hp chng ch nh ny. Vi cc thuc gim au khc
thuc loi morphin, nn thn trng v nu phi hp cn thit, phi lm mt test vi 1/4
liu thuc gim au v theo di trong nhiu gi cc phn ng ca ngi bnh.Vi cc
thuc khc thuc loi morphin, cn nhc nguy c tu theo liu dng. Trnh dng cc
thuc gim ho c cha opioid.
trng.
Phn tch: Tng mn cm vi cc dn cht halogen ho. Nguy c tru mch trm
X l: Ngng thuc c ch MAO khng chn lc 15 ngy trc khi can thip.
Khuyn ngi bnh, trc khi phu thut, bo cho thy thuc gy m cc thuc ang
dng.
Thuc ti thu nhn serotonin - paroxetin - nefazodone
Phn tch: Tng ti thu nhn serotonin c th ci thin p ng vi iu tr, nhng
thi gian sau lm tng cc tc dng c nghim trng (h nhit,
co git...).
bng thuc chng trm cm serotoninergic, ch mt tun mi dng thuc c ch MAO
(vi fluoxetin, khong cch l 5 tun).
999

Bupropion
Phn tch: Khi dng cng vi mt s thuc c ch MAO khng c hiu, c tnh
cp ca bupropion c th tng. C ch cn cha r.
X l: Chng ch nh phi hp bupropion vi thuc c ch MAO. Phi ch t nht
hai tun l k t khi ngng thuc c ch MAO mi c dng bupropion.
Cafein
Phn tch: ngi ung nhiu c ph, c th tng nguy c lon nhp tim trm trng
v/ hoc h huyt p trm trng, v tc dng cng giao cm ca cafein.
X l: Bo cho ngi bnh h gim hoc ngng dng c ph (hoc cc thuc
mch bo c cafein) trong khi iu tr.
Dextropropoxyphen
Phn tch: Tng tc dng c ch h thn kinh trung ng, dn n tng cc tc
ngi li tu xe v ngi vn hnh my mc. Khuyn khng ung ru v khng t
Heptaminol
Phn tch: Heptaminol c tnh cht cng giao cm; phi hp vi thuc c ch
MAO hoc cc hp cht c tnh cht thuc c ch MAO, c th dn n cc cn tng
huyt p.
X l: Chng ch nh phi hp ny. Thay i chin lc iu tr. Hy khong
cch t nht hai tun sau khi ngng thuc c ch MAO v trc khi iu tr bng
heptaminol.
Insulin
Phn tch: Vic kt hp vi thuc c ch MAO s lm tng p ng h glucose
mu do insulin, v trng thi glucose mu s lu tr v bnh thng sau khi h thp.
C ch do cc thuc c ch MAO kch thch c th sn sinh ra insulin v c ch s tn
to glucose.
X l: Khi kt hp thuc c ch MAO vi insulin, phi theo di cht ch glucose
mu, v phi hiu chnh liu lng insulin nu cn.
Procarbazin
Phn tch: Tng tc dc lc, tc dng hip ng. Nguy c ri lon huyt p
trm trng do hot tnh thuc c ch MAO ca cc thuc ny.
X l: Cn trnh phi hp. Thit lp mt chin lc iu tr khc.
1000
Ru
Phn tch: Hip ng trn tc dng c ch h thn kinh trung ng. Ch thn
trng ngi vn hnh my mc v tu xe. Phi theo di.
X l: Tt hn, khng nn phi hp hai thuc, v ngi k n khng th kim
sot c vic dng ru ca ngi bnh. Nguy c an thn nguy him nht l ngi
li tu xe v ngi vn hnh my mc. Khuyn khng ung ru v khng t dng
Sulfonylurea
Phn tch: Vic kt hp vi thuc c ch MAO s lm tng p ng h glucose
mu do cc sulfonylurea. C ch cn cha r.
X l: Nu bnh nhn dng phi hp thuc v b h glucose mu, phi ngh n
tng tc thuc v phi hiu chnh liu thuc dng a glucose mu v gi tr bnh
thng.
Phn tch: Nguy c ri lon huyt p nng (tng huyt p), do tch lu amin co
mch, do cng hp tc dng, mt thuc cung cp cc amin, thuc kia c ch s d ho
ca cc amin ny. V thuc c ch MAO o thi chm, tng tc ny c th cn biu
hin 15 ngy sau khi ngng iu tr.
X l: Phi hp ny ch c th thc hin di s kim sot cht ch ca cc nh
chuyn khoa.
Phn tch: Vi ephedrin, fenoterol, terbutalin, tng tc thuc loi dc lc: tng
cc tc dng trn h tim mch. Thuc c ch MAO gy tch lu cc amin co mch, vi
nguy c ri lon trm trng huyt p, nhc u, lon nhp tim, nn...
X l: Trnh k n cc thuc ny k c mt s thuc dng ti ch, trong t nht
15 ngy sau khi ngng thuc c ch MAO.
Thuc c ch MAO typ B
Phn tch: Nguy c tng huyt p kch pht do tch lu cc catecholamin no.
X l: Phi cm phi hp. Chn mt bin php iu tr khc. Phi hp levodopa
vi mt cht c ch dopa decarboxylase c th lm tng tc ny t kh nng xy ra
hn.

Phn tch: Do tnh cht i khng dopaminergic ca thuc c ch MAO c kh
nng lm tng nng ca prolactin v i khng tc dng ca bromocriptin.
X l: Tc dng i khng ny c nguy c lm ri lon mc tiu iu tr chnh.
Phi theo di hoc thay i thuc phi hp. Lu l tc dng i khng dopaminergic
kh yu v tu thuc liu dng.
1001
Buspiron
X l: Theo di huyt p khi bt u, trong v sau khi kt hp iu tr thm mt
trong hai thuc ny. Nu khng, hy thay i phi hp hoc ngng dng buspiron trong
khi iu tr bng thuc c ch MAO v c 15 ngy sau khi ngng thuc c ch MAO.
Khuyn ngi bnh gp li thy thuc trong trng hp c vn v huyt p.
Diazoxyd; dihydropyridin; diltiazem; furosemid hoc thuc tng t;
guanethidin hoc thuc tng t; sotalol; thuc chn beta; thuc gin mch
chng tng huyt p; thuc c ch enzym chuyn dng angiotensin; verapamil
huyt p quan trng.
X l: Cc thuc c ch MAO c s dng kh him, cc tng tc th nhiu v
him khi k n nn c t cc nhn xt v cnh gic thuc. Tun th khong cch 2
n 3 tun sau khi ngng thuc, trc khi k n thuc c ch MAO.
Gluthetimid hoc thuc tng t; medifoxamin; methyldopa; viloxazin
huyt p quan trng. Ngoi ra cn thm tc dng c ch h thn kinh
trung ng.
X l: Cc thuc c ch MAO c s dng kh him, cc tng tc th nhiu v
him khi k n nn c t cc nhn xt v cnh gic thuc. Tun th khong cch 2
n 3 tun sau khi ngng thuc, trc khi k n thuc c ch MAO.

Phn tch: i khng tc dng. C th lm tng tnh hung hn ng i nghi n
amphetamin.
ngi bnh gp li bc s iu tr, nu thy kt qu khng n nh.
Phn tch: C l thuc c ch MAO c ch chuyn ho cc thuc ny
gan v ko di tc dng c ch h thn kinh trung ng. y l hin tng tc th.
X l: Phi tnh n tng an thn trong v sau khi iu tr, c bit ngi li tu
xe v ngi vn hnh my mc. Thng tin cho ngi bnh khng c ung ru.
Benzamid; thuc an thn kinh cc loi
Phn tch: Tng tc dng c ch h h thn kinh trung ng, dn n tng tc
ngi li tu xe v ngi vn hnh my mc. Khuyn khng ung ru v khng t
1002

huyt p quan trng. Ngoi ra, cn thm tc dng c ch h thn kinh trung ng.
X l: Cc thuc c ch MAO c s dng kh him trong iu tr, cc tng
tc gp nhiu, ng thi him khi k n nn c t cc nhn xt v cnh gic thu c.
Tun th khong cch 2 n 3 tun sau khi ngng thuc, trc khi k n thuc c
ch MAO.
Dn cht phenothiazin
Phn tch: Tng tc dng an thn v h huyt p th ng, do cng hp tc dng
ca hai thuc (ch ngi bnh cao tui nhy cm vi h huyt p th ng), v tng
cc phn ng ngoi thp.
X l: Phi hp phi c theo di c bit ngi bnh cao tui, ngi
li tu xe v ngi vn hnh my mc. Khuyn ngi bnh khng dng thm ru.
Thuc gy m cc loi
X l: Khuyn ngi bnh, trc khi phu thut thng bo cho ngi gy m cc
thuc ang dng.
Phn tch: S dng ng thi vi thuc c ch MAO c th ko di tc dng
khng cholinergic v c ch h thn kinh trung ng.
X l: Nn trnh phi hp ny. Nu c th, hy thay i chin lc iu tr.
X l: Nu cn phi hp, lu nguy c ny khi gy m v la chn liu. Yu cu
ngi bnh thng bo cho ngi gy m vic dng thuc c ch MAO.
THUC C CH H THN KINH TRUNG NG CC LOI

Ch : Barbituric, benzodiazepin, thuc gy ng, thuc an thn kinh,
buspiron hp thnh nhng h ring, cn metaqualon tuy l thuc gy ng
nhng cng nm trong h ny
1003
CC THUC TRONG NHM

ETIFOXIN nang 50 mg
Stresam nang 50 mg
HYDROXYZIN vin nn 25 mg; 100 mg; siro 2 mg/mL
Atarax vin nn 25 mg; 100 mg
Atarax siro 2 mg/mL
ZOPICLON vin nn 7,5 mg
Imovane vin nn 7,5 mg
CH KHI CH NH THUC

n ung; ru: Ru lm tng cc tc dng c ch h thn kinh trung ng.
Thn trng: mc 2
Thi k mang thai: Nn king, khng cho cc thuc c ch thn kinh trung ng
trong ba thng u ca thai k.
TNG TC THUC

Benzodiazepin; dantrolen
thn. Tng tc dc l.
Ru
an thn. C th ghi nhn vi mt s sn phm, mt s tc dng tm thn vn ng,
nht l trong tun u iu tr. Tng tc dc l.
X l: Tt nht, khng nn phi hp hai thuc, v ngi k n khng th kim tra
c ngi bnh ung ru. Nguy c an thn nguy him c bit ngi li xe v
ngi s dng my mc. Khuyn khng ung ru v khng t dng thuc hoc cc
ch phm c ru.
1004

Baclofen; benzamid; butyrophenon; carbamat hoc thuc tng t;
carbamazepin; dextropoxyphen; reserpin; thuc chng ng kinh khng
barbituric
X l: Lu nguy c ny iu chnh liu lng ca hai thuc, nu cn phi hp
ny. Ngh n gim tnh to ngi li xe v ngi s dng my mc. Khuyn khng ung
Buspiron
an thn. C th ghi nhn, vi mt s sn phm, mt s tc dng tm thn vn ng,
nht l trong tun u iu tr. Tng tc dc l.
X l: Tt nht khng nn phi hp hai thuc, v ngi k n khng kim sot
c ngi bnh dng ru. Nguy c an thn c bit nguy him ngi li xe v
ngi s dng my mc. Khuyn khng ung ru v khng t dng thuc hoc cc
ch phm c ru.
Phn tch: Tc dng hip ng c ch h thn kinh trung ng. Ch n ngi
li xe v ngi s dng my mc. Cn nh l rilmenidin liu thng thng, khng lm
tng cc tc dng c ch h thn kinh trung ng ca cc thuc ny.
Clozapin; gluthetimid hoc thuc tng t; interferon alpha ti t hp;
medifoxamin; thuc an thn kinh cc loi; paroxetin; phenothiazin; primidon
hoc dn cht; procarbazin
ngi li xe v ngi s dng my mc. Khuyn khng ung ru v khng t
dng thuc hoc cc ch phm c ru.

amphetamin.
ngi bnh gp li bc s nu thy iu tr khng n nh.
1005
Barbituric; fluoxetin; mianserin; oxaflozan; thuc chng trm cm ba vng hoc

tng t; thuc khng histamin khng H1, an thn; viloxazin
ngi li xe v ngi s dng my mc. Khuyn khng ung ru v khng dng
Cht ch vn morphin
Citalopram
Phn tch: Tng tc dng an thn ca cht c ch ti nhp serotonin.
X l: Phi thn trng khi phi hp thuc v lun lun kh kim sot vic ung
ru trong khi iu tr, nht l nhng ngi bnh li xe hoc s dng my, i hi
lun lun tnh to.
Methadon
Phn tch: Tng tc dng c ch h thn kinh trung ng km vi an thn mnh,
c hi c bit cho ngi li xe v ngi s dng my mc.
X l: S tng cng tc dng an thn ny phi c ngi k n lu cho
li khuyn ph hp: trnh li xe, trnh vn hnh my mc, thng bo cho ng i xung
quanh bit mi nguy him.
Phn tch: Nguy c tng cng cc tc dng c ch h thn kinh trung ng.
X l: Nu cn phi hp hai thuc ny, lu nguy c ny khi gy m v la chn
liu. Khuyn ngi bnh sp phi phu thut thng bo cho ngi gy m nhng thuc
ang dng.
TICLOPIDIN
Thuc chng kt tp tiu cu
CC THUC TRONG NHM

TICLOPIDIN vin bao phim 250 mg
1006
Ticlid vin bao phim 250 mg

CH KHI CH NH THUC
Chng ch nh: mc 4
Cc trng hp: Ri lon bm sinh hay mc phi v cm mu. Tng chy mu.
Tn thng thc th c th chy mu. Qa mn vi thuc.

Bnh mu: Thi gian chy mu ko di, tin s gim bch cu, gim tiu cu,
mt bch cu ht
Lot d dy - t trng; vim d dy: L cht chng kt tp tiu cu, chng ch
nh ticlopidin i vi bt c tn thng no c th chy mu. c ch tiu cu, do tng
nng prostaglandin D2 v E1 c tnh chng kt tp trong tiu cu, lm tng nguy c
chy mu ch lot.
Thn trng: mc 2
Thi k cho con b: Tnh khng c hi ca ticlopidin dng cho ph n cho con
b cha c xc nhn.
Thi k mang thai: Tnh khng c hi ca ticlopidin dng cho ngi mang thai
cha c xc nhn.
TNG TC THUC

Nhn ny c tnh cht nh mt dn cht coumarin c tc dng chng ng mu khng
vitamin K; nh vy thm tc dng chng ng mu ca n vo tnh cht hoc khng
vitamin K, hoc chng kt tp tiu cu ca cc cht ang xt.
mu. Cn cnh gic vi cc khng sinh ny khi dng liu cao.
Dextran
mu v tnh cht chng kt tp tiu cu, phi trnh hoc kim sot c nguy c chy
mu.
X l: Trnh phi hp cc thuc ny, v kh qun l c hon ho mc gim
ng mu mong mun, v nguy c chy mu km theo.
Dipyridamol
ng mu lm tng nguy c chy mu. Nhng hin nay, ngi ta cn ang tranh ci
tng tc ny, do cha c nhng nhn xt lm sng chng minh nguy c chy mu.
1007
X l: Phi hp thuc ny i hi phi thc hin nhng xt nghim ng mu

thch hp trong v sau khi iu tr vi ticlopidin hay vi dipyridamol.
Phenytoin
Phn tch: Khi kt hp vi ticlopidin, nng phenytoin trong huyt tng tng,
lm tng nguy c gy cc tc dng ph. Nng ny tng dn trong khong thi gian 1
thng, do ticlopidin c ch s chuyn ho ca phenytoin gan.
X l: Theo di nng phenytoin trong huyt tng v theo di p ng ca
ngi bnh khi bt u dng, khi ngng dng hoc khi thay i li u dng ticlopidin.
Hiu chnh liu phenytoin nu cn.
Indometacin hoc dn cht; pyrazol; salicylat
Phn tch: Phi hp vi mi thuc c tnh cht kt tp tiu cu hay chng ng
mu lm tng nguy c chy mu. Tc dng ny li tng ln do tnh kch ng ca cc
thuc chng vim khng steroid trn nim mc d dy (chy mu ng tiu ho).
X l: Nu cn phi hp thuc ny, phi thc hin nhng xt nghim ng mu
thch hp nh thi gian Howell v thi gian cephalin kaolin. Rt nn tm mt liu php
khc cho ngi bnh c tin s lot d dy.
Thuc chng vim khng steroid; heparin; pentoxyfylin
Phn tch: Phi hp vi mi thuc c tnh chng kt tp tiu cu hay chng ng
mu u lm tng nguy c chy mu.
X l: Phi hp thuc ny i hi phi thc hin cc xt nghim ng mu thch
hp (thi gian Howell, thi gian cephalin-kaolin). Rt nn chn liu php khc, nu c
th.
Phn tch: Ticlopidin c tnh cht chng kt tp tiu cu, ko di trong 6 n 7
ngy. Nguy c chy mu tng rt nhiu nu dng ticlopidin phi hp vi mt thuc
chng ng mu.
X l: Do ticlopidin gy chy mu nghim trng v i khi t vong, khng nn ghi
n phi hp ny.

Phn tch: Tng tc dc ng hc v o thi thuc. Tng theophylin trong
mu. Nguy c qu liu do gim thanh lc theophylin huyt tng.
X l: Nguy c qu liu. Hiu chnh li liu lng cho thch hp, theo nng
hu hiu ca theophylin trong mu (khong t 5 n 15 mg/lt) da vo tr s o c
trong phng th nghim. Cn nh nhng du hiu lm sng ca qu li u theophylin
ngi ln l co git, st cao, ngng tim; tr em l kch ng, ni nhiu, l ln, nn lin
tip, st cao, nhp tim nhanh, rung tht, co git, huyt p h, ri lon h hp, tng thng
kh, ri suy h hp.
1008

Thuc tan huyt khi
X l: Thng thng, k n v dng cc thuc tan huyt khi phi do bc s
chuyn khoa (bc s tim mch, v bc s i cp cu) m nhn, v thuc c phm vi
iu tr hp, v cch dng chuyn bit. Nu cn phi hp thuc ny phi thc hin cc
xt nghim ng mu thch hp nh thi gian Howell, thi gian cephalin - kaolin. Nu c
th, tm mt liu php khc.
TRH (hormon gii phng hormon kch thch tuyn gip,

THYROTROPHINE RELEASING HORMONE)
Protirelin l mt tripeptid tng hp, tng ng vi TRH, c tc dng gii phng
TSH, TSH ny kch thch tuyn gip tit hormon. Vic dng cht ny cho php nh gi
hot tnh chc nng hng gip ca tuyn yn, v cng kch thch
gii phng prolactin
CC THUC TRONG NHM

PROTIRELIN ng tim 0,2 mg; 0,25 mg
Stimu - TSH ng tim 0,2 mg; 0,25 mg
CH KHI CH NH THUC
Thn trng: mc 2
Thi k mang thai: Do thn trng, khi cha c thng tin
TRIMEBUTIN
C tc dng lm thay i vn ng ca rut, dng trong iu tr mt s
dng au ng tiu ho v ng dn mt
1009
CC THUC TRONG NHM

TRIMEBUTIN: vin nn 100 mg; vin t 100 mg; nang 150 mg; ng tim 50
mg/5mL; cm pha hn dch ung 1,2 g/250 mL
Bimetin vin nn 100 mg
Debridat cm pha hn dch ung 1,2 g/250 mL
Debridat vin nn 100 mg
Debridat ng tim 50 mg/5 mL
Debridat vin t 100 mg
Detriat vin nn 100 mg
Digerent nang 150 mg
Rimebutin vin nn 100 mg
Vebutin vin nn 100 mg
CH KHI CH NH THUC

Thi k cho con b: Do thiu thng tin, d liu.
Thi k mang thai: Trnh dng trong ba thng u thai k.
1010
TRIMETHOPRIM
Thuc khng khun, thuc nhm aminopyrimidin
CC THUC TRONG NHM

TRIMETHOPRIM vin nn 100 mg v 200 mg
Wellcoprim vin nn 100 mg v 200 mg
Phi hp vi sulfamethoxazol
khun
Xem cc tn bit dc mc sulfamethoxazol thuc nhm cc sulfamid khng

Phi hp vi erythromycin v sulfamethoxazol
Co-eryc TNP
Erybacsultrim E
Erybacsultrim F
Erybact 365
Ery-Becotrim
Erycotrim
Erymetazol
Erysulprim
Erysulprim F
Ery-Vicotrim
Sulferycin
Sulferycin F
CH KHI CH NH THUC

Thi k cho con b: Thuc qua c sa m, c nguy c thiu ht acid folic tr
b m.
Thi k mang thai: Thuc qua hng ro nhau thai, c nguy c thiu ht acid folic
tr s sinh. Cn m bo b sung acid folic.
Cc trng hp khc: Thiu mu nguyn hng cu khng l, do thiu ht acid
folic.
Thn trng: mc 2
Suy gan: Do thuc chuyn ho gan.
1011
Suy thn: Nguy c gim o thi thuc thn.

TNG TC THUC

Methotrexat
Phn tch: Nguy c tng c tnh vi mu do c ch ty xng, do hip ng tc
dng trn dihydrofolat reductase, c th dn n thiu mu nguyn hng cu khng l.
X l: Nu cn phi hp thuc, phi dng liu thp hn cho mi thuc, v phi
theo di cht ch huyt . Phi hp ny dnh cho cc bc s chuyn khoa, v phc
iu tr thng c n nh r rng. C th b sung thm acid folic.

Lamivudin
Phn tch: Trimethoprim c kiu o thi qua thn tng t lamivudin (o thi
tch cc qua ng thn), nn ko theo gim thanh lc qua thn ca lamivudin 40%.
X l: Phi hp thuc khng i hi phi hiu chnh liu lng lamivudin nu
chc nng thn bnh thng. Khi suy thn, phi hiu chnh liu lng lamivudin theo
thanh lc creatinin. Cn ch n ngi bnh cao tui.
Procainamid
Phn tch: Dng phi hp vi trimethoprim, nng procainamid v dn cht
acetyl ho ca n trong huyt tng tng, lm tng tc dng dc l v cc tc dng
ph ca thuc. C ch do c s cnh tranh trong s o thi hai thuc di dng
cation tiu qun thn.
X l: Theo di nng procainamid v dn cht acetyl ho ca n trong huyt
tng v chc nng tim ca ngi bnh. Hiu chnh liu dng cho ph hp.
Sulfon
Phn tch: Khi sulfon (dapson) kt hp vi trimethoprim th nng c 2 thuc
trong huyt tng u tng, lm tc dng dc l v c tnh hai thuc cng tng theo.
C ch cn cha r, nhng c th l do thuc ny ngn cn s thanh lc ca thuc kia.
X l: Theo di ngi bnh dng ng thi hai thuc trn, c bit v nhng biu
hin c tnh ca dapson (methemoglobin mu).

Phn tch: Trimethoprim c tc dng nh cht i khng acid folic, do c ch
dihydrofolat reductase. Tng tc ny cng c ngha nu liu dng cng cao v thi
gian iu tr cng di.
X l: Kim tra huyt v nu cn, dng acid folinic, c bit vi ng i bnh
dng thuc khng folat liu cao, hoc ngi bnh iu tr di ngy. nhng ngi
bnh ny, nn b sung acid folinic.
1012
Ganciclovir; interferon alpha ti t hp

Phn tch: Nguy c tng c tnh vi mu, do c ch ty xng do hip ng tc
dng, c th dn ti gim bch cu ht.
X l: Nu c th, trnh phi hp thuc ny. Nu cn phi hp, nn dng cc
thuc vi liu thp hn v phi theo di huyt cht ch. Phi hp thuc ny ch
dnh cho cc bc s chuyn khoa v thng phc iu tr c xc nh r rng.
Phn tch: Phi hp hai thuc c ch ty xng.
X l: Interleukin ch c dng c s chuyn khoa, do bnh l nghim trng.
Khi , cc tng tc thuc s c cn nhc, v tt c cc chc nng ca c th cn
c theo di lin tc. Bt buc phi theo di huyt .
Phn tch: Dng ng thi hai cht c ch ty xng c th ko theo nhng ri
lon mu nghim trng, tu theo thi gian iu tr. Cng phi theo di chc nng thn.
X l: Khi phi hp thuc, phi theo di huyt hc v thn.
Phenytoin; pyrimethamin; natri valproat hoc dn cht; zidovudin
Phn tch: Nguy c tng c tnh vi mu do c ch ty xng, do hip ng tc
dng trn dihydrofolat reductase, c th dn ti thiu mu nguyn hng cu khng l.
X l: Nu cn phi hp thuc, phi dng liu thp hn vi mi thuc v phi
theo di cht ch huyt . Phi hp thuc ny dnh cho cc bc s chuyn khoa, v
thng cc phc iu tr c xc nh r. C th b sung thm acid folinic.
Thuc li tiu gi kali
Phn tch: Trong nhm thuc li niu gi kali, ch c triamteren l c tnh cht i
khng acid folic, do c ch dihydrofolat reductase. Tng tc ny cng c ngha nu
liu dng cng cao v thi gian iu tr cng di.
X l: Kim tra huyt , v nu cn, dng acid folinic, c bit vi ng i bnh
dng thuc khng folat liu cao, hoc ngi bnh iu tr di ngy. nhng ngi
bnh ny, nn b sung acid folinic, c bit trong thi gian mang thai.

Ciclosporin
Phn tch: Tng nguy c c vi thn, c bit khi trimethoprim c phi hp
vi sulfamid. thy gim nng ciclosporin khi dng phi hp sulfamid/ trimethoprim
tim tnh mch cng vi ciclosporin. C ch cn cha r.
X l: Theo di ng thi chc nng thn v nng ciclosporin trong mu. Tu
theo ng dng trimethoprim, nh gi nguy c. Hiu chnh liu lng, v nu c th
xem li chin lc iu tr. Thng bo cho ngi bnh phi tun th thc hin cc xt
nghim c qui nh
1013
VACCIN SNG GIM C LC

Gm c nhng vaccin sau: BCG, st vng, quai b, bi lit ung (v ch c loi
ung), si, ruben, thy u, hecpet. Mt s vaccin bt hot (cm v vim gan)
nhng ngi suy gim mim dch, c th c tc dng gy min dch yu
CC THUC TRONG NHM

Vaccin bi lit sng
BCG Pasteur
Rouvax
Vaccin varicelle
CH KHI CH NH THUC

Thi k mang thai: Dt khot cm tim chng vaccin ruben trong sut thai k
(nguy c d tt mt v tim). Cc vaccin u ma, si, st vng, bi lit loi Sabin hnh
nh t nguy him, nhng khng c dng, v tuyt i cm trong 3 thng u thai k.
Tuy nhin, tim phng cho mt ph n mang thai m khng bit khng bin minh cho
vic lm sy thai, no thai.
Suy tim: Khng c tim phng khi c bnh tim mt b.
Cc trng hp khc: Khng tim phng khi c bnh nhim khun cp tnh, ung
th, suy gim min dch bm sinh hay mc phi v khi iu tr vi cc thuc gy suy
gim min dch. Qu mn vi mt thnh phn ca vaccin.
TNG TC THUC

Dactinomycin D; asparaginase; azathioprin; carmustin hoc dn cht;
ciclosporin; cisplatin hoc dn cht; cyclophosphamid hoc thuc tng t;
doxorubicin hay cc dn cht; fluoro - 5- uracil; globulin min dch khng lympho
bo; glucocorticoid; interferon alpha ti t hp; melphalan; mercaptopurin;
methotrexat; pentostatin; procarbazin; tetracosactid; thiotepa; vincristin hoc
thuc tng t
Phn tch: Nguy c pht trin nhim khun tng ng vi vaccin do tc dng c
X l: Tim phng vaccin v dng thuc k trn phi cch nhau t ba thng n
mt nm; khong cch thi gian ny di ngn ph thuc vo mc c ch min dch.
Tacrolimus
ch min dch ca tacrolimus.
X l: Khong cch thi gian cn tun th gia dng hai thuc l t ba thng n
mt nm, v ph thuc vo mc c ch min dch.
1014

Phn tch: Tng tc c hiu c th xy ra vi vaccin chng cm. Mc du
tng tc ny cn ang tranh ci, ngi ta ngh rng vaccin chng cm lm gim o
thi cc thuc c chuyn ho gan qua cytocrom P450, lm tng nng trong huyt
thanh v tng na i ca theophylin v cc dn cht. Cng c kin cho rng tng
tc ny khng xy ra vi vaccin c tinh khit cao, lm cho ta ngh n vai tr c a
mt tp cht trong mt s vaccin.
X l: Nh vy cn thn trng khi phi tin hnh hai liu php ng thi, mc
du cha c mt tai bin iu tr thc s no c ghi trong y vn. C th c hai thi
trc tnh trng hiu bit hin nay ca chng ta: gim liu lng theophylin khong
50% trong 24 gi sau khi tim phng; hng ti dng cc vaccin c tinh khi t cao.
Nu nhng thay i dc ng hc dn n nhng du hiu nhim c trn lm sng,
th chuyn nhng nhn xt v Trung tm cnh gic thuc.
VANCOMYCIN
Khng sinh glycopeptid dit khun c hot ph hp: cc chng Gram dng.
Ch yu dng khi nhim khun t cu dai dng
CC THUC TRONG NHM

VANCOMYCIN bt pha tim 500 mg/l
Vancomycin hydrochlorid bt pha tim 500 mg/l
Vancotex bt pha tim 500 mg/l
CH KHI CH NH THUC
Chng ch nh: mc 4
Thi k mang thai: Vancomycin c th gy c cho tai v thn ca thai nhi, nn
khng dng cho ph n mang thai.
Cc trng hp khc: Qu mn vi vancomycin.

Ngi bnh cao tui: Ngi bnh cao tui c nguy c c vi tai ln hn
Cn theo di: mc 1
Thi k cho con b: Nn thn trng, cha chng minh c thuc qua c sa
m
1015
Suy thn: Nguy c c vi thn

TNG TC THUC
Phn tch: Ch dng Interleukin ti c s chuyn khoa. C nguy c hip ng tc
X l: Ch c thc hin iu tr bng Interleukin ti c s chuyn khoa, do tnh
cht nghim trng ca bnh. Khi , cc tng tc phi xt theo tnh trng chung ca
ngi bnh. Nu khng th hon dng c mt trong hai thuc, cn theo di cht ch
ion v thanh lc creatinin.
Phn tch: Cc khng sinh polypeptid, c th nh vancomycin c th c tc dng
hip ng vi cc thuc gy th doi c khng kh cc trn chc nng thn kinh c
trc hoc sau synap. Kt qu l tc dng phong b thn kinh c c tng cng.
X l: Nu c th, trnh dng phi hp thuc ny. Nu bt buc phi dng, cn
theo di cht chc nng thn kinh c, xc nh liu lng thuc gy th doi c khng
kh cc v chun b phng tin tr gip h hp phng khi cn thit.
Vng
Liu php vng chng thp khp
Cc thuc trong nhm
VNG ng tim 25 mg; 50 mg; 100 mg
Allochrysine ng tim 25 mg; 50 mg; 100 mg
Ch khi ch nh thuc
Chng ch nh: mc 4
Thi k cho con b: V thiu d liu nn trnh dng thuc ny trong thi k cho
con b, v c tim nng c ca thuc.
Thi k mang thai: Cc dn cht ny gy qui thai sc vt. S dng cch nga
thai hiu qu.
Trng hp khc: Tin s tai bin nng vi cc mui vng; tin s suy ty; vim
ming.
ht.
Bnh mu: Nguy c tng bch cu a eosin, gim tiu cu v gim bch cu
Suy tim: Cn nhc tng quan nguy c/li ch.
Suy gan: Dng di ngy cc mui vng dn n cc bnh tch t thuc gan.
c thng bo nhng trng hp vim gan do thuc km mt trong gan.
1016
Suy thn: Vng tc ng ch yu n cu thn v gy protein niu v hi chng

h thn, tin trin thng thun li. Nu xut hin protein niu, dt khot chng ch
nh liu php dng vng.
Trng hp khc: Eczema, cc bnh da.
Cn theo di: mc 1
Suy h hp - hen: Do tc dng khng mong mun ca thuc ny.
Ngi bnh cao tui: Lu l ngi bnh cao tui thng c thanh lc
creatinin gim.
Tng tc thuc
Ciclosporin; foscarnet
thn. Cng hp tc dng khng mong mun.
X l: Nhng phi hp ny c th hay gp, nht l bnh vin. Tuy cch dng
liu duy nht hng ngy hn ch c tnh vi tai v thn, song khi cn phi hp, nn
iu chnh liu tu theo thanh lc creatinin (cng thc Cockroft). Theo di c bit
ngi bnh cao tui.
Pyrazol; quinin hoc thuc tng t
Phn tch: Nguy c ri lon cc dng t bo mu (bt sn ty) nng thm.
X l: Khi phi hp, cn theo di sinh hc ngi c nguy c (huyt ).
Phn tch: Tng nguy c c vi thn, ri lon huyt hc v ban da.
X l: Cn nhc k tng quan li ch/nguy c i vi bi cnh sinh l-bnh l.
Theo di phi hp thuc c s chuyn khoa, nu cn phi hp.
Aminosid tim hoc ti ch
Phn tch: Tng creatin niu. Hip ng tc dng c vi thn.
X l: Nhng phi hp ny c th hay gp, nht l c s bnh vin. Mc du
vic dng liu duy nht hng ngy hn ch c c vi tai v c vi thn, song khi
cn phi hp, nn tin hnh iu chnh liu ty theo thanh lc creatinin (cng thc
Cockroft v Gault). Theo di c bit khi dng ngi bnh cao tui.
Amphotericin B
Phn tch: Phi hp amphotericin B tim vi cc cht c vi ty khc buc phi
rt thn trng. Nguy c thiu mu hoc cc ri lon huyt hc khc.
cn.
X l: Khi cn phi hp, theo di cht ch huyt v tin hnh gim liu nu
Azathioprin; dantrolen; progabid; rifampicin; thuc chng nm dn xut imidazol
1017

khng mong mun).
(ASAT, ALAT, phosphatase kim, bilirubin) hoc hon mt trong hai li u php nu c
th. Xc minh l ngi bnh khng ung ru thng xuyn, v khng c tin s vim
gan virus. Cc triu chng lm sng chnh khng c hiu: bun nn, st vng da. Nu
thy ng thi ban da, nga v hch to th hng v bnh cn do thuc. Ty theo kt
qu cc xt nghim sinh hc, cn phn bit r nguy c xut hin vim gan tiu t bo
khng phc hi v vim gan mt phc hi c khi ngng thuc.
Carmustin hoc dn cht; doxorubicin hoc dn cht; mercaptopurin; methotrexat
Phn tch: Phi hp hai thuc c tim nng c vi gan v c vi mu.
X l: Khi phi hp hai thuc c vi gan v c vi mu ny, phi theo di cht
ch chc nng gan (ASAT, ALAT, phosphatase kim, bilirubin) v huyt , hoc hon
mt trong hai liu php nu c th. Xc minh l ngi bnh khng ung ru thng
xuyn v khng c tin s vim gan virus. Cc triu chng lm sng chnh khng c
liu: bun nn, st, vng da... Nu thy ng thi ban da, nga v hch to th hng
v bnh cn do thuc. Ty theo kt qu cc xt nghim sinh hc, phn bit r nguy c
xut hin vim gan tiu t bo khng phc hi v vim gan mt phc hi c khi
ngng iu tr.
Cyclophosphamid hoc thuc tng t; thuc chng ung th cc loi
Phn tch: Nguy c tng c tnh huyt hc do hip ng tc dng c ch ty
X l: Nu c th, trnh phi hp. Nu cn phi hp, dng liu thp vi mi
thuc v theo di cht ch huyt . Phi hp thuc ny c cc bc s chuyn khoa
thc hin v cc phc iu tr thng c xc nh tt.
Fluoro - 5 - uracil; procarbazin; thiotepa
Phn tch: Nguy c ri lon cc dng t bo mu (bt sn ty) nng thm.
X l: Khi phi hp thuc, cn theo di huyt hc ngi bnh c nguy c
(huyt ).
Phn tch: Interleukin ch c th dng c s chuyn khoa. Nguy c cng hp tc
X l: Vic iu tr bng interleukin ch c th thc hin ti c s chuyn khoa, do
tnh nghim trng ca ch nh. V vy phi cn nhc so snh cc t ng tc ty theo
tnh trng chung ca ngi bnh. Nu khng th hon c mt trong hai li u trnh,
phi theo di cn thn ion v thanh lc creatinin.
Niridazol
Phn tch: Phi hp hai thuc c vi gan. Cng c c c tnh thn kinh ca
niridazol. Nguy c xut hin co git, ri lon tm thn v c tnh vi gan trong trng
hp phi hp thuc.
1018
(ASAT, ALAT, phosphatase kim, bilirubin) hoc hon mt trong hai thuc, nu c th
c. Xc minh l ngi bnh khng ung ru thng xuyn v khng c tin s
vim gan virus. Cc triu chng lm sng chnh khng c hiu: bun nn, s t, vng
da... Nu thy ng thi ban da, nga, v hch to th hng v bnh cn do thuc. Ty
theo kt qu xt nghim sinh hc, phn bit r nguy c xut hin vim gan tiu t bo
khng phc hi v vim gan mt phc hi c khi ngng thuc.
Paracetamol
Phn tch: Ung paracetamol di ngy, vi liu ln hn 6g/ngy (theo cn nng)
gy c vi gan (vim gan tiu t bo). Khi phi hp vi mt ch phm c v i gan
khc, nguy c c vi gan ny tng ln.
(ASAT, ALAT, phosphatase kim, bilirubin), hoc hon mt trong 2 thuc, nu c.
Xc minh l ngi bnh khng ung ru thng xuyn v khng c tin s vim gan
do virus. Cc triu chng lm sng chnh khng c hiu: bun nn, st, vng da t c
mt. Nu c phi hp ban da, nga v hch to th c th bnh cn do thuc. Phn bit
r, tu theo cc th nghim sinh hc, nguy c xut hin vim gan tiu t bo khng
phc hi vi vim gan tc mt phc hi c khi ngng thuc.
VERAPAMIL
Thuc chng au tht ngc, chn knh calci v c tnh cht c ch enzym
Cc thuc trong nhm
VERAPAMIL: ng tim 50 mg/2mL, ng tim 2 mg/2mL; vin nn bao phim 40 mg,
80 mg, 240 mg
Isoptin vin nn bao phim 40 mg; 80 mg
Isoptin ng tim 2 mg/2mL
Isoptin SR vin nn bao phim 240 mg
Verapamil hydrochloride ng tim 50 mg/2mL
ch khi ch nh thuc
Chng ch nh: mc 4
Cc trng hp khc: Bloc nh-tht hon ton v giai on cp tnh ca nhi mu
c tim. Huyt p thp (tm thu di 90mm Hg). Ri lon chc nng xoang (tim)
Tr em - tr cn b: Trnh dng cho tr em di 15 tui v thn trng.
Thi k mang thai: V thn trng do thiu d liu.
Suy tim: Cn thn trng khi s dng cho ngi suy tim cc cht chng lon nhp,
do c tc dng c ch chc nng c tim. Verapamil vi tc dng lm gim co c tim l
ln nht, l nguyn nhn try tim mch, gy t vong ngi suy tim.
Tng tc thuc
1019
Bepridil
Phn tch: V nguy c xon nh c th do bepridil, khng nn phi hp vi mt
thuc chng lon nhp lm chm nhp tim.
X l: Tt hn, trnh phi hp, tr khi c h thng theo di lin t c (khoa hi
sc). Thc vy, phi hp cc thuc chng lon nhp vi nhau ni chung rt kh, i hi
phi tng cng theo di lm sng v in tm , nhng cn phi trnh trong trng
hp c bit ca bepridil.
Pht thuc: Thng bo cho bc s k n nguy c ca phi hp ny.
Dantrolen
Phn tch: c nhng trng hp rung tht gy t vong c quan st thng
xuyn trn sc vt. Do thn trng, chng ch nh phi hp thuc ny, mc du v i
ngi, c nhng ngi bnh s dng mt s phi hp thuc m khng c tr ngi
g.
X l: Khng nn chuc ly nguy c, nu khng c tt c cc phng tin theo
di v can thip tc th (khoa hi sc).
Disopyramid
Phn tch: Hai thuc u c tc dng gim co c tim, nn c nguy c tng cc tc
dng chng lon nhp, v cc tc dng khng mong mun ca hai thuc. c cc
trng hp t vong.
X l: Khng c dng disopyramid trong vng 48 gi trc hay trong vng 24
gi sau khi dng verapamil, do tc dng gim co c tim ca cc cht ny.
Amiodaron
Phn tch: Amiodaron c th lm nhp tim chm thm do mt s cht chn beta,
nh diltiazem hay verapamil gy ra. C th xut hin ri lon nhp xoang v bloc nh
tht, nht l nhng ngi bnh c tin s ri lon nhp xoang.
X l: Nu phi phi hp thuc ny, iu quan trng l phi gim liu lng v
phi theo di in tm . Cn ch amiodaron c na i l 28 ngy, nn tc d ng
ca tng tc c th tn ti nhiu tun sau khi ngng iu tr.
Buspiron
Phn tch: Dng phi hp vi verapamil, tnh cht dc l v nhng tc dng ph
ca buspiron tng. C ch do chuyn ho ca buspiron gan v rut non gi m do
verapamil c ch CYP3A4, nn lm tng sinh kh dng ca thuc.
X l: Cn theo di cht p ng ca ngi bnh vi buspiron trn lm sng khi
bt u dng thm v khi ngng dng verapamil. Hiu chnh liu buspiron khi cn. Cht
dihydropyridin chn knh calci no m khng c ch CYP 3A4 th khng tng tc vi
verapamil. Ngc li, mt thuc gii lo khng b CYP 3A4 chuyn ha th khng tng
tc vi buspiron.
Prazosin
1020
Phn tch: Verapamil lm tng nng prazosin trong huyt thanh v c th lm

tng nguy c h huyt p t th ng do prazosin. C ch cn cha r.
X l: Khi phi hp hai thuc ny, phi nhc nh ngi bnh cn thn trng khi
h huyt p th ng khi bt u dng prazosin.
Lithi
Phn tch: C th thy nhiu kiu tng tc khc nhau, vi c ch cn cha
c bit, trong s c: tng c tnh lithi, gim nng lithi trong huyt thanh. C
hai trng hp nhp tim chm (trong mt trng hp sau c nhi mu c tim gy
t vong) c bo co.
X l: Theo di trong thi gian u xem phi hp thuc ny c tht cn khng.
Nu ng nh vy, thi gian tip theo, theo di cht ch cc phn ng ca c nhn
ngi bnh (cc phn ng ny n nay vn cha d on c), c bit vi ng i
bnh cao tui v/ hoc c ri lon tim mch. m t hin tng c vi thn kinh
nh: bun nn, nn, tiu chy, mt iu ho.... Bo co tt c cc iu bt thng ti
Ritonavir
Phn tch: Ritonavir c i lc mnh vi isoenzym 3A 4 ca cytochrom P450. C nguy
c cnh tranh quan trng gia ritonavir vi cc thuc khc nhau b chuyn ho ho c
nghi ng b chuyn ho bi isoenzym ny. S cnh tranh ny lm gim chuyn ho v
gy nguy c tng mnh nng cc thuc trong huyt tng. Nguy c gim huyt
p mnh v sc tim khi dng verapamil. Tng tc dc ng hc v chuyn ho
thuc.
X l: Theo di cht ch ngi bnh v c tnh, v khi cn, gim liu cht i
khng calci.
Phn tch: Tc dng ca thuc gy th doi c khng kh cc c th tng khi
phi hp vi verapamil. Hin tng suy h hp c th lu hn. C th do c ch knh
calci ti mng c xng sau synap.
X l: Trnh phi hp thuc ny nu c th. Nu khng, hiu chnh liu thuc gy
th doi c khng kh cc, v theo di chc nng h hp v dng bin php h tr h
hp bng my.
Thuc c ch HMG -CoA reductase
Phn tch: Verapamil lm tng nng mt s thuc c ch HMG-CoA reductase
trong huyt tng, lm tng c tnh ca thuc (vim c, teo c vn). C ch: c th do
verapamil c ch chuyn ho thuc thng qua CYP3A4.
X l: Nu khng trnh c phi hp thuc ny, ch dng thuc c ch HMGCoA reductase vi liu duy tr, v nhc ngi bnh phi bo co mi biu hin au c,
nhy cm au c, yu c. Trong loi thuc ny, fluvastatin v pravastatin th isoenzym
chu trch nhim chuyn ho ch yu khng phi l CYP 3A4, nn t tng tc vi
verapamil v l nhng thuc thay th an ton.
Baclofen
1021
Phn tch: Nguy c tng tc dng h huyt p v xut hin h huyt p do tc

dng hip ng.
X l: Theo di huyt p v khi cn, hiu chnh liu verapamil.
Barbituric
Phn tch: Tng thanh lc verapamil (khong 4 ln) v gim sinh kh dng
(khong 5 ln)
X l: Tt c tu thuc vo mc tiu iu tr chnh v thi gian iu tr ca mi
thuc. C th tht bi trong iu tr.
Calci
Phn tch: Phi hp c th dng iu tr qu liu cc cht c ch calci v
ngc li. Tc dng dc l t c ch yu khi dng calci ng tnh mch, lm
gim tc dng cc cht c ch calci.
X l: Phi hp thuc ny c s dng kim sot h huyt p v nhp tim
chm gy ra bi verapamil. Phi hp cng c dng iu tr trng hp dng qu
liu cht c ch calci hoc rung tim gy ra do calci gluconat. Ung calci khng c hoc
c t tc dng.
Carbamazepin
Phn tch: Tng tc dc ng hc. Tng ng k nng carbamazepin trong
huyt thanh do c ch enzym chuyn ho thuc.
X l: Chn mt cht i khng calci khc khng c nhc im ny, hoc hiu
chnh liu lng cho thch hp lc bt u, trong khi iu tr v khi ng ng iu tr vi
mt trong hai thuc. Gim liu lng carbamazepin.
Phn tch: Tng tc dng h huyt p, tng nguy c h huyt p th ng.
X l: Theo di huyt p khi phi hp hai thuc ny. Ty loi thuc dng, h
huyt p c th nng nh khc nhau. Nu cn, hiu chnh liu ca mt hay hai thuc.
Lp k hoch dng thuc u n. Tng cng theo di ngi cao tui (nguy c ng),
v khuyn h chuyn dn dn t t th nm hoc ngi sang t th ng. Khuyn
ngi bnh gp li bc s hiu chnh li liu lng, nu thy chng mt khi bt u
iu tr.
Ciclosporin
Phn tch: Tng nng ciclosporin trong huyt thanh, do c ch mt nhm
enzym ca cytochrom P450.
X l: Nu cn phi hp thuc ny, phi theo di cht ch nng ciclosporin
trong huyt thanh, v hiu chnh liu lng lc bt u v khi ngng dng verapamil.
Cn lu nng ciclosporin c nhng bin ng ln gia cc c th, v phi theo di
phi u n.
Clozapin
1022
X l: Theo di huyt p v hiu chnh liu lng thuc chng tng huyt p th
u, trong khi iu tr v sau khi ngng dng clozapin. Cn thn trng c bit ngi
bnh cao tui.
Glycosid tr tim
Phn tch: Nguy c tng nng digoxin trong huyt thanh. Tng nguy c ri lon
nh-tht v nhp tim chm, do tng tc dng ca digoxin trn tnh t ng v dn truyn
tim, v do gim o thi thuc ny. Phi theo di c s chuyn khoa, nht l trong
tun u tin.
X l: Theo di c s chuyn khoa: theo di lm sng, in tm , mu (hm
lng digoxin trong mu). Khi cn, hiu chnh liu lng digoxin trong khi iu tr v sau
khi
ngng
verapamil.
Cn
ch
l
natri
a
vo
c
th qua thc n hay qua thuc, c th gy nguy c ph phi cp ngi suy tim nng.
Phn tch: Nguy c tng c tnh c hai thuc do b y khi v tr lin kt vi
protein huyt tng. Tng tc dc ng hc v phn b thuc.
X l: Theo di p ng lm sng vi verapamil, v hiu chnh li u l ng ca
cht c ch calci ny. Theo di cc tc dng khng mong mun ca indometacin (au
bng, tiu chy, to bn, bun nn, nn, chn n...)
Phn tch: Verapamil l cht c ch mt s cytochrom P450 v c th gy tng
nng trong huyt thanh v tng c tnh ca thuc phi hp.
X l: V tng tc dc ng hc ny, cn theo di cht ch nng trong
huyt thanh ca valproat do c phm vi iu tr hp.
Nicorandil
Phn tch: Phi hp vi bt k mt thuc h huyt p no u c th lm tng
nguy c h huyt p, c th dn n sc.
X l: Tng cng theo di huyt p trong khi dng v khi ngng mt trong hai
thuc. Cn c bit ch n iu ny ngi bnh cao tui.
Pyrazol
Phn tch: Nguy c tng c tnh ca hai thuc do b y khi v tr lin kt vi
protein huyt tng. Tng tc dc ng hc v phn b thuc. Tng tc ny cn
xem xt trong hon cnh hin nay phn ln cc pyrazol c dng t i ch, nh v y
theo tin nghim, hu nh khng c tc dng ton thn nu s dng ng cch.
X l: Theo di p ng lm sng vi verapamil, v hiu chnh li u l ng ca
cht c ch calci ny. Theo di nhng tc dng khng mong mun ca pyrazol (au
bng, tiu chy, bun nn, kh tiu, chn n).
Quinidin hoc dn cht
Phn tch: Tng tc dc ng: verapamil l cht c ch mt s enzym
cytochrom P450; c th gy tng nng quinidin trong huyt thanh, v c th xut hin
tc dng c ca quinidin.
1023
X l: V tng tc dc ng ny, cn theo di cht ch nng trong huyt

thanh v quinidin c phm vi iu tr hp.
Rifampicin
Phn tch: Gim nng verapamil trong huyt thanh, c th do tc d ng cm
ng enzym ca rifampicin. Tng tc dc ng hc v chuyn ho thuc.
X l: Theo di p ng lm sng vi verapamil, v nng verapamil trong
huyt thanh. Nu cn, hiu chnh liu lng verapamil v c nguy c iu tr tht bi.
Salicylat
Phn tch: Nguy c tng c tnh ca hai thuc do b y ra khi v tr lin kt vi
protein huyt tng. Tng tc dc ng hc v phn b thuc.
X l: Theo di p ng lm sng vi verapamil v hiu chnh liu lng ca cht
c ch calci ny. Theo di nhng tc dng ph ca cc salicylat gm au bng, chy
mu cam, chy mu li, tai, nhc u.
Sotalol
Phn tch: Do tc dng gim co c tim r rt ca cc thuc ny, c nguy c thc
s v nhp tim chm qu mc, ngng xoang, ri lon dn truyn xoang, nh - tht v
suy tim.
X l: Ch k n phi hp ny nu theo di in tm c thc hi n u
n, c bit ngi bnh cao tui v vo lc bt u iu tr. Cn ch khi ngng
hai thuc ngi c bnh ng mch vnh.
Tacrolimus
Phn tch: C th c c ch chuyn ho tacrolimus gan. Tng tc dc ng
hc v chuyn ho thuc.
X l: Cn gim liu tacrolimus v theo di chc nng thn qua nh lng
creatinin mu. Theo di nng tacrolimus trong huyt tng trong khi iu tr v sau
khi ngng thuc.
Phn tch: C th do cc tnh cht c ch enzym ca thuc phi hp, nn c
nguy c qu liu theophylin.
X l: Theo di lm sng v sinh hc (nh lng nng trong huyt thanh) ca
theophylin. Hiu chnh liu lng theo kt qu lm sng v sinh hc. Cn nh nhng
du hiu lm sng ch yu v ng c theophylin l bun nn, tim p nhanh, nhc
u, nn v nguy c co git.
Thuc chn alpha
Phn tch: Phi hp hai thuc chng tng huyt p gy nguy c h huyt p quan
trng ngi bnh.
X l: C th phi hp hai thuc chng tng huyt p th hai. Thng bo cho
ngi bnh v nguy c h huyt p, v xy dng mt k hoch dng thuc tri u
trong c ngy, c tnh ti tnh cht dc ng hc ca cc thuc. Khuyn ngi bnh
t theo di u n khi dng thm thuc th hai, v khi ngng mt trong hai thuc.
1024
Thuc chn beta

Phn tch: Do tc dng gim co c tim mnh ca c hai thuc ny (k c d ng
thuc nh mt ca cht chn beta) c nguy c thc s chm nhp tim qu mc, ngng
xoang, ri lon dn truyn xoang - nh tht, v suy tim.
X l: Ch c th k n phi hp thuc ny nu theo di in tm c tin
hnh u n, c bit vi ngi bnh cao tui v lc bt u iu tr. Ch lc ngng
hai thuc ny ngi b bnh mch vnh.
Thuc chng tng huyt p, gin mch
Phn tch: Tng thm tc dng chng tng huyt p.
X l: Cn phi hiu chnh liu lng. Xy dng mt k hoch dng thuc u
n, v yu cu ngi bnh tun th. giai on u iu tr, khuyn ngi bnh o
(hay nh o) huyt p u n, cho n khi lp c cn bng trong iu tr.
Phn tch: C th h huyt p thm, mc du cc cht i khng calci c th c
ch d phng nhp tim nhanh trn tht, tng huyt p v co tht ng mch vnh
trong khi phu thut.
X l: Tng tc m bc s gy m phi qun l, da theo cc thng s theo di
trong qu trnh phu thut.
Phn tch: Dng ng thi hai thuc c th gy bin ng huyt p quan trng.
X l: Cc thuc c ch MAO c s dng tng i t, cc tng tc th nhiu,
do vic t c k n, nn cc nhn xt v cnh gic thuc t c. Tuy nhin, v th n
trng, nn m bo mt khong cch 2 n 3 tun l k t lc ngng thuc n khi li
k n thuc c ch MAO.
Phn tch: Qua y vn, cc thng tin mu thun vi nhau: c th verapamil y
vincristin khi glycoprotein trong mu; c th gim hp thu verapamil rut do vincristin
gy ra. Tng tc cn cn thm nhiu ti liu b sung
X l: Theo di p ng lm sng vi verapamil v phi hiu chnh liu lng cho
thch hp.
Saquinavir
Phn tch: Do cnh tranh khu cytochrom P450, nn saquinavir c th lm gim
chuyn ho ca thuc phi hp, ko theo tng nng trong huyt tng v c tnh
ca n.
X l: Theo di cht ch ngi bnh v s xut hin cc tc dng c.
1025
X l: Theo di huyt p, mc du phi hp ny vn thng c dng m

khng bt buc phi hiu chnh li liu lng hay thay i cch iu tr.
Phn tch: Gim tc dng chng tng huyt p. Cc thuc chng vim khng
steroid c ch tng hp prostaglandin thn gy gin mch v ko theo hin tng gi
natri v nc. C nguy c suy thn cp ngi bnh mt nc.
X l: Kim tra chc chn l ngi bnh c tip nc y . Theo di chc
nng thn ( thanh lc creatinin), kim sot tnh n nh ca huyt p, nht l khi bt
u iu tr. c bit cn lu tng tc ny khi k n indometacin v cc d n cht
salicylat vi liu cao. Khuyn ngi bnh theo di u n huyt p.
VIDARABIN
Thuc khng virus thuc nhm nucleosid ca purin
Cc thuc trong nhm
VIDARABIN: thuc m tra mt 3%; gel bi 10%
Vira A thuc m tra mt 3%
Vira MP gel bi 10%
ch khi ch nh thuc
Chng ch nh: mc 4
Thi k cho con b: Hin cha bit thuc c qua c sa m khng, nn c n
trnh dng trong thi k cho con b.
Thi k mang thai: m t tc dng sinh qui thai ng vt. Do phi thc
hin mt bin php nga thai.
Cc trng hp khc: Qu mn cm vi thuc.
Thn trng: mc 2
Cc trng hp khc: Nguy c tng ri lon thn kinh trong trng hp ph no.
Cn theo di: mc 1
Suy gan: Tng transaminase v bilirubin, cho nn s dng cho ngi bnh suy
gan cn phi thn trng, v phi tin hnh theo di cc thng s ni trn.
Suy thn: Gim o thi khi suy thn, nn phi gim liu lng theo thanh lc
creatinin.
Tng tc thuc
Phn tch: Nguy c ri lon thn kinh kiu run hay ri lon lp . Nguy c c vi
thn kinh v c nhng tc dng khng mong mun khc nh thiu mu, bun nn, au,
nga.
1026
X l: Nu phi hp thuc tuyt i cn thit, phi theo di cht ch trn lm

sng. Khuyn ngi bnh n khm li khi thy cc triu chng k
trn.
VIGABATRIN
Thuc chng ng kinh, c tc dng c ch GABA transaminase, l enzym chu
trch nhim d ho cht dn truyn thn kinh GABA
cc thuc trong nhm
VIGABATRIN: thuc cm 500 mg/gi; vin nn bao ng 500 mg
Sabril thuc cm 500 mg/gi
Sabril vin nn bao ng 500 mg
ch khi ch nh thuc
Chng ch nh: mc 4
Trng hp: qu mn vi thuc.
Thi k cho con b: V thn trng, do cha c d liu.
Thi k mang thai: Tuy c tc dng gy qui thai ng vt, thuc c th dng
vi iu kin theo di cht ch.
1027
VILOXAZIN
Thuc chng trm cm gn ging loi ba vng
cc thuc trong nhm
VILOXAZIN: ng tim 100 mg/5mL; vin nn 100 mg, 300 mg
Vivalan ng tim 100 mg/5mL
Vivalan vin nn 100 mg
Vivalan LP vin nn 300 mg
ch khi ch nh thuc
Thi k cho con b: Do thn trng, v cha c d liu.
Thi k mang thai: Tuy cha pht hin tc dng gy qui thai no nhng khng
dng thuc trong ba thng u thai k.
Thn trng: mc 2
n ung; ru: Vi ngi nghin ru, dung np viloxazin ng tiu ho c
th gim i. Liu lng phi tng dn, v khuyn khng nn ung ru, d ru khng
lm tng cc tc dng ln h thn kinh trung ng.
Cc trng hp khc: Nguy c xut hin t vn, lc mi iu tr.
Tng tc thuc
Ru
Phn tch: Tng tc dng c ch h thn kinh trung ng ko theo tng tc dng
an thn, tng tc dng c ch h hp v tc dng h huyt p.
X l: ngi bnh nghin ru, cn gim liu lng ca cht ch vn. Ch
n ngi bnh ngoi tr, n ngi li xe v ngi ng my. Khi k n mt cht c
ch h thn kinh trung ng, phi khuyn ngi bnh trnh dng ru ng thi, v
khng dng cc ch phm c cha ru.
Phn tch: Nguy c tng nng theophylin trong huyt thanh, do viloxazin lm
gim chuyn ho theophylin gan.
K n: Tng cng theo di lm sng: theo di cht ch nng theophylin trong
mu v, khi cn, hiu chnh liu lng theophylin nu vic iu tr vi viloxazin khng th
ngng hay thay i c. Cc du hiu lm sng ng c theophylin gm bun nn,
nn, au vng thng v, nhc u, kch thch, mt ng, nhp tim nhanh. Co git thng
l du hiu khng nh ng c, nhng cng c th l du hiu u tin c bit tr
em. Khuyn ngi bnh gp li bc s, nu t thy cc du hiu ng c theophylin
xut hin.
1028
Amineptin; fluoxetin
X l: Tnh ti nguy c ny hiu chnh liu lng hai thuc, nu cn phi hp.
Cn ngh ti gim tnh to ngi li xe, ngi ng my. Khuyn khng ung ru,
v nu ngi bnh t dng thuc ring, kim tra xem cc t dc ca cc thuc c
cha ru khng.
Buspiron
Phn tch: Tng tc dng c ch h thn kinh trung ng, ko theo tng thm tc
dng an thn. C th thy thuc c tc dng tm thn vn ng, c bit trong tun
iu tr u tin. Tng tc dc lc.
X l: Tt nht, khng nn phi hp hai thuc ny, v bc s iu tr khng th
m bo c ngi bnh khng ung ru. Nguy c an thn c bit nguy him vi
ngi li xe v ngi ng my. Khuyn khng ung ru v khng dng cc ch
phm c ru.
Carbamazepin
Phn tch: C ba tc dng c ghi nhn gm h thp ngng gy ng kinh do
viloxazin; c ch cnh tranh hydroxyl ho nn d ho carbamazepin gim i; tng tc
dng c ch h thn kinh trung ng, lm tng tc dng an thn. Tng tc dc lc.
X l: Tnh n nhng nguy c ny hiu chnh liu lng hai thuc nu cn
phi hp. Phi ngh n gim tnh to ngi li xe v ngi ng my. Khuyn khng
ung ru, v khng dng cc ch phm c ru.
Fluvoxamin; medifoxamin
X l: Ngh n gim tnh to ngi li xe v ngi ng my. Khuyn ngi
bnh khng ung ru, v khng dng cc ch phm c ru.
Phenytoin
Phn tch: C ba tc dng c ghi nhn gm: h thp ngng gy ng kinh do
viloxazin; c ch cnh tranh hydroxyl ho nn d ho phenytoin gim i; tng c ch h
thn kinh trung ng, ko theo tng tc dng an thn. Tng tc dc ng hc.
X l: Nu cn phi hp thuc, phi gim liu phenytoin. Kim tra bng cch
nh lng thuc trong huyt tng (nng iu tr t 5 n 15mg/lt). Phi ngh n
gim tnh to ngi li xe v ngi ng my. Khuyn ngi bnh khng ung ru,
v nu ngi bnh t dng thuc, kim tra xem t dc thuc c cha ru khng.
Phn tch: Dng ng thi viloxazin vi hai thuc ny c th dn n nhng bin
ng quan trng v huyt p. Ngoi ra, cn c tc d ng c ch h thn kinh trung
ng.
X l: Cc thuc c ch MAO kh him c dng, cc tng tc li nhiu, v do
t c k n nn cc nhn xt v cnh gic thuc t thy. Tuy nhin, s thn tr ng
1029
i hi phi c mt khong cch thi gian t 2 n 3 tun k t lc ngng thuc n

khi k n li mt thuc c ch MAO.
Phn tch: y l hai cht c ch h thn kinh trung ng. Bc s gy m phi
tnh ti tc dng hip ng v dc l hc ca hai thuc.
X l: Khuyn ngi bnh sp qua phu thut thng bo cho bc s gy m cc
thuc mnh ang dng.
Thuc gy m khc; thuc gy m bay hi cha halogen
Phn tch: Tng tnh cht c ch h thn kinh trung ng, lm tng thm tc
X l: Khuyn ngi bnh sp phu thut thng bo cho bc s gy m cc
thuc mnh ang dng.
amphetamin.
X l: Tnh ti tng tc dc lc ny khi xc nh mc tiu iu tr chnh.
Khuyn ngi bnh n gp li bc s nu thy kt qu iu tr khng n nh.
Baclofen; dextropropoxyphen; khng histamin khng H1 an thn; oxaflozan;
primidon hoc cc dn cht; reserpin; thuc hng thn
X l: Phi tnh n nguy c ny hiu chnh liu lng hai thuc, nu cn phi
hp. Ngh n gim tnh to ngi li xe v ngi ng my. Khuyn khng ung
ru, v khng dng cc ch phm c ru.
Benzamid; benzodiazepin; butyrophenon; cc loi thuc c ch h thn kinh trung
ng; carbamat hoc thuc tng t; interferon alpha ti t hp; mianserin; thuc
chng ng kinh khng barbituric; thuc chng trm cm ba vng hoc thuc tng t
X l: Lu tng tc ny hiu chnh liu lng ca hai thuc, nu cn, khi
phi phi hp thuc. Cn ngh n gim tnh to ngi li xe v ng i ng my.
Khuyn khng ung ru, v khng dng cc ch phm c ru.
Clonidin hoc cht tng t
Phn tch: Tng tc dng c ch h thn kinh trung ng, ko theo tng tc dng an
thn. Tng tc dc lc. Ch rng cht rilmenidin liu thng dng khng lm tng tc
dng c ch h thn kinh trung ng ca cc cht ny.
X l: Cn lu tng tc ny iu chnh liu ca hai thuc. Ngh n gim
tnh to ngi li xe v ngi ng my. Khuyn ngi bnh khng ung ru, v
khng dng cc ch phm, cc sn phm c ru.
1030
VINCAMIN
Alcaloid chit t cy da cn, c tc dng trn tun hon no
thuc trong nhm
VINCAMIN nang 20 mg
Pervincamine nang 20 mg
Amkan vin nn 5 mg phi hp vi cao bch qu
ch khi ch nh thuc
Chng ch nh: mc 4
Thi k mang thai: Thc hin bin php nga thai.
Cc trng hp khc: Cc u no km tng p lc trong s l mt chng ch nh
dng thuc ny.
Tng tc thuc
Amiodaron; bretylium; bepridil; disopyramid; quinidin hoc dn cht; sotalol
Phn tch: Tng nguy c xon nh do cng hp cc tc dng. H kali mu, nhp
tim chm, v khong QT di c t trc (ch nhn thy trn in tm ) l nhng
yu t to iu kin cho xut hin xon nh.
n.
X l: Chng ch nh phi hp c tim nng gy t vong ny v khng c k

Benzamid
Phn tch: Trong nhm benzamid, ch c sultoprid (Barnetil*) gy nguy c. Tt c

cc thuc lm gim co c tim (lm chm nhp tim) c th gy tng nguy c ri lon nhp
tht, c bit xon nh, do nhng tnh cht in sinh l c sultoprid b sung thm.
K n: Chng ch nh v phi cm phi hp thuc ny.
Phn tch: Tng tc mi ch c ni vi astemizol (Hismanal*), l cht khng
histamin H1 c coi l khng an thn; tng nguy c xut hin xon nh. i khi c th
pht trin thnh rung tht, gy t vong.
K n: Chng ch nh phi hp thuc ny. Cn chn mt khng histamin khng
an thn, khng gy xon nh (cetirizin, loratadin).
Macrolid
Phn tch: Tng nguy c xon nh do cc tc dng hip ng ch c m t vi
erythromycin tim tnh mch. H kali mu, nhp tim chm, v khong QT di c t trc
(ch nhn thy trn in tm ) l nhng yu t c th to nguy c xut hi n xon
nh. Trong h macrolid, ch c erythromycin tim tnh mch l c th gy ri lon nhp
tim (ko di khong QT, ngoi tm thu tht, xon nh, bloc nh tht).
X l: Chng ch nh phi hp thuc c tim nng gy t vong ny. Ngay khi ch
dng ring, erythromycin tim tnh mch c th gy lon nhp tim. Nh vy khuyn
1031
co khng tim nhanh c liu mt ln, m phi truyn tnh mch lin tc hay chia lm
nhiu ln, thi gian truyn mi ln t nht l 60 pht.
Pentamidin
Phn tch: Tng nguy c xon nh do hip ng cc tc dng in sinh l. H
kali mu, nhp tim chm, v khong QT di c t trc (ch nhn thy trn in tm )
l nhng yu t c th to nguy c xut hin xon nh.
X l: Chng ch nh phi hp thuc c tim nng gy t vong ny. Khng c
k n.
Sparfloxacin
Phn tch: Tng nguy c xon nh, i khi pht trin thnh rung tht gy t vong.
X l: Phi trnh phi hp thuc ny. Cn chn mt fluoroquinolon khc, hoc
mt thuc khc, ty theo mc ch iu tr. Nu phi hp thuc tuyt i cn thit, bt
buc phi theo di lm sng v in tm .
Amphotericin B
Phn tch: Nguy c xon nh khi phi hp vi amphotericin B tim. H kali mu,
nhp tim chm, v khong QT di c t trc (ch nhn thy trn in tm ) l nhng
yu t c th to nguy c xon nh.
X l: Cn trnh phi hp thuc. Dng nhng thuc khng to xon nh. Nu
cn phi hp thuc, phi theo di lin tc khong QT v nh lng u n kali mu.
Khuyn ngi bnh gp li bc s nu thy mt mi, yu c, chut rt.
Mineralocorticoid
Phn tch: Nguy c xon nh khi phi hp thuc ny. H kali mu, nhp tim
chm, v khong QT di c t trc (ch nhn thy trn in tm ) l nhng yu
t c th to nguy c xut hin xon nh, i khi pht trin thnh rung tht.
X l: Cn trnh phi hp thuc ny. Dng cc thuc khng gy xon nh. Nu
cn phi hp ny, phi theo di lin tc khong QT v kim tra u
n kali mu. Khuyn ngi bnh gp li bc s nu thy mt mi, yu c, chut rt.
Furosemid hoc thuc tng t; glucocorticoid; halofantrin; thuc nhun trng
kch thch; thuc li tiu thi kali; tetracosactid
Phn tch: Nguy c xon nh khi phi hp hai thuc. H kali mu, nhp tim chm,
v khong QT di c t trc (ch nhn thy trn in tm ) l nhng yu t c
th to nguy c xut hin xon nh, i khi pht trin thnh rung tht, gy t vong.
X l: Cn trnh phi hp thuc. Dng cc thuc khng gy xon nh. Nu cn
phi hp ny, phi theo di lin tc khong QT v phi nh lng kali mu u n.
Khuyn ngi bnh gp li bc s nu thy mt mi, yu c, chut rt.
Phn tch: Thuc nhun trng lm trn, dng lu di, c th dn n h kali mu
v t tng nguy c xon nh khi phi hp vi vincamin. H kali mu, nhp tim chm,
1032
v khong QT di c t trc (ch nhn thy trn in tm ) l nhng yu t c

th to nguy c xut hin xon nh.
X l: Phi theo di khi phi hp thuc ny. Nn ngng thuc nhun trng, hoc
dng nhng thuc khng gy xon nh.
Zidovudin
Phn tch: Phi hp zidovudin vi cc thuc khc c vi ty xng i hi phi
rt thn trng. C nguy c thiu mu hay cc ri lon huyt hc khc.
X l: Khi cn phi hp thuc, phi theo di cht ch huyt v gim liu lng
nu cn.
Alcaloid ca cy da cn; chng gin phn
Cc thuc trong nhm
VINCRISTIN SULFAT dung dch tim 1mg/1mL
Vincristin sulfat dung dch tim 1mg/1mL
VINBLASTIN SULFAT bt pha dung dch tim 5 mg/5mL
Vinblastine bt pha dung dch tim 5 mg/5mL
ch khi ch nh thuc
S dng loi thuc ny i hi bc s k n phi c chuyn khoa ho. Do ,
nhng chng ch nh cn c xem xt theo tnh trng ngi bnh v c bc s
chuyn khoa nh gi.
Tng tc thuc
Vaccin sng gim c lc
Phn tch: Nguy c nhim khun tng ng vi vaccin, do tc dng c ch min
dch ca thuc phi hp.
X l: Khong thi gian gia lc tim phng v khi dng thuc phi m bo t
ba thng n mt nm, tu mc c ch min dch.
Actinomycin D
Phn tch: Nguy c tng c tnh vi mu do c ch ty xng, do hip ng cc
tc dng, c th dn ti mt bch cu ht.
X l: Nu cn phi hp thuc ny, nn dng liu thp cho mi thuc. Theo di
cht ch huyt .
Amphotericin B
Phn tch: Phi hp thuc amphotericin B tim vi cc thuc c vi ty xng
khc i hi thn trng rt cao. C nguy c thiu mu hay cc r i lon v huy t h c
khc.
1033
X l: Khi cn phi hp thuc, phi theo di cht ch huyt , v nu cn, gim

liu lng.
Asparaginase
Phn tch: Tng tc dng lm tng glucose mu v tng nguy c bnh thn kinh
v ri lon to hng cu.
X l: Phi hp thuc ny phi c cc bc s chuyn khoa qun l c s
bnh vin. c tnh s thp hn nu dng asparaginase sau vincristin, m khng dng
trc hay dng ng thi.
Azathioprin; carmustin hoc dn cht; cisplatin hoc dn cht; cyclophosphamid
hoc thuc tng t; doxorubicin hoc dn cht; fluoro - 5- uracil; ganciclovir; interferon
alpha ti t hp; melphalan; mercaptopurin; methotrexat; pentostatin; procarbazin;
thiotepa; thuc chng ung th khc
Phn tch: Nguy c tng c tnh vi mu do c ch ty xng do hip ng tc
dng, c th dn n mt bch cu ht.
X l: Nu c th, trnh phi hp thuc ny. Nu xt cn phi hp, nn dng liu
thp vi mi thuc v theo di cht ch huyt . Vic phi hp thuc ny dnh cho
bc s chuyn khoa, v thng thng cc phc iu tr c xc nh r rng.
Clozapin
Phn tch: Nguy c tng c tnh vi mu do c ch ty xng, do cng hp cc
tc dng c th dn n mt bch cu ht. C th mt bch cu ht nghim tr ng
thm ch t vong ngay khi ch dng c nht clozapin (c tnh min dch).
X l: Nu cn phi hp, phi dng vi liu thp hn vi mi thuc. Khng tin
on c mt bch cu ht khi dng clozapin. Vic theo di cht ch huyt , thc
hin bnh thng khi s dng mt cht km t bo, vn c gi tr. Tuy nhin, ng i
bnh cn c bo trc l khi ch st nh, vim hng v lot ming phi ngng iu
tr clozapin ngay.
Phn tch: S dng ng thi mt thuc km t bo vi mt thuc chng bnh
thng phong lm tng nng acid uric trong mu. Ngoi ra cn c nguy c gim bch
cu v gim tiu cu do hip ng cc tc dng ph ca hai thuc.
X l: Nn trnh dng hai thuc ng thi vi nhau, v c th li u php ch ng
bnh thng phong s tht bi. Nn dng alopurinol (thuc c ch tng hp acid uric)
hn l dng cc thuc bi acid uric niu trnh cc bnh thn.
Didanosin
Phn tch: Vin didanosin cha mt cht khng acid nn c nguy c lm gim hp
thu vincristin qua ng tiu ho do tc hp thu, tu thuc s tng pH d dy.
X l: Khuyn ngi bnh dng hai thuc cch nhau t nht 2 gi.
Digoxin
Phn tch: Cc alcaloid da cn (vincristin) lm gim nng digoxin trong huyt
thanh, lm gim tc dng iu tr. C th l cc alcaloid ny lm nh hng n
nim mc rut, lm cho s hp thu digoxin c kh khn v gim i.
1034
X l: Theo di nhng du hiu gim tc dng ca thuc ngi bnh (nh

khng kim sot c nhp tht, suy tim nng ln). Nu cn, tng liu digoxin. Vic o
nng digoxin trong huyt thanh lm cho vic chn liu lng c d dng.
Erythromycin
Phn tch: c tnh cc alcaloid cy da cn c nguy c tng (au c, gim bch
cu trung tnh, to bn). C th l erythromycin c ch s chuyn ho cc alcaloid
ny (c bit vi vinblastin).
X l: Trnh kt hp thuc ny. Nu bt buc phi dng, th ch dng vinblastin vi
liu duy tr, v theo di s xut hin cc tc dng ph ca thuc.
Phn tch: Phi hp hai thuc c ch ty xng.
X l: Interleukin l mt thuc ch c th s dng c s chuyn khoa, v l do
bnh l nghim trng. Nh vy cc tng tc cn c xem xt v tt c cc chc nng
ca c th u cn c theo di lin tc. Nht thit theo di huyt .
Penicillamin hoc thuc tng t
Phn tch: S dng ng thi hai thuc c ch ty xng c th gy ri lon
huyt hc nghim trng, ty theo thi gian iu tr di hay ngn. Cng cn theo di
chc nng thn.
X l: Nu phi hp phi theo di huyt hc v thn.
Phenicol
Phn tch: Nguy c c vi mu do c ch ty xng, do hip ng cc tc dng, c
th dn n mt bch cu ht. Ch dng n c cc phenicol cng c th gy mt bch
cu ht nghim trng, thm ch t vong (c tnh min dch).
X l: Nu cn phi hp thuc, dng cc liu thp hn i vi mi thuc. Khng
th tin on c mt bch cu ht khi dng cc phenicol. Vic theo di cht ch
huyt , thc hin bnh thng khi dng cht km t bo, vn cn gi tr . Tuy v y
ngi bnh cn c cnh bo ch cn st nh, vim hng v lot ming l phi
ngng dng phenicol ngay.
Phenytoin
Phn tch: Dng phi hp vi cc alcaloid da cn, nng phenytoin trong
huyt thanh gim, lm gim tc dng iu tr. C th l do s hp thu phenytoin gi m
hoc s chuyn ho phenytoin tng.
X l: Theo di nng phenytoin trong huyt thanh, v da vo hiu chnh
liu lng thuc.
Tacrolimus
Phn tch: C tng nng vincristin trong ni bo, v tng tc dng ca thuc
chng ung th do c ch glycoprotein G. Thc vy, glycoprotein G lm cho t bo
khng liu php, v lc bnh thng th glycoprotein G hot ng nh mt bm ph
thuc ATP, c kh nng o thi thuc ra khi t bo. Tc dng ny c quan st
in vitro, v hin nay cha c khai thc trn lm sng.
1035
X l: Tng tc ny hnh nh cha c ch li lm sng ngay, nhng phi tnh ti

khi c khng liu php.
Phn tch: c tnh cc alcaloid cy da cn (vinblastin, vincristin) c nguy c
tng (au c, gim bch cu trung tnh, to bn). C th l cc thuc chng nm azol
c ch s chuyn ho cc alcaloid cy da cn thng qua isoenzym CYP 3A4.
X l: Nu c th, trnh phi hp thuc ny. Nu buc phi dng, phi theo di
s xut hin nhng du hiu c tnh ca alcaloid cy da cn. Khi c th ph i
ngng dng cc thuc chng nm azol.
Verapamil
Phn tch: Qua y vn, cc thng tin tri ngc nhau. C th verapamil y
vincristin khi cc lin kt vi protein trong huyt tng. C th c gim hp thu
verapamil rut do vincristin. Tng tc ny cn cn nhiu t liu chng minh.
X l: Theo di p ng lm sng vi verapamil. Khi p ng khng y , phi
hiu chnh liu lng.
Zidovudin
Phn tch: Phi hp zidovudin vi cc thuc c vi ty xng phi ht sc thn
trng. C nguy c thiu mu hay cc ri lon huyt hc khc.
X l: Nu cn phi hp thuc, phi theo di cht ch huyt v khi cn, phi
gim liu lng.
VITAMIN A
Vitamin tan trong du, dng iu tr hay d phng thiu ht vitamin trong nhn
khoa hay da liu. Cn phn bit dng ung v dng dng ngoi, dng ny ch th hin
tc dng ton thn khi bi trn din tch da rng
Cc thuc trong nhm
Vitamin A: vin nn bc 5000 IU
Arovit vin nn 5000 IU
Avibon 500 nang 5000 IU
Mt s bit dc v mt nh:
Eyeton nang mm 2500 IU
Galepo nang mm 2500 IU
Max-Go lutein nang mm 1000 IU
Tobicom nang mm 2500 IU
Vicacom nang mm 2500 IU
Mt s bit dc b dng cha cc vitamin v mui khong nh:
Amorvita Ginseng; Astymin; Calcivita; Centovit; Gynavit; Homtamin; Moriamin fort;
Nutroplex; Obimin; Superton; Pharmaton; Vitacap
1036
ch khi ch nh thuc
Cc trng hp khc: Ri lon hp thu lipid. Km hp thu mn tnh.
Cn theo di: mc 1
Thi k cho con b: C th gy ra bnh tha vitamin A tr mi sinh khi qu liu
(khng vt qu 6000 n v/ ngy i vi ngi m).
Tr em; tr cn b: Tr em nhy cm hn vi liu cao.
Thi k mang thai: Khng pht hin thy d tt khi dng li u i u tr . Khi dng
nhng liu cao (trn 6000 n v/ ngy), ghi nhn d tt thai nhi.
Tng tc thuc
Phn tch: Nguy c tha vitamin A, do tc dng hip ng, c th dn ti ri lon
pht trin xng, nht l tr em.
X l: Phi hp ny khng hp l, c nguy c mc chng tha vitamin A. Nu
cn, theo di cht ch hm lng vitamin A trong huyt tng v theo di nhng tc
dng ph (ri lon th gic lc u...).
Tetracyclin
Phn tch: Tng nguy c tng p lc ni s lnh tnh (nhc u v gim th lc),
tng t nh nguy c trong tng tc vi cc retinoid.
X l: Nguy c cha c ghi nhn vi vitamin A, nhng do tnh cht tng t v
dc l, cn rt thn trng.
Calci
Phn tch: Lm gim tc dng ca cc mui calci. Khi dng vitamin A li u cao
(trn 5000 n v quc t/ ngy), c nguy c mt thnh phn khong
ca xng, c th dn ti tng calci mu v lm gim tc dng ca vic b sung calci.
X l: Tnh ti nguy c tng calci mu hiu chnh liu lng vitamin A. Nhc
ngi bnh khng t dng thm cc ch phm a sinh t.
Cholestyramin
Phn tch: Gim hp thu vitamin A qua ng tiu ho.
X l: Nu k n c hai thuc, khuyn dng vitamin A hoc trc 2 gi hoc 4
gi sau khi dng cholestyramin.
Sucralfat
Phn tch: S dng ng thi cc thuc ny lm gim hp thu v gim tc dng
ca c hai thuc do tng tc dc ng v hp thu thuc.
1037
X l: Khuyn ngi bnh trnh dng ng thi hai thuc ny v m bo mt

khong cch thi gian: Dng vitamin A trc 2 gi hoc 4 gi sau khi dng sucralfat.
Hi ngi bnh v nhng thuc t dng (nht l vi nhng ngi bnh cao tui).
Phn tch: Do vitamin A c lin kt vi cc protein huyt tng, n c th y cc
khng vitamin K ra khi lin kt vi protein huyt tng v lm tng cc tc dng ca
chng. y l tng tc dc ng hc v phn b thuc, xy ra khi dng vitamin A
liu cao.
X l: Theo di t l prothrombin, khi bt u v khi ngng iu tr vi vitamin A,
nu cn hiu chnh liu lng thuc ung chng ng mu.
Phn tch: Dng cc thuc ny vi du paraffin lm gim hp thu v gim tc
dng ca vitamin A, do tng tc dc ng hc v hp thu thuc.
X l: Khuyn ngi bnh trnh dng ng thi hai thuc ny v m bo mt
khong cch thi gian 2 gi trc hoc 4 gi sau khi dng thuc nhun trng dng
vitamin A. Hi ngi bnh v nhng thuc t dng (nht l i vi nhng ngi bnh
cao tui).
1038
VITAMIN B12
Vitamin tan trong nc. Thiu vitamin ny gy thiu mu nguyn hng cu
khng l vi mt myelin si thn kinh
Cc thuc trong nhm
VITAMIN B12: ng tim 100 mcg; 200 mcg; 500 mcg; 1000 mcg
Bedouza 1000 ng tim 1000 mcg
Cc bit dc cha nhiu vitamin v mui khong (xem mc vitamin A)
ch khi ch nh thuc
Chng ch nh: mc 4
Cc trng hp: U c tnh, qu mn vi cobalamin.
VITAMIN NHM B
Vitamin tan trong nc: thiamin (B1); riboflavin (B2); dexpanthenol (B5).
(Vitamin B6 v B12 c ni ring)
Cc thuc trong nhm
THIAMIN
Vitamin B1 Domesco nang 250 mg
Vitamin B1 F.T. Pharma dung dch tim 100 mg/2 ml
RIBOFLAVIN
Vitamin B2 vin nn 2 mg
DEXPANTHEMOL
Pantogen dch truyn (phi hp cc vitamin nhm B v vitamin nhm C) c 500 ml
c 250 mg D-pantothenol.
Sioplex Lysine dung dch ung phi hp lysin vi cc vitamin nhm B, trong c
3 mg vitamin B5/5ml.
Cc bit dc phi hp cc vitamin nhm B hoc cc vitamin khc, nh Astymin;
Centovit; Centrivit; Enervon C; Homtamin; Trivit B; v.v
ch khi ch nh thuc
Cc trng hp: D ng vi vitamin B1 - sc thiamin - qu mn vi thuc
Tng tc thuc
Levodopa
Phn tch: Gim tc dng ca levodopa do tng chuyn ho (kch thch dopa
decarboxylase ngoi bin).
X l: Trnh phi hp thuc ny.
1039
VITAMIN NHM D
Vitamin tan trong du, chng ci xng
Cc thuc trong nhm
COLECALCIFEROL (VITAMIN D3)
Cal-D-Vita vin nn si 400 UI
Calcium Corbire vitamin vin nn si 2000 UI
Vitamin D3 BON dung dch tim 200.000 UI/1ml, v.v
ERGOCALCIFEROL (VITAMIN D2)
Sterogyl Gottes dung dch ung git 50 mg/100 ml
ROCALTROL (Calcitriol) nang 0,25 mg
V cc bit dc phi hp vitamin D vi vitamin A hoc vi cc vitamin khc.
ch khi ch nh thuc
Cn nhc li ch/ nguy c: mc 3
Cc trng hp: Tng calci mu, lon dng xng. Qu mn vi thuc. Bt
ng lu di. Tng calci niu, si calci, nhim calci thn.
Thn trng: mc 2
Thi k cho con b: Khng k n liu cao trong thi k cho con b.
Thi k mang thai: Vi liu iu tr, cha c s c g c bo co. Tuy nhin khi
qu liu, vitamin D gy d tt thai nhi (gim nng tuyn cn gip), v mt c bi t,
chm pht trin tm thn, hp l ng mch ch...).
Suy tim: Nguy c tng calci mu.
Suy thn: Trng hp qu tha vitamin, c nguy c bnh thm nng.
Tng tc thuc
Barbituric; phenytoin; primidon hoc dn cht; rifampicin
Phn tch: Khi iu tr di ngy, cc cht gy cm ng enzym ny c th kch
thch tng nhanh chuyn ho, lm gim tc dng ca vitamin D v gy ri lon chuyn
ho calci.
X l: Phi lu n thi gian iu tr bng cc thuc k trn. Cm ng enzym
ch hnh thnh dn dn. V vy khi iu tr vi barbituric di ngy, cn hiu chnh li u
lng v b sung vitamin D, nu cn.
Calci
Phn tch: L phi hp kinh in trong iu tr. Thc vy, dng ng thi hai
thuc ny, lm hp thu calci rut tng ln rt nhiu, khi calci c dng vi liu cao.
1040
X l: Cn ch khi s dng u n cc ch phm cha nhiu mui calci (th

d cc thuc khng acid). C nguy c tng calci mu. Nu cn, phi kim tra calci mu.
Cng cn ch ngi bnh t dng lung tung cc mui calci ng thi vi vitamin D.
Cholestyramin
Phn tch: Gim hp thu nhiu thuc qua ng tiu ho.
X l: Nu k n hai cht ny, khuyn dng vitamin D hoc trc hai gi, hoc
bn gi sau khi dng cholestyramin.
Glycosid tr tim
Phn tch: Dng ng thi calci v vitamin D mt cch khng kim sot c th gy
tng calci mu. Tng calci mu ny c th lm tng c tnh thuc digitalis km theo
nguy c lon nhp tim.
X l: i vi ngi bnh cao tui, v c bit ph n mn kinh, b sung calci v
vitamin D tr thnh kinh in (iu tr long xng). nhng ngi ny cn phi
thc
nguy
c
khi
k
n
ng
thi
digitalis
vi
calci
v vitamin D. Nu cn, phi theo di calci mu. Cn lu c vi c t i u tr v l m
dng cc ch phm a sinh t v cc cht in gii nhng ngi bnh ny.
Sucralfat
Phn tch: Gim hp thu vitamin D khi c mt sucralfat, do tng tc dc ng
v hp thu.
X l: m bo khong cch thi gian 2 gi gia lc dng hai thuc. Tt nht,
dng thuc khng acid sau ba n (tng tit acid khi n).
Phn tch: S dng cc thuc ny vi du paraffin lm gim hp thu v gim hot
tnh ca vitamin D do tng tc dc ng v hp thu thuc.
X l: Khuyn ngi bnh trnh dng ng thi hai thuc ny v dng vitamin D
trc hai gi hay bn gi sau khi dng thuc nhun trng. Hi ngi bnh nhng thuc
h t dng (c bit ngi bnh cao tui).
yu t tng trng bch cu ht
Dng rt ngn thi gian gim bch cu nng v cc bin chng trong qu
trnh
ho tr liu vi cc thuc c t bo, hoc trong iu tr c ch min dch
Cc thuc trong nhm
MOLGRAMOSTIM bt ng kh pha tim 50 mcg; 150 mcg; 300 mcg; 400 mcg
Leucomax 50 mcg; 150 mcg; 300 mcg; 400 mcg
FILGRASTIM l thuc tim 30 IU/1 mL; 40 IU/1 mL mg/ 1 mL
Neupogen l thuc tim 30 IU/1 mL; 40 IU/1 mL
ch khi ch nh thuc
Chng ch nh: mc 4
1041
Trng hp qu mn vi thuc: Cn thn trng khi tim ln u (theo di lm

sng ngi bnh).
Thi k cho con b/ thi k mang thai: V thiu d liu.
Bnh mu: Trong cc bnh mu dng ty bo, do tnh cht cng lm tng pht
trin mt s t bo u.
1042
Yu t tng trng hng cu

Erythropoietin dng iu tr thiu mu cho ngi ln b ung th c
iu tr bng ho tr liu vi mui platin v cho ngi suy thn mn
phi chy thn nhn to
Cc thuc trong nhm
ERYTHROPOETIN ng tim 2000 IU/1mL; 4000 IU/1mL; 10000 IU/1mL
Eprex thuc tim 1 IU/1mL; 2 IU/1mL; 4 IU/1mL; 10 IU/mL
Recormon thuc tim 1 IU/1mL; 2 IU/1mL; 5 IU/1mL; 10 IU/1mL
Ch khi ch nh thuc
Chng ch nh: mc 4
Tng huyt p: Khi tng huyt p cha c kim sot.
Thi k cho con b: Thiu d liu
Thi k mang thai: Cha chng minh c tnh v hi. Cha bit cc nguy c i
vi thai.
ZALCITABIN
Thuc chng virus dng trong mt s trng hp ngi ln nhim HIV
Cc thuc trong nhm
ZALCITABIN vin nn bao phim 0,375 mg; 0,75 mg
Hivid vin nn bao phim 0,75 mg
Ch khi ch nh thuc
Chng ch nh: mc 4
Thi k cho con b: Khi iu tr, trnh cho con b, v c nhng tc d ng khng
mong mun vi tr.
Thi k mang thai: Cha xc nh c tnh v hi.
Cc trng hp khc: Bnh thn kinh ngoi bin, vim tu, gan to, lot thc qun
v qu mn.
Tng tc thuc
Cisplatin; dapson; disulfiram; isoniazid hoc thuc tng t; phenicol; thuc
chng nm dn xut imidazol; thuc gin mch chng tng huyt p
Phn tch: C th xut hin bnh thn kinh ngoi bin.
X l: Theo di lm sng chng d cm.
Ganciclovir
1043
Phn tch: Tng nguy c xut hin bnh thn kinh ngoi bin, do hip ng cc
tc dng khng mong mun. Tng tc dc lc.
X l: m bo theo di lm sng u n.
Pentamidin
Phn tch: c mt trng hp t vong do vim gan ti cp khi dng pentamidin
tim tnh mch.
X l: Khi iu tr vim phi do Pneumocystis carinii bng pentamidin tim tnh
mch, phi ngng dng zalcitabin.
Aminosid tim hay dng ti ch; amphotericin B; foscarnet; probenecid
c.
Phn tch: Tng nng zalcitabin trong huyt tng, lm tng nguy c nhim
X l: Theo di cc tc dng khng mong mun do zalcitabin. Gim liu lng,

nu cn.
Phn tch: Gim thanh lc zalcitabin thn, ko theo tng c tnh ca
zalcitabin (bnh thn kinh ngoi bin, vim ty, nhim acid lactic, gan to).
X l: Thay cimetidin bng sucralfat hoc dng cc thuc cch nhau hai gi.
Didanosin
Phn tch: Tng nguy c xut hin bnh thn kinh ngoi bin v vim ty, do
cng hp cc tc dng ph. Tng tc dc lc.
X l: m bo theo di lm sng u n, v m bo nh lng amylase mu
thng xuyn (amylase l enzym c ngun gc ty tng hay nc bt, sc tc ging
ho amidon thnh maltose).
ZIDOVUDIN
Thuc chng virus dng iu tr AIDS v ARC (AIDS related complex Phc hp lin quan n bnh AIDS)
Cc thuc trong nhm
ZIDOVUDIN nang 100 mg
Retrovir nang 100 mg
Ch khi ch nh thuc
Chng ch nh: mc 4
Cc trng hp: Qu mn vi thuc. Ri lon huyt hc nghim trng
(hemoglobin v bch cu a nhn trung tnh).
1044
Tr em: Vi tr em c t l transaminase ln hn 5 ln bnh thng hay tng

bilirubin mu.
Thi k mang thai: c bit trc tun th 14 thai k, phi cn nhc k khi k
n, v phi thng tin chi tit cho ngi bnh.
Suy gan: Khi gan to v khi transaminase tng nhanh phi ngng iu tr.
Tng tc thuc
Methotrexat
Phn tch: Nguy c tng c tnh vi mu do c ch ty xng, v hip ng cc
tc dng trn dihydrofolat reductase, c th dn n thiu mu nguyn hng cu khng
l.
X l: Nu cn phi hp thuc ny, phi dng liu thp cho mi thuc v phi
theo di cht ch huyt . Vic phi hp thuc ny dnh cho cc bc s chuyn khoa,
v cc phc iu tr thng c xc nh r rng. C th b sung thm acid
folinic.
Atovaquon
Phn tch: Atovaquon lm tng nng zidovudin trong huyt thanh, do lm
tng c tnh ca zidovudin. C ch l atovaquon c ch s lin hp glucuronic ca
zidovudin.
X l: Theo di tc dng ca zidovudin khi dng phi hp vi atovaquon. Nu
nghi ng c tng tc, gim liu zidovudin.
Paracetamol
Phn tch: Nguy c gim bch cu trung tnh v c vi gan.
X l: C th thay th bng aspirin v/ hay ibuprofen. Nu cn phi hp thuc,
phi theo di s lng v cng thc mu v chc nng gan u n.
Probenecid
Phn tch: C kh nng c ch lin hp glucuronic v gim o thi qua thn, ko
theo tng na i v nng huyt thanh, v nh vy, tng c tnh zidovudin.
X l: Nn trnh phi hp ny.
Aciclovir
Phn tch: Xut hin cc tc dng ph nh ng lm, suy nhc. C ch cha r.
X l: Bo trc cho ngi bnh, yu cu nm ngh, nu cn.
Actinomycin D; azathioprin; carmustin hoc dn cht; cisplatin hoc dn cht;
clozapin; cyclophosphamid hoc thuc tng t; doxorubicin hoc dn cht; fluoro-5uracil; ganciclovir; interferon alpha ti t hp; levamisol; melphalan; mercaptopurin;
1045
phenicol; procarbazin; thiotepa; vincamin; vincristin hoc thuc tng t; thuc chng
ung th khc
Phn tch: Phi hp zidovudin vi cc thuc c vi ty xng i hi phi rt
thn trng. C nguy c thiu mu v cc ri lon huyt hc khc.
X l: Nu cn phi hp thuc, phi theo di cht ch huyt v gi m li u
lng, nu cn.
Amphotericin B
Phn tch: Phi hp amphotericin B tim vi cc thuc c vi ty xng i hi phi
rt thn trng. C nguy c thiu mu hay cc ri lon huyt hc khc.
X l: Nu cn phi hp thuc, phi theo di cht ch huyt v nu cn, gim
liu lng.
Barbituric; carbamazepin; primidon
Phn tch: Ngoi suy t rifampicin v rifabutin, cc thuc k trn s gy gim
nng zidovudin do tng chuyn ho ca n (cm ng enzym).
X l: Nu thy p ng vi zidovudin b gim, hiu chnh li liu lng
zidovudin.
Benzodiazepin
Phn tch: c ch cnh tranh s lin hp glycuronic vi zidovudin v gim
thanh lc cht ny, c bit khi dng cc benzodiazepin c th lin hp vi acid
glycuronic (lorazepam, oxazepam, temazepam). C nguy c tng c tnh ca
zidovudin.
X l: Cn theo di lm sng khi phi hp thuc. Nu c th, trnh phi hp
thuc ny khi thy tng c tnh ca zidovudin, hoc chn mt benzodiazepin
chuyn ho.
Dapson; flucytosin
Phn tch: Tng c tnh vi ty xng.
X l: Theo di u n huyt .
Indometacin; salicylat
Phn tch: Tng c tnh ca mi thuc, do c ch cnh tranh lin hp glycuronic
vi th gan.
X l: Theo di nhng tc dng khng mong mun lin quan n aspirin,
indometacin v zidovudin: theo di huyt hc (s lng v cng thc mu) v lm sng
(suy nhc, bun nn, nn,...).
Macrolid
Phn tch: Clarithromycin c th gy gim nng zidovudin trong huyt tng.
X l: Nu thy gim p ng vi zidovudin sau khi bt u dng clarithromycin,
phi tng liu zidovudin, hay s dng mt khng sinh khc ty theo khng sinh .
Methadon; pentamidin
1046
Phn tch: Cc thuc ny lm tng nng zidovudin trong huyt tng do lm

gim chuyn ho zidovudin.
X l: Gim liu lng zidovudin. Theo di cc tc dng khng mong mun lin
quan n zidovudin (theo di huyt hc v lm sng).
Natri valproat hoc dn cht; pyrimethamin; trimethoprim
Phn tch: Nguy c tng c tnh vi mu do c ch ty xng, do hip ng cc
tc dng trn dihydrofolat reductase, c th dn ti thiu mu nguyn hng cu khng
l.
X l: Nu cn phi hp thuc, phi dng liu thp i vi mi thuc v phi
theo di cht ch huyt . Vic phi hp thuc ny dnh cho cc bc s chuyn khoa,
v thng l cc phc iu tr c quy nh r rng. C th b sung acid folinic.
Phenytoin
Phn tch: c ch chuyn ho zidovudin do s cnh tranh lin hp glucuronic v c
s thanh lc cht ny. Khi phi hp vi zidovudin, nhn thy c s bin i v nng
phenytoin. Theo y vn, nng ny c th thay i theo chiu tng hay gim. Tng tc
ny cn cn c nghin cu thm.
X l: Hiu chnh liu lng zidovudin, theo di cc tc dng huyt hc ca
zidovudin v theo di lm sng v hiu qu ca phenytoin (nh lng trong huyt
tng).
Phn tch: Cc cht ny gy gim nng zidovudin, do tng chuyn ho (cm
ng enzym).
X l: Nu thy gim p ng vi zidovudin, sau khi iu tr vi rifabutin hay vi
rifampicin, phi hiu chnh liu lng zidovudin.
Sulfamid khng khun
Phn tch: C th phi hp thuc. Tng c tnh vi mu do hip ng cc tc
dng c ch trn dihydrofolat reductase (tc dng ring ca trimethoprim).
X l: Tng cng theo di huyt hc i vi nhng ngi bnh ny, v xt vn
trong thc t sinh l bnh hc c th.
Thuc chng nm dn xut ca imidazol
Phn tch: Cc thuc ny lm tng nng zidovudin trong huyt tng do lm
gim chuyn ho zidovudin (i vi fluconazol phi dng liu cao).
X l: Cn gim liu zidovudin. Theo di nhng tc dng khng mong mun c
lin quan n zidovudin (theo di huyt hc v lm sng).
PHN TRA CU
MC LC TRA CU NHM THUC
1047
Tn nhm thuc
A
Benzoyl peroxyd
1
26
Acamprosat
Benzyl benzoat
5
Acetorphan
26
3
Bepridil
5
Aciclovir
Betahistin hoc thuc tng t
3
3
Acid
cromoglycic
thuc tng t
hoc
Biguanid
Biphosphonat
Bretylium
Bromocriptin hoc thuc tng
4
t
4
Buspiron
1
47
Butyrophenon (dn cht)
8
Actinomycin D
1
43
7
Acid ho nc tiu (cc
1
39
cht)
1
38
Acid fusidic
1
33
1
33
8
Acid
chenodesoxycholic
hoc dn cht
2
1
27
6
Acid ascorbic
1
49
Cc thuc loi cura
1
4
Alprostadil
Cafein
8
Amantadin
tng t
hoc
thuc
Calci (mui)
Aminoglycosid (nhm khng
Calcitonin
Carbamat hoc thuc tng t
Carbamazepin
Carmustin
1
77
7
9
1
67
4
1
64
2
Amiodaron
1
63
5
Aminoglycosid ng ung
1
61
2
sinh)
1
59
Amineptin
1
55
Carotenoid
1
82
1048
Tn nhm thuc
Amphotericin B
8
3
Antimon (hp cht)
8
7
Apomorphin
Cephalosporin
tng t
hoc
Cephalosporin
thiomethyltetrazol
thuc
nhn
89
1
91
Cholinergic
9
Azathioprin
Cholestyramin
8
Asparaginase
1
83
1
95
Ciclosporin
1
98
Cimetidin
2
06
Baclofen
Cisaprid
5
Barbituric (dn cht)
9
9
Benzamid (dn cht)
Citalopram
2
26
Clorhexidin
17
Benzofuran (dn cht)
2
22
16
Benzodiazepin (dn cht)
2
18
09
Benzimidazol (dn cht)
2
16
2
33
Clozapin
25
2
34
Fibrat
39
Corticoid - khong
22
2
Finasterid
41
3
25
Cyclophosphamid hoc thuc

2
tng t
46
Cycloserin
Flavoxat
Flecainid hoc thuc tng
2
49
3
26
3
26
Floctafenin
3
29
Danazol
Flucytosin
50
Dantrolen
2
51
1049
3
30
Flumazenil
3
31
Tn nhm thuc
Dapson
Fluor (dn cht)
55
Deferoxamin
32
2
Fluoro-5-uracil
56
Desmopressin
33
2
Fluoxetin
57
Dextran
37
2
Fluvoxamin
58
Dextropropoxyphen
43
2
Foscarnet
59
Diacerhein
48
2
Fosfomycin
63
Diazoxid
50
2
64
Didanosin
Furosemid
tng t
hoc
thuc
Fusafungin
68
Dihydropyridin (dn cht)
3
51
63
Ganciclovir
72
Diltiazem
78
Dipyridamol
63
2
Glucagon
84
Disopyramid
66
2
Glucocorticoid
86
Disulfiram
67
2
93
Doxapram
Glutethimid
tng t
hoc
thuc
Gonadotrophin nhau thai
3
93
Gonadotrophin c hot tnh
3
00
Dng c trnh thai
3
84
96
c t Clostridium Botulinum
79
Glycosid tr tim
2
95
FSH
3
3
94
Griseofulvin
01
3
94
Guanethidin
3
98
02
1050
Tn nhm thuc
Estrogen hoc thuc nga thai
3
estroprogestogen
05
Ethambutol
3
13
Ethosuximid
Halofantrin
Heparin hoc cc dng phn

4
t lng thp
07
Heparin tng hp
14
Etretinat (dn cht)
4
11
Heptaminol
17
Eucalyptol
4
04
4
11
Histamin hoc dn cht
20
4
12
Hormon chng li tiu hoc

4
dn cht
13
F
Fenoverin
3
22
Hormon tuyn gip
Hormon tng trng hoc

4
dn cht
14
Mercaptopurin
14
Huyt thanh khc loi c hiu
18
4
Methadon
18
8-Hydroxyquinolein (dn cht)
5
5
23
Methenamin
18
5
27
Methotroxat
5
28
Idoxuridin hoc thuc tng t
Methyldopa
19
Idrocilamid
Methysergid
19
Mexiletin
Mianserin
Mifepriston
Modafinil
Molsidomin
1051
5
52
4
37
5
51
32
5
50
25
Insulin
5
47
21
5
45
21
Indinavir
5
43
Immunoglobulin khng t bo
4
lympho
20
Immunoglobulin ngi
5
36
Muromonab CD3
5
52
Tn nhm thuc
Naftidrofuryl
42
46
5
53
5
54
Kali (mui)
Nelfinavir
52
Khng sinh nhm polypeptid
5
61
Nha trao i cation
4
54
5
64
Nicorandil
5
65
Lamivudin
Nicotin
56
Lansoprazol
Nilutamid
57
Levodopa
Niridazol
Nitrofuran
Nitroimidazol hoc dn cht
5
73
Nitroxolin
72
Lithi (mui)
5
71
69
Lipid (nh dch tim truyn)
5
69
65
Lincosamid
5
67
60
5
66
5
76
72
Loperamid
Octreotid hoc thuc tng
4
78
Li tiu gi kali
t
4
Omeprazol
79
Li tiu thi kali
Oxaflozan
Oxitriptan
5
84
Oxytocin
98
M
5
81
98
Lu hunh
5
78
86
Li tiu thm thu
5
76
5
85
P
1052
Tn nhm thuc
Macrolid
99
Magnesi (mui)
Paracetamol
10
Medifoxamin
87
5
Paroxetin
11
Melphalan
91
5
16
Penicilin
5
86
Penicilamin
tng t
Ranitidin
hoc
thuc
5
95
99
Pentagastrin
04
Pentamidin
Rifabutin
05
Pentostatin
Rifampicin
09
6
Ritonavir
7
34
Ru
13
Phenicol
7
24
11
Phenazon
7
16
Pentoxyfylin
7
14
7
43
Salicylat (dn cht)
14
Phenothiazin
18
Phenytoin
Saquinavir
28
Phospho hoc phosphat
Sermorelin
Sotalol
Sparfloxacin
6
6
Steroid gy ng ho, alkyl

7
ho C17
82
Succinimid
46
Praziquantel
1053
7
84
6
47
7
78
46
Pralidoxim
7
65
45
Piribedil
7
65
44
Piperazin
7
62
44
Pinaverium bromid
7
53
Sucralfat
7
85
Tn nhm thuc
Primidon
6
48
Probenecid
Sulfamid khng khun
6
60
Procarbazin
Sulfasalazin
Sumatriptan
8
02
Synergystin
75
Propafenon
8
00
73
7
96
65
Progabid
7
87
8
04
Tacrin
79
Prostaglandin chng lot
82
Prostaglandin trong ph khoa
Tacrolimus
82
Protamin
Tamoxifen
Teicoplanin
Terbinafin
Tetracosactid
Tetracyclin
93
8
23
6
93
Pyrimethamin
8
15
Pyridoxin
8
14
87
Pyrethrin hoc dn cht
8
13
85
Pyrazol hoc dn cht
8
12
84
Pyrazinamid
8
07
83
Pyrantel hoc dn cht
8
05
8
28
Thiotepa
95
8
36
8
38
Quinidin hoc dn cht

Quinolon
Thuc bo v chng nh
6
96
sng
7
06
8
46
Thuc cm ng gy rng
trng loi clomifen
846
7
09
1054
Tn nhm thuc
Thuc cm mu
8
47
Thuc chn alpha
Thuc khng histamin khng H1

c tc dng an thn gy bun ng
980
Thuc khng histamin khng H1

9
khng an thn
86
47
Thuc chn alpha-beta
50
Thuc chn bta
Thuc kim ho nc tiu
51
Thuc chng au tht ngc
nitrat
65
Thuc chng hen
8
8
Thuc lm thay i cht nhy

9
ph qun
95
83
8
95
Thuc chng st rt
Thuc gy m v tin m
Thuc gy m bay hi cha
halogen
100
2
100
8
Thuc chng suy nhc kch

8
thch tm thn
97
Thuc chng tng huyt p

8
loi lit hch
98
Thuc nhn trng lm trn
Thuc chng trm cm ba

vng hoc thuc tng t
9
99
95
Thuc chng tiu fibrin
9
97
Thuc chng nm dn xut

8
imidazol
83
Thuc chng nm khc
9
93
82
Thuc chng ho khng opi
9
90
8
99
9
00
101
4
101
5
Thuc nhun trng nhy v
1
thm thu
018
Thuc nga thai dit tinh trng
Thuc st khun dn cht
amoni bc 4
1
020
1
020
loi
Thuc chng ung th cc
Thuc chng vy nn dng

9
ti ch
14
1055
Thuc st khun c iod
09
102
1
Thuc st khun mui kim loi
102
Tn nhm thuc
2
Thuc chng vim khng
9
steroid
15
Thuc st khun c thu ngn
Thuc
morphin
Thuc st khun khc
ch
vn
ca
103
5
26
102
4
Thuc va ch vn va i
9
khng vi morphin
35
Thuc st dng trong iu tr
Thuc cng giao cm

9
alpha-bta
36
Thuc tng oxy no
Thuc cng thn kinh giao

9
cm bta
47
Thuc tiu lp sng
102
5
102
8
102
9
Thuc din hot tng hp

9
Thuc tr , dn cht nm
tc dng phi
54 ca g
102
9
Thuc i khng morphin
Thuc tr h hp
54
Thuc i khng th th
HT3
103
0
9
Thuc tr tim bupyridinic
55
Thuc i quang c baryt
103
1
9
Thuc tr su clor hu c
56
Thuc i quang c iod
Thuc gy mn cm nh
9
57
sng
mch
103
1
9
Thuc gy x cng tnh
60
9
Thuc ung chng ng mu

8
khng
69
vitamin K
Thuc c ch enzym chuyn 103
dng angiotensin
2
60
Thuc gin mch chng
9
Thuc c ch
tng huyt p
61 reductase (cc statin)
Thuc h lipid mu cc loi
9
66
HMG-CoA
104
0
Thuc c ch MAO typ A

104
4
1056
Tn nhm thuc
Thuc khng aicd ung,
9
thuc bao nim mc v hp ph
66
Thuc c ch MAO typ B

104
5
9
lc
72
9
77
Ticlopidin
Thuc c ch MAO khng chn

105
0
Thuc c ch thn kinh trung

1
ng cc loi
059
062
TRH
1
ht
065
Trimebutin
Yu t tng trng bch cu

Yu t tng trng hng cu
065
Trimethoprim
1
102
1
103
066
V
Zalcitabin
1
103
lc
Vaccin sng gim c
1
070
Vancomycin
1
1
072
Verapamil
1
076
Vidarabin
1
084
Vigabatrin
1
085
Viloxazin
1
086
Vincamin
1
089
Vincristin
tng t
hoc
thuc
1
092
Vitamin A
1
096
1057
1
105
071
Vng
Zidovudin
Tn nhm thuc
Vitamin B12
1
099
Vitamin nhm B
1
099
Vitamin nhm D
1
100
1058
MC LC TRA CU TN THUC V BIT DC

Tn thuc
A
Abodine
Acid nalidixic
021
Acamprosat
Acid niflumic
5
Accupril
70
9
91
5
Acid phosphoric
Acid salicylic
48
033
Acebutolol
51
Aceclofenac
Acid tiaprofenic
15
Acemycin
Acid tranexamic
89
9
Acid undecylenic
96
Acenal
91
5
5
Acemuc
89
5
89
5
Acid ursodesoxycholic
Acid valproic
42
86
Acenocoumarol
69
Acetadein
9
cht)
26
Acetaminophen
Acid ho nc tiu (cc
Acitretin
Acnecide
Acodine
5
9
Acoralen F
Actadol
1059
58
8
3
6
92
6
33
Aciclovir
92
6
96
Acetyl-leucin
12
6
Acetylcystein
31
7
86
Acetorphan
71
4
88
Acetazolamid
48
Aciloc
87
Acetaphen
55
4
Actadol codein
92
6
Tn thuc
Acid acetyl-salicylic
Actapulgite
53
96
6
Acid acexamic
Acti-5
Actifed
38
99
Acid alendronic
38
92
7,940
Acid amidotrizoic
Actifed DM
57
94
0
Acid ascorbic
Actilyse
99
3
Acid benzoic
Actinomycin D
51
Actrapid HM
43
024
Acid boric
024
Acid chenodesoxycholic
2
4
Acyclovir
36
2
Acid clavulanic
5
99;601
Acid cromoglycic
Adalat
4
Adancor
4
Acid crysophanic
Adofex
Adrenalin
4
Acid folinic
Aerrane
Aetoxisclerol
92
Altiva
97
Alrafen cough
92
7
11
Alumin gel
96
7
27
3
98
6
Alat
96
0
Al-400
10
02
15
Akineton
91
7
Agrodin
93
Advil
7
Acid mefenamic
44
; 1025
7
5
Acid fusidic
56
5
95
Acid folic
27
3
Alumin hydroxyd
96
6
1060
Tn thuc
Alaxan
91
Alumin phosphat
7
Albendazol
7
11
Alverin
7
Albothyl
10
Alyrane
10
02
44
Amarin
2
Aldol-S
58
6
25
Aldesleukin
96
45
7
93
Amantadin
53
Ambilhar
58
8
Aldomet
6
Aldomet-M
53
Ameflu
13
Ameflu + C
90
Amekrin
6
Alendronat
56
9
92
7; 940
40
6
Alexan
9
Alfentanil
92
Ameproxen
6
Alfuzosin
91
8
84
Ametycin
7
Alicopin
90
9
91
0
92
Amikacin
65
92
Amikaye
65
75
Amiklin
65
51
Aminacrin
6
Aliopin
9
Alka-seltzer
3
Alkeran
6
Aller fort
93
Aminazin
8
Allercet
10
24
61
8
98
Amineptin
62
93
Aminoglycosid
65
6
Allermin
8
Allochrysine
10
72
1061
; 72
Aminophyllin
82
8
Tn thuc
Alminoprofen
91
Amiodaron
10
Amitriptylin
74
5
Almitrin
30
Alopexy
90
0
96
Amkan
10
89
Aloplastine
10
Amlocor
23
Alphosyl
10
Amlodipin
29
Alprostadil
27
2
27
2
58
Amlopress
27
2
Alopurinol
54
Amlor
27
2
Alovell
13
Amodex
59
9
Alten
31
Amolin
59
9
Alex
92
Amorsiklav
59
9
Alteplase
99
Amoni bc 4 (dn cht)
10
20
Altretamin
90
9
Amoni clorid
48
Antacil
96
7
Amorsiklav
59
Antadys
91
7
Amorvita ginseng
10
Antalvic
97
Amox
25
9
59
Antazolin
98
0
Amoxapin
90
Antidol
91
7
Amoxicillin
Antimon (hp cht)
Antipyrin
87
99
Amoxilin
99
61
3
1062
Tn thuc
Amoxycilin
Anti-Thyrox
9;599
Amphetamin
7
5
Antituss siro
99
Amphocyclin
97
93
8
Aotal
Apacef
35
3
Amphotericin B
3
Ampicillin
Apo-Acetazolamide
99
Ampicillin panpharma
18
9
48
6
Apo-Allopurinol
54
Apo-Amilzide
48
99
Ampicillin sedapharm
99
Amrinon
6
1
Apo-Amitriptyline
031
Amsacrin
Apo-Atenol
09
Amtim
Apo-Capto
Apo-Chlorpropamide
Apo-Cloxi
Apo-Diclo SR
Apo-Dimenhydrinate
Apo-Doxy
Apo-Enalapril
Apo-Erythro-base
Apo-Erythro-S
38
1063
49
9
7
83
49
9
Andriol
10
32
38
Andol S
82
3
30
Andol fort
98
0
18
Ancotil
91
6
00
Anapran
60
0
67
Anafranil
78
7
07
Anandron
10
32
88
Analgin quinin
85
1
72
Anadol
90
0
Apo-Famotidine
71
4
Tn thuc
Androcur
Apo-Folic
Apo-Glyburide
44
75
Androgel
82
Anexat
Apo-Haloperidol
31
Angiografin
Apo-Hydro
Apo-ISDN
Apo-Keto
93
Anorex
48
6
86
Anistreplase
15
0
57
Anhydron
78
7
86
5; 866
91
7
Apokinon
Apo-Lovastatin
88
9
Anquin
10
Ansatipine
Apo-methacin
16
Apo-Methyldopa
10
40
42
5
53
Aspirin C
10
Aspirin Domesco
38
6
Apo-Metoclop
9
Apomorphin
75
3
88
Aspirin pH8
75
3
Apo-Nadol
85
Aspirin Upsa-vitamin C
38
91
ASS + C Pharmavit
38
27
Astelong
2
Apo-Naproxen
8
Apo-Nifed PA
3
Apo-prednison
36
Astemizol
8
Apo-Salvent
94
Asthafen
Asthalin
94
8
90
0
98
1
90
Apo-Amitriptyline
98
6
8
Apo-triptyn
98
6
Astymin
109
7;1099
1064
Tn thuc
Apranax
91
Astymin forte
32
Astymin liquid
89
Atafed
39;44
8
Aprindin
39;44
6
Aprotinin
9
Apurone
71
Atarax
0
Arbid
50
Atecortin
15
Ateloc
Atenolol
8
47
Atenova
89
Athymil
84
Atocor
10
40
10
Atorvastatin
21
Aronamin
54
7
7
Arodin
85
1
8
Arhemapectine
85
1
8
Arfonad
85
1
13
Arestal
45
4
6
Aredia
10
59
0
Arduan
94
0
10
40
38
Atovast
10
40
Arovit
10
Atracurium dibesylat
96
Artex
85
Atropin
2
Arthrinal
91
Attapulgite
91
Aturgyl
26
Atussin
92
7
89
Atussin siro
5
Ascormin
93
7
3
ASA
96
6
6
Artrodar
97
2
9
Arthrodont
15
6
48
;927
38
Augmentin
59
9
1065
Tn thuc
Ascortonyl
38
Aulin
91
8
Asmacort
36
Auronim
91
9;828
Asmalin
9
93
Aurorix
10
44
Asmin
Avelox
77
36
Asparaginase
8
8
Avibon
10
9
Aspegic
96
7
Avicrem
36
Bendroflumethiazid
48
53
Avlocardyl
52
Avrazor
6
5
Benecole - B
93
73
Axepim
8
1
Benecole - D
93
84
Axetine
8
1
Benemid
66
86
Axid
0
7
Benfluorex
96
14
Axon
6
1
Benzafibrat
32
86
Azanin
2
9
Benzalkonium
10
1
Azapropazon
20
Benzamid (dn cht)
9
15
Azathioprin
9
1
Azithromicin
Benzathin
benzylpenicillin
60
0
Benzbromaron
12
73
Az-vital
10
9
5
4
Benzethonium
10
20
Benzimidazol
11
6
Bc nitrat
1
022
Benzodiazepin
cht)
(dn
11
7
1066
Tn thuc
Bc sulfadiazin
Benzofuran
022
Bch h hot lc
5
3
Benzo-estradiol
20
Bacitracin
Benzo-Gynoestryl
Benzoyl peroxyd
Benzydamin
Benzyl benzoat
Benzyl penicillin
9
9
Benzyl thiouracil
Bepridil
Berodual
Berotec
Berodud MDI
Beta - caroten
Betadine
Betagan
Betahistin
Betaloc
Betamethason
1067
36
8
1
032
85
2
Benalapril
13
3;412
78
Benadryl
85
2
27
Belifax
10
21
22
B ho
18
2
099
Befizal
94
7
68
Bedouza
94
7
68
Becotide
94
7
070
Beclomethason
12
7
73
BCG Pasteur
97
7
77
Baypress
60
0
56
Basdene
12
6
Bary sulfat
91
5
95
Barbituric (dn cht)
12
6
61
Balsofumine menthol
30
5
5
Baldmin
30
5
54
Baclofen
12
Betanase
78
7
Tn thuc
Benazepril
Betnovate S
032
Benda 500
5
1
Betaxolol
17
Betnovate - GM
85
1
65;368;
Botox
885
Betnovate - S
89
30
0
368;75
Bm Pru
3;895
99
5
Betoptic - S
Bradosol
51
Bibonlax
Bredin
018
Biclothymol
Bretylate
024
1
Bretylium
Briazide
Bricanyl
Briem
Bristaflam
91
5
Bristopen
2
Biodacyna
10
32
065
Bio - Clean
94
8
33
Bimetin
10
32
83
Biguanid
13
9
96
Bifonazol
13
9
77
Bidi - Malaquin
27
3
Bicnu
10
20
60
0
Brivita
Bromazepam
39
5
Biodroxil
83
Biofer
Bromhexin
4
Biogesic
Bromoform
Bromocriptin
72
Biphosphonat
88
3; 996
14
3
1
38
99
6
88
Biperiden
11
7
Broncast siro
98
1
1068
Tn thuc
Bisacodyl
Bromchathiol
008
Bisanthren
6
9
Bronchokod siro
09
Biseptol
99
6
Bronchocyst siro
97
Bisolvon
99
99
6
Brulamycin
Brulex
67
96
Bisoprolol
52
Bi - Spas
Bumetanid
86
Biphosphonat
Brumetidin
38
9
Budesonid
Befexamac
Buformin
Bupiridinic (thuc tr
8
tim)
9
Bupivacain
Buprenex
Buprenorphin
Burinex
Burnol plus
Candid B
1069
Candiderm
88
4
1
47
36
8
97
2; 973
Buspar
10
20
72
Buscopan
35
1
98
Buscomine
93
5
67
Bt nhn sm
93
5
18
Boehmite
46
6
38
B-Nalgesine
10
31
27
Blue-cold tab
13
3
51
Blue cap
91
6
024
Bliconol
36
8
09
Bleu methylen
20
6
09
Bleomycin
35
1
Bleocin
10
23
Canditral
88
4
Tn thuc
Buspiron
Canesten
47
Buston
4
9
Cao ng th
73
Butafen
Capcold
93
8
Captohexal
48
Butyrophenon (dn cht)
32
0
17
Butovent
88
10
32
Captopril
49
10
32
Captussin
93
8
Cc thuc loi cura
1
55
Ca C1000 Sandoz
Carbamat hoc thuc

tng t
4
Carbamazepin
8;39
Cafein
Carbimazol
Carbocystein
Carbophos
Carboplatin
Cardiosel
Cardipin
Cardivas
Carca
Caricin
49
9
Carlytine
100
84
7
1
61
85
2
63
Calcium
85
2
64
Calcitriol
27
3
07
Calcitonin
85
2
07
Calci polystyren sulfonat
21
8
32
Calciparine
96
7
Calci carbonat + Magnesi

9
carbonat
67
Calci nadroparin
99
6
61
Calci fluorid
97
7
73
Calci (mui)
16
7
59
Calanif
16
Carmustin
17
7
1070
Tn thuc
Calcium Corbire
Carotenoid
8;39
Calcium
vitamin
Corbire
Calcium folinat
38;
39; 1100
Carvedilol
Caryolysine
1
Cascara
10
08
Cataflam
63
Cal-C-Vita
90
9
097
Calco
85
2
4
5; 161
Calcivita
18
91
6
38
Catapresan
22
6
Cal-D-Vita
11
Caverject
58
00
Callimon
Cavumox
8
Calypsol
18
6
Cbmycine
66
Cebitex-C300
39
Ceclor
99
Campto
10
Canarif
24
Ceelin
Ceftazidim
8
Cefaclor
Ceftriaxon
Cefuroxim
18
6
Cefzone
83
Cefalexin
18
6
85
Cefadroxil
18
6
83
Cefadin
18
3
18
5
Cegrovit
38
Celaskon
38
Celestamine
36
84
Cefaloject
84
Cefaloridin
84
Cefalotine
1
84
1071
8
Celestone
36
8
Tn thuc
Cefalotine Panpharma
Celiptium
90
84
Cefamandol
9
1
Cenasert
10
89
Cefaperos
20
1
85
Cefapezone
Cenovis
Vitamin D
Calcium
Centrivit
Cepexin
Cephalexin
86
1
Cephalosporin
Cepodem
Ceporex
Ceporin
Cerlergic
Cerivastatin
Cervalit
Cetamol plus
Cetavlon
Cetirizin
Cetrimid
85
10
20
1
89
98
6
Cefotetan
10
20
89
Cefotaxim
92
7
89
Cefoperazon
14
3
89
Cefobis
10
40
85
Cefizox
98
6
86
Cefixim
18
4
85
Cefin
18
4
84
Cefetamet pivoxil
18
6
85
Cefepim
18
3;189
85
Cefzone
18
4
86
Cefazolin
18
4
Cefazime
44
;1099
85
Cefaxone
39;1097
;1099
84
Cefatrizin
16
1
Centovit
89
Cefapirin
&
Cetrine
98
6
1072
Tn thuc
Cefoxitin
Centrivit
44
Cevita
38
Chn alpha (thuc)
85
Cefpirom
86
Cefpodoxim
84
86
Cefradine
7
1
85
Cefrax
Chn
(thuc)
alpha
beta
85
0
Chn beta (thuc)
84
Cefrom
85
1
Chenodex
42
Cipramid
22
86
Chibroxin
10
Childrens Advil
2
9
Ciprobay
17
Chlorambucil
Ciprofibrat
09
Chlorammonic
Ciplox
Ciprofloxacin
Ciproquin
Cisaprid
Cisplatin
Citalopram
Clacef
Claforan
Clamide
91
1073
78
7
1
95
18
5
Cholinergic
18
5
86
Cholestyramin
22
2
86
Chlotride
21
8
18
Chlorthalidon
21
6
14
Chlorquinaldol
71
0
09
Chlorocid
71
0
33
Chlormethin
71
0
14
Chlorhexidin
32
2
8
Cloramphenicol
71
0
Clamoxyl
59
9
Tn thuc
Cholstat
Clar
040
Chorionic gonadotropin
9
3
Claranta
93
Chloroquin
Clari
Claricin
Clariom
Clarisol
Claritek
50
0
Clarithromycin
85
Cilazapril
49
9
19
8; 897
Cifex
49
9
26
Ciclosporin
49
9
032
Cibenzolin
49
9
032
Cibadrex
49
9
95
Cibacen
49
573;49
9;500
103
Clarityne
98
7
C-Flox
Clathrimax
Cleancef
500
10
Cilox
10
Cimet 200
Cledial
06
Cimetidin
Cleridium
Cleron
Clex
Clibite
Climen
Clindamycin
10
46
9
9
80
67
5
Ciplactin
78
7
10
Cinoxacin Denk
18
3
80
Cinoxacin
50
0
96
Cinnarizin
28
4
80
Cineol
51
1
06
Cinarizin
18
3
Clobutinol
88
3
1074
Tn thuc
Cipralan
Clofenac
26
Clofibrat
6
3
Codipront
23
Clomhexal
Codipront N
Coen
Co-eryc TNP
Cofdex
Cognex
26
6
Colchicin
Colchicine Hond
Cold cap F
Colden
Coldex
Coldagen
Coldagro
Coldaur
Coldfacon
Coldmin
Coldi
95
1075
93
7
6
14
93
9
Cloromycetin
93
9
96
Cloroquin phosphat
93
9
96
Cloroquin
93
9
33
Clorhexin
93
8
14
Clorhexidin
93
8
14
Cloraxin
93
8
83
Cloramphenicol
93
8
18
Cloracef forte
23
9
39
Clopromazin
23
9
80
Clopixol
80
5
00
Clorpheniramin
92
7
Clopencil
10
66
00
Clonidin
93
8
46
Clomipramin
92
6
84
Clomiphen
92
6
46
Clomaz
91
Coldi B
93
8
Tn thuc
Clorothiazid
Colecalciferol
11
86
00
Clorpropamid
Colestyramin
19
87
Clostilbegyt
Colfosceril palmitat
46
Clotrimazol
Collydexa
93
84
Cloxacillin
Colpormon
30
00
Cloxil
Colposeptine
30
00
6;418
Clozapin
Colpotrophine
30
34
Coadecoagen fort
Coltramyl
23
38
Coaltar
Combantril
68
14
Coandin
Combivent
94
27
Co-Barcine
Combutol
31
24
Codaewon
Comozol
88
28
Codepect
9
26;938
Comtan
92
Concor
Codein
14
3
85
6;996
Coderin
95
4
2
93
Conler F
93
Conflictan
Cromal
44
81
Contenton
Contratubex
Crysophanic
m)
8
4
(thuc
Cuprenil
07
Contussin
59
6
Cura (cc thuc loi
9
39
89
5
cura)
15
5
1076
Tn thuc
Convulex
Cuterpes
54
Copin tab
41
9
C-Vitamin Pharmavit
38
Cyclo-3 forte
38
Cyclophosphamid
26
Cordaron
4
Cordium
27
Corimol
Cycloserin
41
Corpril
24
9
Cyclothiazid
033
Corotrope
24
6
48
6
Cyclovax
36
Cyclovir
36
Cymevan
031
Cortebios
69
Cortibion
69
Corticoid khong
Cyproheptadin
41
Cortineff
Cyprodine
Cyproteron
Cyta
Cytarabin
Cyteal
Cytosar
90
9
Cytotec
97
Cotussin
23
3
97
Co-trimoxazol
90
9
023
Cotrim fort
50
0
1
Cotaformin
67
5
41
Cosmegen
98
0
52
Coryzal
98
0
68
Corvasal
36
3
68
2
Dacarbazin
39
Coversyl
033
1077
90
9
Tn thuc
Coversyl plus
Dactinomycin
Dafalgan
51
033
Covialler F
39
Cn cnh kin trng
Dafalgan codein
95
Cn khuynh dip
Daigaku
Daiticol
021
Cn opi
93
7;1023
98
1
Daktarin
29
Crestor
92
6
95
Cn iod
58
8
88
5
Daktarin emulgel
Daktarin Oral gel
040
Cristan
84
Crixan
Dallerrin
00
Crixivan
Dalacin C, T hoc V
Depersolon
Depo-Medrol
Depo-Provera
Depressan
Dequadin
Dequalinium
Deroxat
Desatura
87
12
5
5
73
59
1
Daphazyl
10
21
39
Daonil
10
21
27
Dantussin
96
1
51
Dantuoxin
67
6
51
Dantrolen
36
8
18
Dantrium
36
8
50
Danproxen
46
9;470
50
Danazol
93
9
21
Danatrol
88
5
Deseril
54
3
1078
Tn thuc
Dapson
Desferal
55
Dardum
6
1
Desfluran
89
Darob
Desmopressin
Desoxycorton
Desuric
Deticene
Debridat
55
1
Detriat
Devatran
Devicolgen
Devomir
Dexacef
Dexacol
Dexaclor
Dexambutol
Dexambutol INH
Dexamethason
Dexchlorpheniramin
06
1079
98
0
2
56
36
8;454
Deferoxamin
44
6
53
Defense F.C
31
3
39
Deep Heat
36
9
9
27;939
Deconal
36
9
39
Decolsin
18
4
88
Decolgen liquid
98
0
588;9
39;980
Decolgen Ace
93
9
83
Decolgen
55
3
39
Declor
10
66
82
Decamol
10
66
066
Deca-Durabolin
90
9
Debridat
12
5
015
DDS
24
1
20
Du parafin
25
7
20
Du c l hiu Con kh
10
02
65
Du c l Bo Long
25
Dexone
36
8
Tn thuc
Deflucold
Dexpanthenol
39
99
Dehanogen
Dexpin
39
Denoral
Depakine
Dex-tobrin
5
5
Dextromethorphan
54
9
Digoxine Nativelle
28
38
4
Dextropropoxyphen
Di-hydan
59
62
8
Diabinese
Dihydralazin Mesylat
87
96
1
Diacerein
Dihydrocodein
63
92
8
Diacerhein
Dihydroergotamin
63
30
2
Di-Actane
Dihydropyridin
53
27
2
Diafase
Dilatrane
33
82
8
Diamicron
Dilatrend
87
85
2
Diamox
Diltiazem
86
27
8
30
Dimedrol
6;675
98
1
16
Dimeglumin
gadopentetat
1
2
95
7
Dimenhydrinat
59
98
0
Dimetinden
28
Diazepam
92
7
Dextromoramid
Diaphyllin
25
8
Depamide
Di-antalvic
67
Dextran
54
Dianeal Low Calcium
92
7
9
29;939
Diane-35
10
98
0
Dinintel
79
17
1080
Tn thuc
Diazoxid
Dinoprost
64
Dibizide
Diosmectid
87
6
Dipadol F
44
9
Diphenhydramin
16
98
1
Dicloberl
Dipivefrin
16
93
6
Diclo-denk
Dipropyline
16
58
6
Diclofam
Dipyridamol
16
28
4
Diclofenac
Disopyramid
16
28
6
Dicloran SR
Distocide
16
64
7
Dicodin
Disulfiram
28
29
3
Dicold forte
Diurex
39
48
6
Dicortineff
Diurilix
48
6
Didanosin
Dobuject
68
94
7
Diergo-Spray
Doburil
03
48
6
Difflam
Dobutamin
15
94
7
Diflucan
Dobutrex
84
94
7
Difrarel
Dobuject
82
94
7
Digerent
Dodacin
066
1081
93
9
Diclac
38
4
96
7
Dicetel
Digoxin
68
60
0
Dofen forte
91
7
Tn thuc
Dogmatil
1
09
Dolarac
9
15
Dolargan
c
Botulinum
Clostridium
i khng
(dn cht)
0
morphin
ng Sulfododecanoat
9
natri
9
Drapolene
Drill
Droleptane
88
5
Droperidol
Drotaverin
Dudine
Dulcolax
Duphalac siro
Dng c trnh thai
Duscobane
Duspatalin
32
2
Duphaston
00
Dorocardyl
97
2
95
Dorobit
30
1
36
Dopram
10
18
26
Dophasmin
10
08
36
Dopharalgin
71
4
47
Dopegyt
58
6
88
Dopamin
14
9
85
Dopalgan
14
9
4
Doncef
99
6
Domedol
10
20
15
Dolodon
10
23
17
Dolnaltic
10
22
15
Dolgit
95
4
ng sulfat
9
29
Dolfenal
30
67
6
Durabolin
Duxil
Dydrogesteron
782
52
Dorogyne
73
Dorokit
73
84
8;1030
67
6
1082
Tn thuc
Dorolid
Dynacef
00
Doropycin
5
5
Dyrenium
00
Dospamin
47
9
Dysport
86
Dosulvon
18
30
0
96
Dotussal siro
927;
Eclaran 5
939
12
6
Dotoux
Econazine
39
Dotouxi
Econazol
27
Dotoux F
88
4
Edcophar
41
Doxapram
88
4
92
7
Edex A
Ednyt
58
95
Doxat
23
Doxi
Effederm
23
Doxorubicin
10
33
31
8
Effemol
Efferalgan
38
96
Doxorubicin Ebewe
96
Doxycyclin
8
23;824
Efferalgan-vitamin C
Efferalgan codeine
4
Epinephrin
Epivir
Eprex
Eprozinol
41
1083
88
2
9
87
11
03
Eftilora
45
6
37
Eftinasex
93
7
11
Effortil
92
6
0
Effexin
58
8
Epsitron
10
32
Tn thuc
Eftispasmin
Euquimol
86
Eldesin
6
9
Ercefuryl
10
Eldoper
70
57
1
4
78
Elisor
Ergotamin
040
Elitan
Ergocalciferol
09
Elliptinum
Ery
Eryacne
18
2
Erybacsultrim E v F
Erybact 365
Ery-Becotrim
Erycin
Erycotrim
Eryderm
Erylik gel
Erymetazol
Erysulprim
Erysulprim F
Erythrocine
84
49
9
2
46
10
66
Endoxan
10
66
84
Endix-G
10
66
033
Encodex-G
49
9
033
Enam
49
9
032
Enalapril stada
10
66
93
Enalapril
49
9
55
Eminase
10
66
81
Emeset
10
66
10
Emedastin
10
66
81
Emcyt
49
9
33
Emadine
49
9
Eludril
11
00
09
Eloxatin
30
2
Erythromycin
49
9;1066
1084
Tn thuc
Enervon C
39;
Erythromycin Domesco
1099
Enfluran
9
1
Erythropoetin
002
Enoxaparin
Enoximon
Ery-Vicotrim
Esmeron
Esperal
Estraderm TTS
Estradiol
71
9
Estramustin
Estriol
Extencilline
Eyeton
10
97
Facolgen
05
Estreva gel
05
Estulic
Ethambutol
Fadin 40
Famonit
Famotidin
Fansidar
Fas-3 Kit
76
57
3
3
14
69
5
Ethosuximid
71
4
06
Ethisteron
71
4
06
Ethinyl oestradiol
71
4
13
Ethinyl-estradiol
93
9
27
1085
60
0
06
(thuc
30
6
05
Estrogen lin hp
91
0
36
Estrogen
30
5
36
Ephedrin HCl
30
5
Ephedrin
29
3
43
Entero-Cap
15
6
16
Entacapon
10
67
031
Enoxolon
11
03
07
Estro-progestogen
nga thai)
49
Fasigyne
57
3
Tn thuc
Etifoxin
Fastum gel
059
Etilefrin
7
9
Fazol
37
88
4
Etodolac
Febret
16
91
6
Etofenamat
Feemnil
17
93
9
Etomidate
Feldene
99
91
9
Etoposid
Felodipin
10
27
2
Etretinat
Felxicam
17
loi)
91
91
9
Eucalyptol (Du gi cc
Femaxx
44
20
Eucalyptine
Eucalyptine Le Brun
3
21;996
Femic
3
21;926
Fenbid
Eucarose
91
7
Fenistil
21
98
1
Eufineron
Fenofibrat
82
32
3
Eupnerol
Fenofibrat Bayer
82
32
3
Euquimol
Fenofibrat MSD
06
Europerol
91
5
32
3
16
Fenoterol
94
7
Euthyrox
Fenoverin
14
Evra
Fenoxazolin
06
Examin
32
2
93
7
Fenproporex
79
99
Exifine
8
14;895
Fenspirid
88
2
1086
Tn thuc
Exluton
Fentanyl citrat
76
Exoderil
8
8
Fenticonazol
95
Exomuc
88
4
Fenxicam
96
Extraboline
92
91
9
Ferlin
Flumequin
44
82
Ferovit
4
Ferral
Fluimucil
025
Ferronat
Flumazenil
025
3
Flunco
Fludrocortison
Fluocalcic
Fluor
Fluorescein natri
Fluorescein
Fluoro-5-Uracil
Fluorouracil
Fluorure calcium
Fluoxetin
Fluvoxamin
73
1087
34
3
1
55
33
7
Flaxedil
33
2
73
Flagyl
33
3
102
Flagentyl
33
3
25
Filgrastim
33
2
25
Finasterix
33
2
25
Finast
33
2
22
Finasterid
33
2
26
Fibrat
36
8
86
Fiboran
88
4
87
Fexofenadin
33
1
8
Fexofast
99
6
Fervex
71
0
Fluxum
40
8
Tn thuc
Flavoxat
Fluothane
26
10
02
Flecaine
Flupentixol
26
83
8
Flecainid
Fluphenazin
26
61
8
Flixonase
Flurbiprofen
69
91
7
Floctafenin
Fluticare
29
36
9
Flixotide
Fluticason
69
36
9
Flospar
Fluvastatin
78
10
40
Floxyfral
Fluvermal
43
11
6
Fluanxol
Foban
Focus
47
38
Fluanxol LP
38
Flubendazol
Foncitril
16
Fluconazol
57
Fonlipol
6
Forane
Forlax
Formestan
Fortalgesic
Fortax
18
5
Fortrans
86
Fortum
92
9
68
Fluidil
91
0
96
Fludrocortison
10
18
86
Fluditec siro
10
02
30
Fludex
96
6
6
Flucytosin
99
0
3;884
Flucort-N
91
9
10
18
Gardenal
99
86
1088
Tn thuc
Fosamax
Gasmodin
38
Foscarnet
4
3
Gastrofulgite
48
Foscavir
Geldene gel
Gel-patch
Gemfibrozil
Genefadrone
91
0
Genertam
5
Framycetin
32
3
85
Frakidex
75
3
50
Fotaran
91
9
50
Fosfocina
96
6
48
Fosfomycin
71
60
0
Genoptic liquifilm
Genspar
65
5
Fraxiparine
07
Frekacid
77
8
Gentagram
65
Gentacyne
65
Gentamicin
65
Gentamycin
66
Gentobra
67
Gerel
021
Fucicort
7
Fucidin
7
Fucithalmic
7
Fucon
72
Fudikin
7
Fugacar
Geriton
17
Fugacar choco
Ginsomin
Givalex
99
1089
10
24
8
3
89
7
Fungizon
89
7
17
Fulsed
76
5
Glibenclamid
78
7
Tn thuc
Fungazol
Glibenhexal
84
Fungicide
7
8
Glibenese
84
Funginoc
Gliclazid
78
7
Glidabet
51
Fusafungin
78
7
84
Furosemid
78
78
7
Glipizid
63
78
7
Gliquidon
78
7
Gabrene
Glucantime
Glucagon
87
73
Gaiacol
96
Galepo
Gluco C
097
Gallamin triethiodid
Glucocorticoid
Glucofine
Glucophage
Glucotrol XL
Hadocolcen
Hadocold
Hadocort
Hadocort D
Hadocort H
53
94
1
3
84
94
1
Glycosid tr tim
94
1
018
Glycol salicylat
93
9
79
Glycerol
93
9
97
Glutethimid
78
7
87
Glutathion
13
4
97
Glurenorm
13
3
63
Ganidan
36
7
67
Ganciclovir
38
;39
55
Gamaxcin
36
6
Hadophar
10
22
1090
Tn thuc
Glypressin
Hadozyl
13
Gonadotropin
nhau
thai
3
39
Hadosena
Gonadotropin
tnh FSH
57
92
7
hot
Halofantrin
94
Gopten
40
4
10
Halfal
33
40
4
Gm sterculia
Haloperidol
008
Granisetron HCl
Halothan
55
Grepafloxacin
H xa i to hon
78
3
Helicocin
Helmintol
Helmintox
Hemoclar
Hemoxal
Heparin
40
7
Heparin tng hp
73
Gynapax
93
8
73
Gynalfin
41
1
73
Gynekit
68
4
97
Gylmycin
11
7
27
Guanidine
59
9
98
Guanfacin
89
8
94
Guanethidin
10
02
Griseofulvin
15
0
41
1
Hepatoglobine
Heptaminol
45
023
Gynavit
097
Gynopar
Heptamyl
023
Gynefix
Heptylat de testosteron
01
1091
78
3
3
06
41
1
Gynera
41
1
Herperax
36
Tn thuc
Gyne-T200
Herpevir
36
Herpex
36
Hetamintox
01
Gynocal
022
Gynoxa
022
Gyno OPC
Hexabrix
022
Gyno-Pevaryl Depot
Hexamethonium
Hexamidin
Hexapneumine
3
9
Hydrea
Hydrochlorothiazid
Hydrocortison
Hydrocortison - Richter
Hydroperoxyd
Hydroquinidine
Hydroxycarbamid
Hydroxy estron
Hydroxy cloroquin
89
6
8-Hydroxyquinolein
12
41
8
2
06
30
6
87
Histodil
91
0
86
Histamin
69
6
14
Histalor
10
25
06
Histalong
36
7
17
Histac
36
7
95
Himetin
48
6
99
Hildene
91
0
024
Hifen cream
10
24
09
Hiconcil
93
8;1024
Hexaspray
Hexetidin
10
24
Hexastat
89
8
022
Hacyclor
95
7
84
Gynosol OPC
68
4
Hydroxyzin
10
59
1092
Tn thuc
Hivid
Hydrotalcid
103
Ho long m (vin)
7
9
Hyoscine butylbromide
29
Holoxan
Hyoscyamin
97
2
39;45;109
7;1099
Hygroton
897
Hyperium
Homtamin
Ginseng
97
2
46
Homtamin
96
48
6
22
7
Hopace
Hyperstat
033
Hopranolol
Hypnovel
52
Hormon chng li tiu
26
4
99
9
Ibacitabin
13
Hormon tng trng
14
Hormon tuyn gip
Ibuprofen
14
Hotemin
Icavex
hu
Huyt thanh khc loi c
Icool
Idarax
Idoirac
Huyt thanh chng un
rn
Idrocilamid
Idoxuridin
Iduviran
Ifenprodil
044
1093
84
7
4
32
41
9
Humulin L
41
9
18
Humoryl
41
9
18
Huyt thanh chng nc
91
5
18
vn
32
9
18
Huyt thanh chng di
93
7
18
Huyt thanh chng bch
84
7
023
hiu
91
7
19
H nc
41
9
Ifosfamid
24
6
Tn thuc
Humulin N
Igatan
Igol
38
32
Humulin R
32
Humegon
Ikaran
94
1
Intralipid
83
8
Intralipos
66
1
Intralotine
033
Imidazobenzodiazepin
Intron A
31
8
Invirase
02
6
Iod
00
8
Iod (cn)
02
10
21
Imodium
Iopromid
78
95
7
Imovane
Ipobroman
059
Importal
1
t
91
0
Iproniazid
018
10
50
Iridina Due
20
93
7
Irifone
21
91
7
Irizele inf
57
3
Irinotecan
91
0
Isapgol (v ht cy)
86
10
08
4
21
10
21
Imitrex
Indinavir
76
2
Imipenem
Indapamid
43
7
Imigrane
Incital
18
4
Imurel
47
2
Imidapril
Immunoglobulin ngi
47
2
Imdur
khng
30
3
Ilclor
Immunoglobulin
bo lympho
10
09
Iskedyl
84
8
1094
Tn thuc
Indocid
Ismelin
25
39
8
Indocollyre
ISMN
25
86
5;866
Indomethacin
Ismo
25
Indom Collyrium
Isoconazol
25
Indoramin
Isofluran
10
02
Iso Mack
6
Inflamide
88
4
47
Infectoflam
86
6
86
5;866
Isomeride
Isoniazid
79
68
Inocor
031
Insulin
Isoprenalin
32
Isradipin
Isoptin
Isoptin SR
Isosorbid dinitrate
Isosorbid mononitrat
Isotretinoin
Isotrex
Isradipin
Isuprel
Ketamin
93
1095
99
9
8
84
94
8
Itraconazol
27
2
18
Itax
31
8
18
Intetrix
31
8
42
Intermeciam
86
6
57
Interleukin
86
5;866
37
Interlansil
10
76
37
Interferon 2A
10
76
37
Interferon alpha
94
8
72
Interferon
44
6
Ketoconazol
88
4
Tn thuc
Itrazoline
Ketof siro
85
Iyafin funior siro
1
9
Ketofen
41
Izac
98
91
7
66;
72;454
Ketoprofen
91
7
Ketotifen
98
1
Jolid
Ketorudis
52
Josacine
Kezole
00
Josamycin
88
5
Khuynh dip (siro)
00
Jumex
91
7
92
9
Kidrolase
89
045
Justor
1
032
Kim ho nc tiu
(thuc)
0
Kimite
99
97
3
Kaleorid
Kinurea-H
Kirin
Klacid
960
52
Kalfoxime
67
85
Kali Clavulamat
99
Kali clorid
Klacid MR
52
Kali Iodid
Klion
Klion Metro
Klox
60
0
Kogin
00
Karezon
57
3
023
Karazon-S
57
3
90
Kali permanganat
50
0
52
Kali citrat
50
0
89
7
Komix
48
89
1096
Tn thuc
Kayexalate
Komix siro
64
KD=Unase
9
9
Kotocol
93
Kefadin
93
93
8
Kupramickin
Kykaklox
65
86
Kefenin
17
Keflex
Kytril
84
Keflor
60
0
95
5
Labetalol
83
Km oxyd
023
Km sulfat
0
1
Lacidipin
023
Kenacort retard
Lacipil
Lacrypos
Lactiol
Lactulose
Lexomil
11
7
Lidocain
56
Lan-30
10
18
8
14;895
Lamivudin
10
18
99
Lamisil
10
23
17
Ketalar
27
2
84
Keprofen
27
2
68
Kenazon
85
46
6
Likacin
Lipur
65
57
Lanprasol
57
Lanprazol
Lincocin
57
Lansec
1097
4
57;573
46
9
Lincomycin
57
Lansoprazol
32
3
46
9
Lincople
46
9
Tn thuc
Lansoprol
Lincosamid
57
Lansotop
9
4
Lindan
57
Lansotrent
Linopril
Linoritic forte
10
33
Linoritio forte
18
Lariam
10
33
57
Largactil
10
31
57
Lanzap
46
48
6
Lioresal
95
Liothyronin
41
06
Laroscorbine
9
Lasilix
5
3
Lipanor
51
Lasix
Lipanthyl
51
Lasonil
Lipavlon
4
8
Lipid (nh dch tim

truyn)
2
Lipitor
65
Lenitin
Liprobay
Lipur
Lisinopril
Lisoril
102
10
Listril
14
10
33
4
5
48
6;1033
33
Leucovorin
32
3
040
Leucomycine
10
40
34
Leucomax
10
40
Lescol
10
Lipovas
10
Leponex
47
40
17
Lentaron IM
32
3
57
Lenitral
32
3
11
Lasoprol
32
2
Lisurid
14
3
1098
Tn thuc
Leukeran
Lixusine
10
09
Levobunolol
25
8
Lithium carbonat
47
52
Levodopa
2
4
Lobacin
60
Levomepromazin
66;72;
454
Locabiotal
36
18
Levothyrox
3
4
Locacid
31
14
Levothyroxin
8
4
Lodimax
27
14
Levotonine
2
5
Lodine
91
84
Logimax
6
2
Li tiu thm thu
49
72
Lokit
8
5
Lubentyl
10
78
Lomaday
15
7
Lc thn thu
92
10
Lomac
9
5
Lucidril
78
Lomedium
Lutenyl
78
Lomexin
Lutocyclin
Lybutol
Lycortin-S
Lydic
Lyfaxone
Lyforan
78
1099
18
5
1
032
18
6
Lopril
91
6
61
Loperamid
36
7
96
Lonotan
31
3
61
Long no nang mm
67
6
72
Loniten
67
6
84
Lomir
102
8
Lykacetin S
61
4
Tn thuc
Loprofen
Lykadex
18
Loratadin
7
9
Lykaklox
87
Loratin
Lykalidin
Lyka-lydox
Lykamidil
Lykamilox
Lykamox
6
9
Lymphoglobulin
Lynamide
Lynestrenol
Lypressin
Lyproquin
Lysenyl forte
Lysin acetyl salicylat
Lysopaine
Lysozym
Lysurid
14
3
Lu hunh
18
Loxoprofen
45
4
39
Loxfen
45
4
39
Loxapin
75
3
6
Loxapac
14
3
07
Lovir
71
0
040
Lovenox
41
3
78
Lovastatin
67
6
78
Losec Mups
68
5
86
Losec
42
0
78
Lorvas
59
9
87
Lormide
27
2
Lorinol
88
4
95
Lorinden - N
82
4
87
Lorinden A
71
4
41
Lorfast
60
0
87
Loratin D-Sinus
92
49
8
18
1100
Tn thuc
Li tiu gi kali
Maalox
79
Li tiu thi kali
Macgel
86
4
Maxitrol
54
1
Maxmox
018
Macrolid
Mazipredon
M-Cam
73
5
Mebendazol
10
5
Mebeverin
10
5
Mecam
10
Mecamylamin
51
Meclofenoxat
Magnesi lactat
10
28
Medamarin
10
Magnesi sulfat
89
8
0;967
45
7
Medgen
10
93
9
5
10;967
Mediatensyl
84
8
Mediator
67
96
6
Medicaine
57
93
7
Medicefa
10
Majeptil
91
8
5
10;967
Magnomint
32
2
Magnesi (mui)
Magnevist
11
7
Magn - B6
Pellegrino
91
8
Magie B6
Magnesia-S
36
8
Madiplot
Anis
59
9
99
Magnesi trisilicat
45
4
Macrogol 4000
Magnesi hydroxyd
51
0
Maxitrol
Magnesi carbonat
51
18
4
Mediclovir
Medicol
36
19
Mandol
89
1101
92
7
Tn thuc
Manidipin
Medicoldac
73
Maninil
Medifoxamin
87
51
1
Manitol
Medocephine
98
Mannitol
93
18
6
49
8;1018
Mantadix
Medoclor
18
3
Medofadin
71
4
Marcain
Medomycin
66
82
4
Marie Rose Suractive
Medotam
93
10
28
Marsilid
Medovir
Medoxicam
36
050
Marvelon
06
Mastu S
84
Medrol
6;916
Mastu S forte
Matader
Medroxyprogesteron
Mefenamic
Mefenix
Mefloquin
Meglucon
Meglumin amidotrizoat
Meprobamat
16
4
Mequitazin
57
61
9
9
57
95
7
Meglumin toxitalamat
13
3
84
Meglumine dung dch
70
6
097
Meglumin antimoniat
91
5
09
Max-Go Lutein
91
5
27
Maxdotyl
67
6
82
Maxcom
36
8
46
Maxipime
91
8
Mequinol
70
6
1102
Tn thuc
Meglumine telebrix
Merbromin
57
Megyna
23
5
Mercaptopurin
73
Meko-Allergy F
Mercilon
Mercurobutol
Mercryl Lauryl
Merislon
Mesterolon
84
9
Mesulid
Metabol
Metforal
Metformin
Methadon
Methenamin
Methergin
Methorphan siro
Methotrexat
Methoxsalen
5-Methoxypsoralen
19
1103
96
0
9
18
96
0
Melobic
52
8
18
Melleril
92
7;939
60
Melgesic
10
29
94
Meladinine
52
7
54
Menotropin
52
3
73
Mekotricin
13
3
39
Meko-Tigyl
13
4
96
Mekotamol
78
2
07
Meko-Sulfableu
91
9
00
Mekoquinin
78
2
26
Mekopen
13
3
Mekodin
10
23
84
Meko-Cepha
10
23
83
Mekocefal
30
6
024
Mekocefaclor
91
;518
39
Mekoblue
10
Methyldopa
53
6
Tn thuc
Mel OD
Methylergometrin
18
Melogesic
29
9
Methyl Gag
18
Melomax
Methyl Prednisolon
Methyl salicylat
Methylthiouracil
Methysergid
Metizol
18
9
Metoclopramid
Metohexal
Metopimazin
Metoprolol
Mitomycin C Kyowa
Mitoxantron
Mivacron
Mivacurium
Mizolastin
Mizollen
MK-Actitab
85
94
1
8
85
98
7
Micozal
98
7
85
Micostat
15
6
47
Miconazol
15
6
63
Mianserin
91
0
45
Miacalcic
91
0
88
Mexiletin
85
2
73
Mexcold
61
9
78
Metronidazol
85
2
78
Mepraz
10
9
21
Meprasac
97
7
95
Mentholatum
54
3
Menthol
97
7
16
Melwin
75
3
18
Melphalan
36
8
18
Meloxicam
91
0
18
Melonex
10
MK-Cloroquin
89
6
1104
Tn thuc
Microclismi gel
ML Cu
018
Microlax
2
1
Moclobemid
018
Mictasol blue
Mobic
91
8
Modafinil
73
Midazolam
10
44
52
7;1024
Midazol
30
55
1
99
Modecate
61
8
Mifegyne
Moderatan
79
Modiodal
55
50
Mifepriston
50
Mikin
1
6
Moditen
5
Minakin
Modopar
5
MK-Actitab
Moduretic
Modustatine
Mofen
Molgramostim
Molsidomin
Moniphens
Monocinque
2
9
Monofluorphosphatdisodic
1105
85
2
4
32
33
2
Montebloc
61
Mixtard
86
5;866
57
Minoxidil
86
5;866
87
Minirin
55
2
41
Minidiab
11
02
15
Mineralocorticoid
91
7
4
Minalfene
57
6
031
Milurit
48
6
06
Milrinon
46
0
41
Mekrofollin forte
61
8
Monurol
35
0
Tn thuc
Misoprostol
Moriamin forte
82
Miten 400
;1097
1
Morniflumat
17
Mithracin
Morphin
Morphin hydroclorid
Motrin
Moxadil
Nalone
28
5
Naloxon
Nandrolon
Nandrolon decanoat
Naphacogyl
57
3
Naphacollyre
009
Mucomyst
78
2
77
Mucinum
78
2
47
MTU
95
5
78
Moxisylit
95
5
99
Moxifloxacin
90
0
Moxiclav
91
7
10
Moxcontin
92
8
10
Mitomycin
92
8
10
Mitoguazon
91
8
10
Mithramycin
45
93
7
Napharax
Naphtazolin
36
96
Mui
khun)
kim
loi
(st
022
Muromonab CD3
Naproxen
52
Muxystine
Narcan
95
5
Nasivion
13
Mycoheal
91
8
96
Mycobutol
93
7
93
8
Natalvit
Natri bicarbonat
45
85
Mycospor-Onychoset
83
96
7
1106
Tn thuc
Mycosyst
Natri chlorid
84
Mytob
25
6
Natri citrat
7
My-Vita multivitamin
99
0
Natri docusat
9
My-Vita vitamin C
10
10
14
Natri fluorid
33
2
Natri hydrocarbonat
96
7
Nabuflam
Natri laurylsulfoacetat
18
Nabica
Natri meglumin
67
Nabumeton
10
18
95
7
Natri stibogluconat
Natri valproat
87
18
Naclof
16
Nadolol
Natulan
52
Nadroparin
Natussal siro
Nautamine
Navelbine
Navoban
Necovo
Necovon
92
7
Nedelin
28
Naligram
92
7
86
Nalbuphin
95
6
53
Nakaxone
91
1
95
Naftilux
98
1
53
Naftifin
92
8;940
32
Naftidrofuryl
66
5
07
Naf
55
4
93
7
Nedocromil
Negaflox
44
09
Nalline
54
1107
71
0
Tn thuc
Nalorphin
Negram forte
54
Nelfinavir
9
5
Nhun trng
1008;1014;1
(thuc)
015;1018
Nh dch du u tng
tinh ch
72
61
Nelticin
6
Neltolon
Nha hc n
83
Nemydexan
Niaprazin
Nibiol
26
9
Nicardipin
Nicergolin
Nicol - fort
Nicorandil
Nicotin
Nicotinell TTS
Nidol
Nidrel
Nifedipin
Nifehexal Retard
27
3
Niflugel
19
91
5
9
61
27
3
28
Neoxidil
27
3
6;573
Neotica
93
9;940
16
Neo-Terpin
56
6
Neo-Tergynan
56
6
6;72
Neo-Pyrazol
56
5
6;72
Neomycinum
92
6
77
Neomycin Diaman
84
8
27
Neomycin
27
3
6;369
Neo-Mercazol
57
6
19
Neogodian DM
61
9
Neodexa
56
4
Neodene
10
Nha trao i cation
27
Neo-Codion
29
6
Neo-coadon
70
Nifluril
91
5
1108
Tn thuc
Neo-Zengynan
Nifluril vin t
Nepressol
Nifuroxazid
61
Nesdonal
Netilmicin
Nifurzid
Nilutamid
56
7
Netromycin
Nimegesic
91
9
Neuleptil
Nimerid
19
Neumomicid
Neupogen
Nimesulid
Nimetab
Nimfast
Nimica
Nimodipin
Nimotas OD
Nimotop
Nimovon MD
Nipent
Nortussin siro
Norvase
69
Nise
27
Norvase
19
27
3
2
73
92
7 ;938
3
Nisoldipin
60
9
61
Niridazol
91
9
67
Nipride
27
3
98
Magnesi
91
8
98
Nhn sm hi m
27
3
98
Nhn sm tam tht
91
8
06
Nhn sm lc nhung
91
8
66
New-Choice
91
8
10
New-Diatals
91
8
102
Nevamycin
91
8
00
1109
57
1
57
1
97
Nhm
hydroxyd
91
Norvir
73
4
Tn thuc
Nitrendipin
Noscapin
73
Nitroderm TTS
8
8
Nos-Bra
65
Nitrofuran
Nospa
Nostravin
Nitroimidazol hoc dn
Noten
Novantrone
Novo-Butazone
65
8
Novo-Cloxin
Novo-Furan
Novogyl
Novo-Loperamid
Novo-Medopa
Novo-methacin
Novomycine
Novo-pranol
Novo-Sorbide
Novo-Triptyn
Novynette
12
30
7
8
12
90
0
Nolvadex D
86
6
84
Nolvadex
85
2
83
Nofung
50
0
85
Nockwo-Cefaclor
42
5
14
Nizoral
53
6
19
Nizatidin
47
8
96
Nivolid
57
3
76
Nivaquine
57
1
61
Nitroxolin
60
0
61
Nitroprussid (sodium)
68
7
65
Nitropress
91
0
Nitromint
85
1
73
Nitro Mack
94
1
65
cht
58
6
71
Nitro glycerin
58
6
71
Nitrofurantoin
92
Nozinan
61
8
1110
Tn thuc
Nomegestrol
Nubain
76
92
8
Non-Spas
Nucofed
86
92
6;941
Nootropyl
Nuril
028
Nopron
10
33
Nutri Ginsen
19
89
7
Nora
Nutroplex
85
10
97
Norcepin
Nyolol
10
85
2
Norcuron
Nyolol gel
56
85
2
Norgalax
Obimin
014
Normacol
009
Norfloxacin
Ocid
10
57
8
Octreotid
Opi (cao)
76
92
9
Ocufen
Opiterpen
17
92
9
Odasol
Opi terpin
78
Odrik
45
;1097
92
9
10
Opizoic
33
92
9
Ofan-Timolol
Opssi Multivitamin
Opta
40
52
Oflocet
11
Oflovit
91
6
Opticron
44
Oracefal
18
11
Ofloxacin
10
Ofus
7
11
1111
4
Orafar
32
1
Tn thuc
Okacin
Oramin
45
Orange Multivitamin
40
Orap
10
Oligosol P
44
Olit -20
78
83
9
Olopatadin
Orthoclone OKT
87
55
2
Omeli
Orelox
41
18
6
Ome-20
Ornidazol
78
57
3
Omenat
Oropivalone
78
45
4
Omefloxacin
Osetion
Osetron
10
Omepar
78
Omeprazol
57
Ospamox
3;578
Omeral
95
6
59
9
57
Ospen
60
0
Omez
Ospexin
78
Omicap
Osteofluor
78
Omizac
18
4
33
2
Ortenal
Otecpin
79
79
Omniflox
78
OMP
Otdin
79
Omzol
Oterben
Otilin
55
93
8;941
7
10
92
9
Opecipro
94
1
79
Ondansetron
92
9
Otipax
61
3
1112
Tn thuc
Opcon A
Otrivin
37
Opekacin
1
6
Ovestin
5
Opeclacine
Oxacillin
Oxaflozan
Oxaliplatin
Paroxetin
Patanol
19
5
Patitussin
Paverid
Pavulon
15
6
Paxeladine
37
Oxytocin
58
6
26
Oxymetazolin
32
1
19
Oxy 5 v Oxy 10
98
7
84
Oxomemazin
59
1
Oxitriptan
21
8
83
Oximezin
58
1
57
Oxeladin
60
0
84
Opelansol
30
6
00
Opedroxil
94
88
3
Paxirasol
85
99
6
Pectin
84
7
Pacodal
Peflacine
26
Padolgen
Pefloxacin
40
Padol plus
Peflox
Pelox
Penicillamin
28
1113
59
5
6
46
71
1
PAM v PAM-A
71
1
40
Palfium
71
1
40
Pafemin
71
1
Penicilin
59
9
Tn thuc
Pampara
Penicillin G benzathine
46
Pamidronat
0
1
Penicillin V
38
Panacef
Pentacarinat
Pentagastrin
Pentamidin
Pentavlon
Pentazocin
84
1
Pentothal
Pentosan Polysulfat
Pentostatin
Pentoxyfylin
Pepcidine
Peptavlon
Perfalgan
Perfane
10
31
Pergolid
26
Paraplatin
58
8
26
Paracodein
60
4
87
Paracetamol-codein
71
4
86
Paracetamol
61
1
54
Papaverin
60
9
099
Papain
41
1
26
Pantogen
99
7
40
Panoxyl
92
9
56
Pandol plus
60
4
Pancuronium bromid
60
5
97
Pan-Cefalotin
60
4
84
Panaxia
60
5
88
Panatel
60
0
83
Panadol
60
14
3
Periactone
Perindopril
18
Paregoric
29
Parnaparin
33
4
08
10
Periset
95
6
1114
Tn thuc
Permethrin
Pimozid
93
Peristil
9
2
Pinaverium bromid
16
Peritol
Pipecurium
Piperazin
Pipolphen
Piportil
Pipothiazin
29
8
Piracetam
Piriactone
Pirapyl
Piribedil
Piroxicam
Pizotifen
Plaquenil
Plastenan
Platinex
Plendil
Plendil ER
96
1115
27
2
6
18
27
2
Phenothiazin
21
8
9
Phenol
89
9
81
Phenobarbital
89
6
14
Pheniramin
98
1
6
19;981
Phenicol
91
9
13
Phenergan
64
6
97
Phenazon
10
28
97
Pharmax G2
98
0
89
7;1097
Pharmax
10
28
020
Pharmaton
61
9
97
Pharmatex
61
9
Pharmagin plus
61
9;981
85
Pethidin
64
5
089
Petcef
15
6
43
Pervincamine
64
4
80
Permax
83
Plenyl
45
Tn thuc
Phenothrin
Plentiva
93
Phenoxymethyl-penicillin
6;676
6
Plussz Multivitamin
00
Phenylbutazon
30
40
;45
Plussz junior
45
Plussz vitamin C
39
Pneumorel
87
Phenylephrin
38
Phenyl Hg borat
023
Phenylpropanolamin
Podophyllotoxin
38
Phenytoin
Polaramine
28
6
Polcortolone
Polery siro
Policresulen
Polidocanol
Polipirox
91
9
Pologyl
44
Phosphore Sandoz
96
0
44
Phosphor
10
25
67
Phosphat v c
92
6
8
Phosphalugel
36
8
29
Phosofrome
98
0
87
Pholcodin siro
91
0
Phetadine
88
2
57
3
Polyamine forte
Polycyclin
45
44
Pilocarpin
95
Polydeson
Primalan
37
Polydeta
Primidon
64
8
Primperan
37
Polydexa
61
9
37
Polydelzal
82
4
66;4
54;938
10
9
Pristinamycin
804
1116
Tn thuc
Polydoxancol
93
Probenecid
66
0
Polygynax
Probitor
6;454
Polymax
Procarbazin
37
Polymyxin
Pro-dafalgan
Profenid
Profenid gel
Profenid LP
14
3
Propofol
Profol
99
9
Progabid
15
Potassium chloride
99
9
37
Ponstan
91
7
9
Polyxacol
91
7
Polytonyl enfant
91
7
54
Polytar
58
8
54
Polypeptid
66
5
54
Polymyxin B
57
9
67
3
Progara
Progestasert
66
52
Povid
021
Povidin
Progesteron
021
Povidon-iod
Progestogel
6
cht
1
Progestogen hoc dn
Prograf
Proleukin
Prolixan
53
1117
91
5
6
47
44
2
Praziquantel
80
7
040
Praxilene
67
5
040
Pravastatin
67
5;676
46
Pravachol
67
6
021
Pralidoxim
30
2
Promegeston
67
6
Tn thuc
Precyclan
Promestrien
30
64
Predian
6
7
Promethazin
Promin
Propafenon
61
9 ;981
87
Prednison
45
68
Prednisolon
67
68
Prefamone chronules
9
7
Propericiazin
61
9
Pregnyl
9
3
Propine
93
93
Prempak
6
3
Propranolol
85
06
Prepulsid
2
2
Proprofol lipuro
99
16
Prevacid
9
4
Propylthiouracil
97
57
Previt
7
4
Proscar
32
5
Prostaglandin chng lot
5
6
Questran
19
82
Prostaglandin trong ph
khoa
1
6
Quinapril
10
82
Prostin F2 Alpha
33
6
Quinidin hoc dn cht
82
Protamin
Quinidurule
69
83
Prothazine
6
6
Quinin
96
19
Protimol
0
9
Quinin hydrochlorid
40
Protimol F
Quinin dihydrochlorid
Quinin ethyl carbonat
065
70
6
5
79
70
7
Protoloc
70
7
40
Protirelin
69
6
Quinin
tng t
hoc
thuc
70
6
1118
Tn thuc
Provironum
Quinin sulfat
82
70
7
Proxalyoc
Quinolon
19
70
9
Proxen
Quinolox
18
71
0
Prozac
Quinoserum
37
70
7
Pryde
Racef
16
Pseudo-ephedrin
40
Psoraderin - 5
Ramipril
60
9
Ranitidin
28
9
Rantac
40
5
Rapifen
18
1
Raubasin
95
57
Raxar
45
Razogyl
8
R-Cin
Reclide
Recofor Lipuro
99
9
Recormon
85
11
03
Recotus
87
1119
78
7
84
92
8
6
93
72
4
84
Pyreflor
57
3
04
Pyrazol
77
8
7;573
Pyrazinamid
84
8
3;579
Pyrantel pamoat
92
6
P.V. Carpine
Pyrantel
71
4
Purinethol
Pyostacine
71
4
Pultissin
Pylokit
10
33
Pulmofar
Pylobact
18
5
Red Kogin
89
8
Tn thuc
Pyrethrin
Regaine
93
96
1
Pyridoxin
Regulon
93
30
7
Pyrimethamin
Rencid
95
96
7
Renitec
10
33
Quamatel
Rennie
14
Renova
Roaccutane
18
3
Rocaltrol
18
11
00
Retrovir
Rocephine
105
Revigin
18
6
Rocgel
97
96
7
Revigin Ginseng Plus
Rocuronium
15
6
Rheomacrodex
Rodazol
58
57
3
Rheumon
Rodogyl
17
50
0;573
Rhicap
Roferon
40
43
7
Rhinafed
Romesec
41
57
9
Rhinarin
Ropril
37
10
32
Rhinex
Rosampline
37
59
9
93
Rosuvastatin
8;986
Rhinopront
31
8
Retacnyl
Rhinil
96
7
10
40
93
Rotaforte
57
3
Rhinotussal
9
38
Rovamycine
50
0
1120
Tn thuc
Rhisolin
Rovazol
37
Rhumenol D500
3
92
Rouvax
8;940
Rhumenol NF
57
10
70
94
Roxitacin
0;980
Riboflavin
Roxithromycin
099
Ricridene
50
0
Rulid
71
Rifabutin
50
0
50
0
Rutin C
39
Ru
74
16
Rifacin
24
Rifadin
3
7
Ru thuc (cc loi)
Rythmol
24
Rifampicin
24
Rigenox
67
9
Rytmodan
79
Rigevidon
74
3 ;744
28
6
Sabril
07
Rilmenidin
27
Rimebutin
Sacnel
066
Rimifon
10
85
49
8
Saferon
Saizen
45
46
Rimpin
24
Ringer lactate
Salazopyrine
52
Risordan
Salbutamol
Salbuvent
45
1121
94
8
7
34
94
8
Ritonavir
80
0
66
Ritalmex
41
4
Salicylat (dn cht)
75
3
Tn thuc
Salicylic acid
Selegilin
53
Salonpas
10
45
Selemycin
Senna
65
53
Salonpas liniment
53
Salprol
Sepexin
57
Samulide
Sepratis
Seretide
Serc
81
4
Sering Nova
Sering T
Sermion
Sermorelin
Serocryptin
Seromycin
Seropram
Sertan
64
8
Servambutol
025
St fumarat
22
2
16
St aminoat
24
9
62
Sarcolysin
14
3
73
Saquinavir
76
5
98
Sansvigyl
84
8
022
Sanotensin
30
2
76
Sanofar OPC
30
2
76
Sandostatin LAR
41
2
21
Sandostatin
36
9
Sandoglobulin
71
0
98
Sandomigran
18
4
19
Sandimmum
10
08
31
3
Servigenta
66
Servispor
18
025
St gluconat
025
St oxalat
4
1
025
Setam
10
29
1122
Tn thuc
St sulfat
Setronax
025
95
6
Sm nhung linh dc
Sevofluran
98
10
02
Scaboma
Sevorane
031
10
02
Scandonest
Sicorten plus
37
10
25
Scopolamin
Siderfol
45
Siderplex
45
Silomat
88
72
Secalip
23
Secnidazol
73
Sectral
Silubin
51
Seczol DS
Silvirin
Simvastatin
73
Sedacoron
4
9
Seduxen
Sinemet
1
Sintrom
Siofor
1
Spasmaverine
Spasmopriv
Spasverin
58
6
Spasvina
67
1123
32
2
29
58
6
3
9
58
6
96
Soda C
13
4
099
Smecta
86
9
03
Siro khuynh dip
46
0
17
Siro
57
3
9
28;941
Sioplex Lysine
10
Sindazol
41
Seglor lyoc
79
7;1022
40
Sedafed
Sedopharm
13
3
Spectinomycin
67
Tn thuc
Sodium nitroprussid
Spersalerg
61
Sodium tetradecyl sulfat
0
9
Spike
60
Sofgard
Spiramycin
Spironolacton
Sporal
Speenac
91
5
Srilane
9
Solu-Medrol
88
4
96
Solucetyl
47
9
21
Solmux-Broncho
50
0
5
Solcean
88
5
40
Soframycin
98
41
9
Stadaglicin
Stallor
44
68
Somatostatin
76
Somatropin
Standacilline
14
Sonben
Staphylomycine
Staren
Statin (cc dn cht)
Sterogyl Gouttes
Steroid gy ng ho
Stiemycin
Stieva A
Stimu-TSH
78
10
65
7
78
31
8
Spardac
49
9
65
Sparbact
78
2
65
Sotalol
11
00
65
Sotalex
10
40
17
Sotahexal
91
6
018
Soriatane
80
4
53
Sorbitol
59
9
83
Sophtal
10
40
Stomex
57
9
1124
Tn thuc
Spartin
Stopare
78
Sparfloxacin
47
8
Strep-Berin
Streptomycin
72
78
Spasdipyrin
86
Spasforin
Streptomycin
Panphama
67
Streptomycin
Sedapharm
67
86
Spasma
86
Spasmebi
67
;72
Streptomycin sulfat
67
Stresam
10
86
Spasmag
10
Spasmapharm
59
5
Stugeron
86
Spasmapyrin
Succinimid
86
Sucrabes
Suprane
Surfexo-neonatal
Surgam
Surgestone
Survanta
Sustanon
Suwelin
Sympatol
Synacthene
17
1125
81
5
7
11
94
1
Sudo-ofloxacin
20
6
6
Sudo-Albendazol
78
2
41
Sudo-Acyclovir
95
4
2
Sudafed
67
6
85
Sucvector
91
5
85
Sucrase
95
4
85
Sucrat
10
02
85
Sucralfat
78
4
85
Sucrafar
98
0
Synacthene retard
81
5
Tn thuc
Sulbactam
Syncortyl
00
Sulfableu
Syncosterol
96
7
Synephrin
96
Synergistin
Sulfamid
ng
chng
79
Syntopressin
41
3
79
7;1066
tiu
Syscor
27
3
Tacrin
87
Sulfamid khng khun

96
Sulfarin
80
4
7
Sulfamethoxazol
94
1
79
7;1022
Sulfaguamidin
24
1
Sulfacetamid
Sulfadiazin Ag (bc)
24
7
97;937
Sulferycin
Tacrolimus
1
Tad 300 v 600
Tafedine
Tagera forte
Talcid
Talliton
Tamik
Tamofen
Tamoxifen
Tanatril
02
10
33
9
37
81
2
Sunfarin
81
2
09
Sumatriptan
30
3
00
Sulpirid
85
2
98
Sultamicillin Tosylate
96
7
98
Sulfothiorine
57
3
00
Sulfonyl Monal
98
7
37
Sulfasalazin
89
7
067
Sulfedrin
80
7
067
Sulferycin F
80
5
Tanganil
13
3
1126
Tn thuc
Sunplay
Tarcevis
46
Supercold
5
9
Tarcefandol
41
Superton
1
4
Tardyferon
Terpicod
Terpincodein
Terpin codein F
Terpin Copham
86
5
Terpin Mekong
Terpin narcotin
92
8
Terpina
29
Tegretol
92
8
57
Tecopi
92
8
88
Tatazol
92
7
Tatanol
92
6
86
Tartriakson
92
7
13
Tarsime
10
25
5
Targocid
18
9
097
Tardyferon B9
18
92
8
Terpin Trodex
67
Teicoplanin
28
8
Terpotrophan
13
Teldane
28
9
Tertatolol
87
Telebrix
52
9
Testosteron
57
Telfast BD
82
9
Testosteron-Depot
87
Telfast HD
82
9
Testosteron Deanoat
87
Temgesic
82
9
Testosteron enanthat
35
Ten 400
83
1
Testosteron undecanoat
17
Tenadine
9
87
1127
83
Testoviron Depot
78
3
Tn thuc
Teniposid
Tetracyclin
10
3;824
Tenolol
Tetracosactid
51
8
Tetramethylammonium iodid
51
8
Tetryzolin
51
41
Tenoric
Thalamonal
51
Than hot
8
51
9
Theolair LP
19
9
Theophylin
19
8
28
Tensiomin
Theostat
032
Tenuate
28
7
Thiamin
099
Teralithe
Thiamazol
72
9
77
81
Thiamphenicol
4;895
6
14
Thiocolchicosid
48
2
39
Thiofon
27
98
9
Thiopental Natri
87
9
97
Thiophenicol
19
Terlipressin
8
28
Tenoxitic
Terfluzine
9
67
Tenoxicam
Terfenadin
9
28
Tenormin
Tercodin
8
98
Tenoretic
Terbutalin
8
15
Tenoret
Terbinafin
82
6
14
Thioproperazin
13
6
19
Thioridazin
Tinifil
19
Thiotepa
73
8
36
Tioconazol
8
85
1128
Tn thuc
Thuc n
Tiorfan
96
Thuc
5
1
Tiotil
023
Thuc tm
77
1
Tipharhinel
023
37
Thu ngn (thuc st khun c

1
thu ngn)
023
Thymoglobulin
Tiratricol
4
15
Tisercin
20
Thym
18
9
Titan dioxid
95
Thymol
46
1
Tobrabact
025
Thyrox
415
Toracin
67
Thyrostatic
977
Tobradex
67
Thyrotrophine
1065
Tobrex
67
Thyroxin
415
Tobrin
67
Tiadenol
966
Tobramycin
67
Tiafen
915
Tobramycina IBI
67
Tiberal
573
Tobicom
10
97
Ticarcillin
601
Tobitil
91
9
Ticlid
1062
Togocide
67
Ticlopidin
1062
Tolbutamid
78
7
Tienam
600
Toloxaton
10
44
Tiffy siro v vin nn
938;9
Topaal
40
Tifocin
51
0;966
614
Topcid
71
4
Tilade
44
Toplexil
61
9
Tilbroquinol
1129
418
Toracin
67
Tn thuc
Tilcotil
919
Torental
61
1
Tildiem
278
Totapen
59
9
Tiliquinol
418
Touxirup siro
92
8
Tiller fort
940
Tracrium
15
6
Timentin
601
Traguton
32
1
Timolol
852;85
Trandate
85
0
Tinh du Lavande
995
Trandolapril
10
33
Tinida
573
Transamin
89
9
Tinidazol
573
Trapha
10
22
Traumon
Trobicin
Trolovol
67
17
Trasipressol
61
Trasylol
Trombovar
99
Traverin
59
6
96
0
Tropic
Tropisetron
45
86
Tredol
51
Trepin
Trosyd
99
Tretinoin
Tuspi
Tustophan siro
Tuxiril siro
065
94
0
4
15
92
8;940
Triacana
94
0
87
TRH
88
5
18
Trexydin
95
6
Tuxo siro
92
8;940
1130
Tn thuc
Triacold
Tydol
40
Triamcinolon
8
3
TV colmax
68
Triamein D
94
0
Tyrothricin
40
Triamteren
58
45
4
Ucetam
79
Triatec
033
Triclosan
Ulcar
025
Triflucan
Ultravist
84
4
Unasyn
60
1
Undecylenat km
07
Triherpine
95
7
19
Trigegol
78
5
Trifluridin
10
28
89
5
Uninetil
Unidox
66
19
Triiodthyronine
15
Trimazol
82
4
Union-topracin Inj
Uniplas
67
97
Trimebutin
065
Trimethaphan
Unifen
98
Trimethoprim
84
7
98
1
Upsa-C
39
Upsa-C calcium
39
Urapidyl
066
Trimeton
81
Trimoxazol
97
Trinacin
Urodic
40
Trinitrine simple laleuf
1131
71
0
8
65
84
8
Urgo
84
7
Tn thuc
Tripluperazin
Urim
19
Trivacocin
6
9
Urobacid
40
Trivastal
Urografin
Urokinase
Vidacold
94
0
Vidarabin
86
Utrogestan
99
3
2
Utizine
95
7
099
Ursolvan
71
0
46
Trivit B
32
10
84
Videx
76
26
8
Vidorygyl
57
3
Vaccin bi lit sng
Vigabatrin
070
lc
Vaccin sng gim c
Viloxazin
070
Vaccin Varicelle
Vinakion
Vinblastine
Vincamin
Vincoldem
Vincristin
Vindesin
Vinorelbin
Vinphazin
17
57
3
5
54
91
1
Valpromid
91
0
06
Valium
10
92
76
Vagifem
93
8
47
Vageston
10
89
6
Vadilex
10
92
86
Vacrax
57
3
40
Vacoverin
10
86
070
Vaco-Aller F
10
85
Vinstu
98
0
1132
Tn thuc
Vng
Vioral
072
Vancomycin
0
1
Vira A
071
Vancotex
Viracept
Vira MP
Virginiamycin
80
4
Virondo
040
V-coldin
10
84
73
Vasten
56
1
10
Vasodin
10
84
071
Vartec
94
93
7
Virucid
Visine
36
41
Vebutin
066
Vectarion
Visine LS
030
Vecuronium
94
1
93
8
Vita C
39
Vita-cal C
39
Vitacap
56
Ventolin
48
Vepesid
10
Verapamil
Vitamin A
076
Vercyt
Vitamin B1
Vitamin B1, B6, B12
16
Verospiron
Vitamin B2
Vitamin B6
54
1133
10
99
69
3
1
097
10
99
Vicacom
69
Vitamin nhm B
80
Veylirol-Tyrothricine
69
4;1099
4
79
Vertizin
10
96
10
Vermiflu
45
;1097
Vitamin B12
10
99
Tn thuc
Vicold
Vitamin C
39
40
Vitamin C Bil
9
Vitamin C Oberlin
Yu t tng trng bch

1
cu ht
102
Yu t tng trng
hng cu
03
9
Vitamin D2
100
Vitamin D3
Yohimbin
100
Vitamin D3 BON
48
1
Yohimbine Hond
100
Vitrimix KV
84
8
Yucomy
72
Vivalan
11
88
5
Zagam
086
Vivalan LP
086
Vogalene
Zalcitabin
19
Volmax
Zanocin
Zantac
Zantrene
Zarontin
31
4
Zastidin
80
Voren
90
9
16
Vomina
71
4
16
Voltaren SR
71
1
16
Voltaren Emulgel
11
03
48
Voltaren
77
8
71
4
Zedex
Zedex siro
48
16
Voren plus gel
16
V ht cy Isapgol
Zentel
008
Vumon
11
7
9
10
99
6
Zerocid
57
9
1134
Tn thuc
W
Zidenol
78
7
Wellcoprim
Zidovudin
066
Wokadine
Zinacef
021
Wydora
11
05
18
6
Zinnat
47
18
6
Zipix
48
6
Xanh methylen
Zolstan
024
Xatral
Zophren
47
Xatral SR
Zopiclon
10
59
Zoran
86
Xyclometazolin
95
6
47
Xipamid
88
4
71
4
Zoraxin
36
Zovirax
36
Zuclopentixol
38
Xylobalan
41
Xylocain
66
Xylometazolin
83
9
Zyatin
41
10
40
Zyloric
54
Zymafluor
33
2
Zyrtec
98
6
TI LIU THAM KHO CHINH

- B Y t, (2002), Dc th Quc gia Vit Nam, Nh xut bn Y hc, H Ni.
1135
- Hong Tch Huyn v cng s, (1997), Tc dng khng mong mun ca thuc,
Nh xut bn Y hc, H Ni.
- Hong Tch Huyn, Phm Khu, (1992), Dng thuc vi ngi cao tui, Nh
xut bn Y hc, H Ni.
- Trng i hc Y H Ni (B mn Dc l), (1998), Dc l hc, Nh xut bn
Y hc, H Ni.
- Trng i hc Dc H Ni (B mn Dc lm sng), (2000), Dc lm sng
i cng, Nh xut bn Y hc, H Ni.
- British National Formulary (BNF 50); 9/2005.
- British National Formulary, (September, 2001), BNF (42ed), British Medical
Association, - - - Royal Pharmaceutical Society of Great Britain.
- David S. Tatro, PharmD, Drug Information Analyst, San Carlos, California, (2003),
Drug Interaction Facts, Facts and Comparisons, St. Louis, A Wolters Kluwer company.
- D.M. Davies: Textbook of Adverse Drug Reactions; 4. Edition; Oxford University
Press (1991).
- Elsevier, (1992), Meylers Side effects of drugs (12ed).
- Gerald, G. Briggs: Drugs in Pregnancy and Lactation; 5. Edition (1997).
- Gilles Oaulagner, Jean Calop, (1998), Incompatex (10ed), Socit d ditions
Mdicopharmaceutiques (SEMP).
- Goodman & Gilmans, (1996), The Pharmacological Basis of Therapeutics (9ed),
Mc. Graw - Hill.
- Stockley, I.H., (1996), Drug Interactions (4ed), The Pharmaceutical Press,
London.
- Stockley, I.H., (1999), Drug Interactions (5ed), The Pharmaceutical Press,
London.
- The Merck Manual (17ed), (1999).
- William, M. Bennett: Drugs and Renal Disease; 2. Edition (1986).
- WHO Model Formulary 2004.
1136

Tương Tác Thuốc Và Chú ý Khi Chỉ Định

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Tương Tác Thuốc Và Chú ý Khi Chỉ Định

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B y t

Hng dn s dng sch v phn mm

I. Tra cu thng tin

1. Tra sch tm thng tin

2. Tra trn phn mm tm thng tin

II. Mc tng tc v ch khi ch nh

III. nh gi nguy c tng tc thuc

Khi nim v tng tc thuc

I. Tng tc thuc - thuc

II. Tng tc thuc - thc n

1. nh hng ca thc n ti ng hc, tc dng v c tnh ca thuc

2. nh hng ca thc ung ti ng hc, tc dng v c tnh ca thuc

III. Tng tc thuc - trng thi bnh l

Mc lc tra cu cc nhm thuc

Mc lc tra cu tn thuc v bit dc

Ti liu tham kho

HNG DN S DNG SCH V PHN MM

Thay thuc khc khng c hoc c tng tc mc thp hn;

Theo di nng ca mt thuc (trong cc thuc) trong huyt tng.

iu chnh liu khi c s tng hoc gim tc dng ca mt thuc;

Thay i ng dng ca mt thuc ny hay thuc khc.

Ngng iu tr t ngt mt trong nhng thuc dng ng thi c th xut hin

ny, phng cc nguy him c th xy ra. iu ny ch c th thc hin nu trc

KHI NIM V TNG TC THUC

I. TNG TC THUC - THUC

Trong qu trnh hp thu, phn b, chuyn ha, tch ly v o thi, thuc ph i

- Chuyn ha v o thi: Thuc c chuyn ha, cht chuyn ha s thi

Gim hp thu digoxin do b tng

Gim hp thu digoxin,

Gim hp thu ketoconazol do

To chelat gim hp thu

Ranitidin lm tng pH d dy,

Propanthelin lm gim tho

1.1.2. i khng khu chuyn ha

Nhng phn ng ging ha

oxy ha N mt alkyl, oxy ha O mt alkyl...

Nhng phn ng lin hp (phn ng pha II)

Phenytoin, warfarin, dicoumarol, theophylin, primidon,

Thuc khng vitamin K, corticoid, cyclosporin, digitoxin,

Thuc ung nga thai, corticoid

V d, ph n b lao dng rifampicin hoc b ng kinh dng phenobarbital,

Ngn cn ti hp thu qua ng thn

Thuc A c tc dng l m, thuc B c tc dng l n. Gi l hip ng (hp lc),

Cn c bit lu khi k n vi cc nhm thuc sau ( trnh tng tc

Bng 3. Mt s v d v Tng tc do c ch enzym chuyn ha thuc

Ung thuc chng

Thuc chng lon

1.2.4. Gim o thi qua thn

Probenecid cnh tranh trn cng carrier ng thn vi penicilin G, ampicilin,

2.1. Tng tc i khng

C khi s dng kiu tng tc ny gii c thuc. V d:

Morphin coi nh cha kha m kha (th th), cn naloxon, naltrexon l bn

V d khc v tc dng i khng khng cnh tranh th th:

Thuc chng ri lon

2.2. Tng tc hip ng

to nn cng thc thuc khng khun nh Bactrim (co-trimoxazol; Biseptol; tc l

Phi hp rifampicin vi isoniazid cng l hip ng vt mc: tng tc ny va

Khng cholinergic + khng

To nguyn hng cu khng l ty

Thuc c vi thn + Thuc

Tng c tnh vi thn

Tng phong b thn kinh - c; Chm

Thuc cha K+ + thuc li niu

Gia cc thuc chng vim